前列腺癌图像引导放疗基准标志物置入中会阴神经阻滞后疼痛评价和风险分析

Pain evaluation and risk analysis after perineal nerve block during prostate cancer fiducial marker implantation for image-guided radiotherapy

目的:评价前列腺癌图像引导放疗中经直肠超声引导下经会阴途径穿刺置入黄金基准标志物(gold fiducial marker,GFM)时会阴神经阻滞的疼痛控制效果并分析其风险因素。方法:筛选符合纳入标准的前列腺癌患者176例,将其分为接受会阴神经阻滞的试验组(n=92)和前列腺周围神经阻滞的对照组(n=84)。使用视觉模拟评分(VAS)评价并比较两组患者GFM置入术中和术后6 h、12 h、24 h的疼痛。对试验组行Logistic回归分析置入术中VAS≥4分的风险因素。结果:试验组GFM置入术中VAS为(2.61±1.32)分,显著低于对照组的(4.82±1.93)分(P<0.001);试验组置入术后6 h VAS为(1.95±0.94)分,显著低于对照组的(3.24±1.53)分(P<0.001);术后12 h、24 h VAS两组间比较差异无统计学意义。回归分析结果显示,前列腺体积、会阴神经选择和GFM置入部位分别是导致VAS≥4分的独立影响因素(均P<0.01),前列腺体积每增加1 cm 3、选择会阴神经浅支(以深支为对照)和置入部位为底部(以顶部为对照)时相对风险分别升高约1.308倍、2.446倍和2.602倍。结论:与前列腺周围神经阻滞相比,GFM置入术6 h内会阴神经阻滞疼痛控制效果更好。GFM置入术中应尽量规避风险因素,从而进一步降低患者疼痛。

Objective:To evaluate the pain control effect of perineal nerve block by transrectal ultrasound-guided transperineal puncture during the gold fiducial marker(GFM)implantation in image-guided radiotherapy for prostate cancer and to analyze the risk factors.Methods:A total of 176 patients with prostate cancer who met the inclusion criteria were selected and divided into experiment group(n=92)receiving perineal nerve block and control group(n=84)receiving periprostatic nerve block.Visual analog scale(VAS)was used to evaluate and compare the pain during GFM implantation and after 6 h,12 h and 24 h for the patients in two groups.The risk factors of VAS≥4 during implantation were analyzed by using Logistic regression.Results:The VAS in experiment group was(2.61±1.32)score during GFM implantation,significantly lower than that in control group(4.82±1.93)score(P<0.001).The VAS in experiment group 6 h after GFM implantation was(1.95±0.94)score,significantly lower than that in control group(3.24±1.53)score(P<0.001).The results at other time points were not statistically significant.Regression analysis showed that prostate volume,perineal nerve selection and GFM implantation site were independent risk factors which resulted in VAS≥4(all P<0.01).The risk would increase by 1.308 times if the prostate volume increased by 1 cm 3.The risk would increase by 2.446 times or 2.602 times respectively if the shallow branch of perineal nerve(taking the deep branch as reference)or the bottom implantation site(taking the top as reference)were selected.Conclusion:Compared with periprostatic nerve block,perineal nerve block has better pain control effect within 6 h.Risk factors should be avoided as much as possible during GFM implantation so as to reduce the pain of patient.