CAJ | 학술논문

目的比较上腹部癌性痛患者三种腹腔神经丛毁损术的效果.方法选择上腹部癌症患者67例,性别不限,体重52～ 69 kg,采用随机数字表法将其分为3组:单侧膈肌脚后间隙毁损组(S组,n=23)、双侧膈肌脚后间隙毁损组(D组,n=22)和膈肌脚后间隙连续毁损组(C组,n=22).S组、D组分别在CT引导下经皮单针、双针穿刺成功后注入无水乙醇总计25 ～ 30 ml行腹腔神经丛毁损,C组穿刺至膈肌脚后间隙后置管,经导管注入无水乙醇25～30 ml行腹腔神经丛毁损,每天1次,连续3d.治疗前、治疗后1周、1个月、2个月、4个月、6个月时记录吗啡日用量和VAS评分,采用VAS加权计算法评定疗效,记录治疗后腹泻、低血压、排尿困难、神经损伤等不良反应的发生情况.结果与S组或D组比较,C组治疗后4～6个月吗啡日用量降低,治疗后4～6个月治疗有效率升高,C组和D组腹泻发生率较S组高,C组低血压发生率低于其他2组(P＜0.05).结论对于腹部癌性痛患者,膈肌脚后间隙连续腹腔神经丛毁损术的毁损效果较完善,且不良反应较少,效果优于单侧膈肌脚后间隙毁损术和双侧膈肌脚后间隙毁损术.
목적 비교상복부암성통환자삼충복강신경총훼손술적효과.방법 선택상복부암증환자67례,성별불한,체중52～ 69 kg,채용수궤수자표법장기분위3조:단측격기각후간극훼손조(S조,n=23)、쌍측격기각후간극훼손조(D조,n=22)화격기각후간극련속훼손조(C조,n=22).S조、D조분별재CT인도하경피단침、쌍침천자성공후주입무수을순총계25 ～ 30 ml행복강신경총훼손,C조천자지격기각후간극후치관,경도관주입무수을순25～30 ml행복강신경총훼손,매천1차,련속3d.치료전、치료후1주、1개월、2개월、4개월、6개월시기록마배일용량화VAS평분,채용VAS가권계산법평정료효,기록치료후복사、저혈압、배뇨곤난、신경손상등불량반응적발생정황.결과 여S조혹D조비교,C조치료후4～6개월마배일용량강저,치료후4～6개월치료유효솔승고,C조화D조복사발생솔교S조고,C조저혈압발생솔저우기타2조(P＜0.05).결론 대우복부암성통환자,격기각후간극련속복강신경총훼손술적훼손효과교완선,차불량반응교소,효과우우단측격기각후간극훼손술화쌍측격기각후간극훼손술.
Objective To compare the efficacy of three kinds of neurolytic celiac plexus block (NCPB) in the patients with upper abdominal cancer pain.Methods Sixty-seven patients of both sexes,with upper abdominal cancer,aged 45-64 yr,weighing 52-69 kg,were randomly divided into 3 groups using a random number table:single-needle NCPB using crura of diaphragm space approach group (group S,n =23),double-needle NCPB via an anterior and posterior crura of diaphragm space approach group (group D,n =22),and continuous NCPB via crura of diaphragm space approach group (group C,n =22).In S and D groups,NCPB was performed with single injection of anhydrous alcohol 25-30 ml after CT-guided successful single and double punctures,respectively.In group C,a catheter was inserted into the crura of diaphragm space and then anhydrous alcohol 25-30 ml was injected via the catheter once a day for 3 consecutive days to perform NCPB.Before treatment,at 1 week after treatment,1,2,4 and 6 months after treatment,the daily consumption of morphine and VAS score were recorded.The therapeutic efficacy was evaluated using VAS weighted value calculation.The development of adverse effects such as diarrhea,hypotension,dysuria and damage to nerves was recorded.Results Compared with S or D groups,the daily consumption of morphine was significantly decreased at 4-6 months after treatment,the rate of effective treatment was increased at 4-6 months after treatment,and the incidence of hypotension was decreased in group C.The incidence of diarrhea was significantly higher in D and C groups than in group S.Conclusion For the patients with upper abdominal cancer pain,continuous NCPB via crura ofdiaphragm space approach provides perfect efficacy with fewer adverse reactions,and the efficacy is better than that of single-needle NCPB using crura of diaphragm space approach or double-needle NCPB via an anterior and posterior crura of diaphragm space approach.