论文部分内容阅读
目的 探讨超声引导注射无水乙醇阻滞腹腔神经丛对上腹部恶性肿瘤的止痛效果。方法 在识别腹腔神经丛及肠系膜上丛声像图特征的基础上 ,在超声引导下经腹穿刺 ,穿刺角度与腹腔动脉、肠系膜上动脉根部呈 2 0～ 30°夹角 ,向腹腔动脉、肠系膜上动脉、腹主动脉、下腔静脉等两旁及肿瘤压迫部背侧区域行多点无水乙醇注射 ,注射量 2 0～ 5 0ml。穿刺时经过肿瘤者 ,退针时向肿瘤内注射无水乙醇。结果 2 8例上腹部晚期恶性肿瘤患者接受治疗 ,其中 15例 (5 3.6 % )止痛效果为一时性完全缓解 ,12例 (4 2 .8% )部分缓解 ,总有效率为 96 .4% (2 7/ 2 8)。止痛效果与乙醇注射量有一定关系 ,注射量≤ 12ml者 4例 ,1例无效 ,3例部分缓解 ;注射 15～ 2 8ml者 6例 ,2例获一时性完全缓解 ;注射30～ 5 0ml者 18例 ,13例 (72 .2 % )达一时性完全缓解 ,2例经 2次注射、1例经 3次注射后达死亡前完全止痛 (3～ 6个月 )。对 9例经过肿瘤穿刺者同时向肿瘤内注射乙醇 ,6例肿瘤缩小 ,局部压痛明显缓解。 9例 (32 .1% )发生并发症 ,其中 4例为体位性低血压 ,2例呕吐 ,2例呃逆 ,1例腹泻 ,经对症处理均缓解。结论 超声引导腹腔神经丛阻滞对上腹部晚期肿瘤所致顽固性疼痛 ,为较安全有效可行的止痛方法之一。
Objective To investigate the analgesic effect of ultrasound-guided injection of absolute alcohol to block the celiac plexus in upper abdominal cancer. Methods On the basis of identifying the features of celiac plexus and superior mesenteric plexus, transabdominal puncture was performed under ultrasound guidance. The puncture angle was between 20 and 30 degrees from the celiac artery and the superior mesenteric artery root, and the celiac artery and mesentery were observed. The upper artery, the abdominal aorta, the inferior vena cava, and the dorsal region of the tumor compression part were injected with more ethanol, and the injection volume was 20-50 ml. Those who passed the tumor during puncture injected absolute ethanol into the tumor when the needle was withdrawn. Results Twenty-eight patients with advanced malignant tumors of the upper abdomen were treated. Among them, 15 (5 3.6 %) analgesic effect was a one-time complete remission, and 12 (42.8%) were partially relieved. The total effective rate was 96.4% ( 2 7/ 2 8). The analgesic effect was related to the amount of ethanol injected. Four injections of ≤ 12ml were given, one was ineffective, and three were partial remission. Six injections of 15 to 28ml resulted in complete remission in one case and injection of 30 to 50ml. 18 cases, 13 cases (72.2%) achieved complete relief, and 2 cases completely relieved pain (3-6 months) before reaching death after 2 injections and 1 injection after 3 injections. Nine patients who had tumor puncture injected ethanol into the tumor at the same time. Six tumors shrank, and local tenderness was relieved. Nine cases (32.1%) had complications, including 4 cases of orthostatic hypotension, 2 cases of vomiting, 2 cases of hiccups, and 1 case of diarrhea, which were relieved by symptomatic treatment. Conclusion Ultrasound-guided celiac plexus block is one of safe, effective and feasible methods for relieving pain caused by late upper abdominal tumors.