中国医科大学学报

中国医科大学学报

中国医科大学学报 ›› 2016, Vol. 45 ›› Issue (4): 301–304.doi: 10.12007/j.issn.0258-4646.2016.04.004

• 论著 • 上一篇    下一篇

经膈脚后间隙穿刺损毁内脏神经治疗胰腺癌疼痛的临床疗效分析

于雪,刘妍,奚奇,万成福,董道松,赵林,宋涛   

  1. 中国医科大学附属第一医院疼痛科,沈阳 110001
  • 收稿日期:2015-10-02 出版日期:2016-04-28 发布日期:2016-04-05
  • 通讯作者: 宋涛 E-mail:songt2001@163.com
  • 作者简介:于雪(1987 -),女,医师,硕士.
  • 基金资助:
    国家自然科学基金(81271371)

Clinical Efficiency Analysis of Visceral Nerve Plexus Neurolysis through Post-curs of Diaphragm Approach in Pancreatic Cancer Pain Management

YU Xue,LIU Yan,XI Qi,WAN Cheng-fu,DONG Dao-song,ZHAO Lin,SONG Tao   

  1. Department of Pain Medicine,The First Hospital,China Medical University,Shenyang 110001,China
  • Received:2015-10-02 Online:2016-04-28 Published:2016-04-05

摘要: 目的 探讨 CT 引导下经膈脚后间隙穿刺毁损内脏神经治疗胰腺癌疼痛患者的疗效及安全性。方法 收集 2013 年 10 月至 2014 年 12 月于中国医科大学附属第一医院疼痛科就诊的 58 例胰腺癌痛患者,按病情基本接近结合患者及家属的意愿原 则将患者分为 2 组,内脏神经毁损组(A 组,32 例)、非毁损组(B 组,26 例)。A 组行膈脚后间隙(内脏神经)穿刺,注入无水乙醇15 mL;B 组应用奥施康定配合吗啡即释片止痛治疗。分别在 A 组术前(T0)、B 组为入组当日,术后 1 d(T1)、15 d(T15)、30 d(T30)、60 d(T60)观察 2 组患者疼痛缓解、阿片类药物用量、生活质量、睡眠质量、不良反应及并发症。结果 A 组患者无穿刺失败,术后疼痛视觉模拟评分(VAS)评分较 T0 明显降低(P < 0.01)。2 组 VAS、生活质量评分(Karnofsky 评分)、睡眠质量评分(PSQI 评分)在 T1、T15、T30、T60 均有统计学差异(P < 0.05),A 组明显优于 B 组。B 组阿片类药物应用量与 A 组比较明显增多(P < 0.01)。A 组术后出现不良反应为体位性低血压(6 例)、肋间神经痛(2 例)、腹泻(2 例);B 组的不良反应为恶心(20 例)、便秘(11 例)、头晕(8 例)。结论 CT 引导下经膈脚后间隙内脏神经毁损治疗胰腺癌疼痛疗效确切,安全性高,并发症少。

关键词: 膈脚后间隙, 内脏神经, 毁损, 胰腺癌, 疼痛

Abstract: Objective To evaluate the clinical effect of computed tomography-guided visceral nerve plexus ethanol neurolysis through post-curs of diaphragm approach in the treatment of patients with pancreatic cancer pain using,and study the safety and life quality improvement of patients . Methods A total of 58 patients suffered from pancreatic cancer pain,who were treated in the department of pain medicine of the First Hospital of China Medical University from October 2013 to December 2014,were recruited for the study. The patients were divided into two groups according to the willing of the patients and their families,group A(32 cases)was treated with Visceral Nerve Plexus ethanol Neurolysis,while group B(26 cases)was treated with oral opioid drugs. The analgesic effect,changes in the amount of opioid drugs,changes in the PSQI scores and the improvement of quality of life were evaluated before treatment and 1 day(T1),15 days(T15),30 days(T30),60 days(T60)after treatment. Record the adverse reactions in the course of treatment. Results All the patients of group A successfully received visceral nerve plexus ethanol neurolysis,the VAS scores,Karnofsky scores,and PSQI scores of all the observed time points(after the operation)were statistically different compared to those before treatment and group B. Statistically difference was also observed in quality of life between two groups(P < 0.05). The amount of opioid drugs of group B was statistically increased than that of group A(P < 0.01)。The most common side effects in Group A were postural hypotension(6 cases),diarrhea(2 cases),and intercostal neuralgia,while nausea(20 cases),constipation(11 cases)and dizziness(8 cases)were seen in the Group B. Con- clusion Visceral nerve plexus ethanol neurolysis through post-curs of diaphragm approach by the guide of CT is effective and safe for the patients with pancreatic cancer pain,and the complications were totally acceptable.

Key words: post-curs of diaphragm, visceral nerve plexus, neurolysis, pancreatic cancer, pain

中图分类号: 

  • R735.9
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