奇神经节射频热凝术联合阴部神经脉冲射频术治疗会阴部疼痛的临床疗效

The efficacy of ganglion impar radiofrequency thermocoagulation combined with pudendal nerve pulse radiofrequency for the treatment of patients with perineal pain

目的:探讨奇神经节射频热凝术联合阴部神经脉冲射频术治疗会阴部疼痛的安全性与临床疗效。方法:随机将重庆市第七人民医院疼痛科2014年7月至2019年11月收治的36例会阴部疼痛患者分成3组,C型臂引导下奇神经节射频热凝术治疗组(奇神经节组)、超声引导下阴部神经脉冲射频术治疗组(阴部神经组)与两者联合治疗组(联合组)。在治疗后3个月时采用数字等级评分(NRS)、疼痛障碍指数(PDI)、匹兹堡睡眠质量指数(PSQI)、生活质量指数量表评分(QLIS)以及治疗总有效率评价疗效,同时观察不良反应和并发症。结果:治疗后3个月时联合组患者的疼痛程度评估、功能障碍程度评估、睡眠质量评估以及生活质量评估均显著优于奇神经节组和阴部神经组患者( P均<0.05),并且奇神经节组的疼痛程度评估、功能障碍程度评估、睡眠质量评估以及生活质量评估均显著优于阴部神经组( P均<0.05)。治疗后3个月时的临床有效率,联合组为91. 7%(11/12例),奇神经组为75.0%(9/12例),阴部神经组为66.7%(8/12例)联合组优于其他两组( P均<0.05)。此外,3组患者均未见不良反应和并发症。 结论:C型臂引导下奇神经节射频热凝术联合超声引导下阴部神经脉冲射频术治疗会阴部疼痛疗效确切,与上述单一方法比较,能明显提高治疗效果,并且安全可行。

Objective To investigation the efficacy and safety of ganglion impar radiofrequency thermocoagulation combined with pudendal nerve pulse radiofrequency for the treatment of patients with perineal pain.Methods Thirty-six patients with perineal pain,in Department of Painology,Chongqing Seventh People's Hospital,from July 2014 to November 2019,were randomly divided into three groups:ganglion impar radiofrequency thermocoagulation under the guidance of C-arm X-ray group(ganglion impar group),pudendal nerve pulse radiofrequency under ultrasound guidance group(pudendal nerve group),and combined the two methods group(combination group).The numerical rating scale(NRS),pain disorder index(PDI),Pittsburgh sleep quality index(PSQI),quality of life index scale(QLIS),the effective rate,and complications or adverse effects were analyzed at 3 months after the treatment.Results The NRS,PDI,and PSQI were significantly lower in the combination group than those in the ganglion impar group and pudendal nerve group at 3 months after the treatment(all P<0.05).The NRS,PDI,and PSQI were significantly lower in the ganglion impar group than those in the pudendal nerve group at 3 months after the treatment(all P<0.05).The QLIS was significantly higher in the combination group than that in the ganglion impar and pudendal nerve groups.And all indicators in the ganglion impar group were superior to those in the pudendal nerve group(all P<0.05).The effective rate was 91.7%(11/12 cases)in the combination group,75%(9/12 cases)in the ganglion impar group and 66.7%(8/12 cases)in the pudendal nerve group respectively at 3 months after the treatment,the effective rate is higher in the pudendal nerve group than the other two groups(all P<0.05).No complication or adverse effects were observed.Conclusion Ganglion impar radiofrequency thermocoagulation combined with pudendal nerve pulse radiofrequency under the guidance of C-arm X-ray machine for the treatment of perineal pain are effective,safe and feasible,and superior to the ganglion impar radiofrequency thermocoagulation or pudendal nerve pulse radiofrequency alone.