四维 CT 引导腹腔神经丛阻滞术治疗上腹部顽固性癌痛的临床疗效

目的：评价四维CT引导经皮穿刺行腹腔神经丛阻滞术，对腹腔恶性肿瘤伴有腹膜后淋巴结转移，并侵犯、包裹腹腔神经丛的顽固性癌痛的止痛效果以及安全性。方法48例晚期癌症患者，均有严重的上腹部束带样疼痛、经影像学证实腹膜后淋巴结肿大。应用四维CT引导经皮穿刺对其腹腔神经丛阻滞治疗。结果治疗后24 h，2周，1、2、3个月的有效率分别为100%、96%、94%、90%和83%，治愈率分别为67%、64%、58%、52%和50%。围手术期无严重并发症。结论对恶性肿瘤伴有后腹膜淋巴结转移并侵犯、包裹腹腔神经丛的顽固性癌痛患者，采用四维CT引导腹腔神经丛阻滞术，可取得较好的止痛治疗效果，穿刺过程中实时监控，安全性高，具有较高的临床推广价值。

Four-dimensional CT-guided percutaneous ethanol nerve block therapy for intractable abdominal pain

Objective To evaluate four-dimensional CT navigation percutaneous absolute ethanol nerve block therapy of celiac plexus embedded in metastatic lymph nodes in treating intractable carcinomatous abdominal pain. Methods A total of 48 patients with late stage cancers were enrolled in this study. All patients suffered from serious carcinomatous pain at upper abdomen and their retroperitoneal lymph nodes were extensively enlarged , together with the involved celiac plexus. As the patients failed to respond to opioid analgesics, four-dimensional CT navigation ethanol nerve block therapy of celiac plexus was carried out by pushing the puncture needle through the fused lym-phatic mass to celiac plexus site. The analgesic effects and complications were observed and the therapeutic results were evaluated. Results The analgesic effective rate at 24 h past procedure was 100%, and cure rate at 24 h, 2 weeks, 1, 2, 3 months after treatment was 67%、64%、58%、52%、50% respectively. No serious complications oc-curred during perioperative period. The quality of life was significantly improved in all patients. Conclusion For the treatment of intractable carcinomatous abdominal pain of invaded celiac plexus and retroperitoneal lymph node metas-tases from malignant tumor, CT-guided percutaneous ethanol nerve block therapy is a promising effective treatment. As it′s timely monitored during the whole procedure, it′s with insurable safety, and worth for an extensive clinical pro-motion.