上腹下丛联合奇神经节毁损对盆腔癌痛的疗效评估

Efficacy of superior hypogastric plexus combined with ganglion impar neurolytic blocks for cancer pain relief

关键词:  上腹下丛  奇神经节  盆腔癌痛

Key words:  superior hypogastric plexus  ganglion impar  pelvic cancer

摘要:

目的对比上腹下丛毁损及上腹下丛联合奇神经节毁损对中晚期盆腔癌痛的临床疗效。方法2018年4月至2018年9月同济大学附属第十人民医院麻醉疼痛科收治的中晚期盆腔癌痛患者中选取42例，随机分为上腹下丛毁损组（SHGP组）、上腹下丛联合奇神经节毁损组（SHGP+GI组）。于超声联合C臂机引导下，分别经椎旁及骶尾关节入路，注入无水酒精行上腹下丛及奇神经节毁损。观察手术中及手术后是否有并发症；术前及术后1 d，1周，1、3、6个月评估患者的疼痛视觉模拟量表评分（visual analog pain scale, VAS）、疼痛障碍指数(pain disability index, PDI)、匹兹堡睡眠质量指数(Pittsburgh sleep quality index, PSQI)、口服止痛药情况，计算总有效率。结果无1例患者发生严重并发症，2名患者因中途死亡未能随访至最后，治疗后两组VAS、PDI、PSQI及止痛药口服情况均较术前显著下降，SHGP+GI组效果更显著且更完善，两组间差异均有统计学意义（P<0.05）。结论针对顽固性盆腔癌痛的介入治疗，上腹下丛联合奇神经节阻滞较单独上腹下丛阻滞效果更完善，长期疗效良好，且安全可行，不增加并发症的风险。

Abstract:

ObjectiveTo assess the efficacy of superior hypogastric plexus combined with ganglion impar neurolytic blocks for management of pelvic cancer pain. MethodsForty-two patients with mid-term or advanced pelvic cancer admitted in our Tenth People's Hospital, Tongji University from April 2018 to December 2018 were enrolled. Patients were randomly assigned to receive superior hypogastric plexus block(SHGP group) or superior hypogastric plexus combined with ganglion impar neurolytic blocks(SHGP+GI group) for cancer pain relief. The superior hypogastric plexus and ganglion impar were blocked by injection of absolute alcohol through the L5-S1 interlaminar space and sacrococcygeal joint guided by ultrasound and C-arm fluoroscopy. Complications during and after the surgery were recorded. The visual analog pain scale(VAS), pain disability index(PDI) and Pittsburgh sleep quality index(PSQI) were evaluated and analgesic consumption was documented immediately before operation, 1 day,1 week and 1, 3 and 6 months after operation. The total effective rate of treatment was calculated. ResultsThere was no case with serious complication, two cases died during the follow up. The VAS, PDI and analgesic consumption at all time points after the surgery were significantly lower than those before surgery in both groups; while the efficacy of SHGP+GI group was more marked than that of SHGP group(P<0.05). ConclusionSuperior hypogastric plexus combined with ganglion impar blocks is more efficient than superior hypogastric plexus block alone, for relieving the severe pain of pelvic cancer patients.