经皮腹腔神经丛阻滞治疗癌性疼痛

目的:评价CT引导下经皮腹腔神经丛阻滞(NCBP)治疗癌性疼痛的安全性和疗效。方法:11例晚期肿瘤伴持续性疼痛患者,在CT引导下采用双侧后路膈脚前阻滞法阻滞腹腔神经丛。结果:11例NCBP技术成功率100%。术后1周完全缓解(CR)7例、部分缓解(PR)3例、轻度缓解(MR)1例,有效率90.9%。术后2个月CR:5例、PR:3例、MR:3例,有效率72.7%。3例发生体位性低血压,3例出现轻中度腹泻。结论:CT引导下经皮腹腔神经丛阻滞治疗癌性疼痛,是一种安全、有效的方法。     

内镜超声引导下腹腔神经丛无水乙醇注射治疗上腹部癌痛的护理

目的探讨内镜超声(EUS)引导下腹腔神经丛注射无水乙醇治疗癌痛患者的临床护理。方法术前应用数字分级法进行癌痛护理评估,做好患者和家属解释工作,解除思想顾虑,同时完备各项术前检查;术后加强生命体征及疼痛缓解的观察,尤其是术后并发症的观察。结果注射前疼痛分数最高为6.80±0.65,治疗后为1.85±0.98。本组病例无感染、穿孔及其他并发症。结论做好术前癌痛护理评估、心理护理及术前检查、术后生命体征及并发症的观察,对提高治疗效果有着重要的意义。     

CT导向下腹腔神经丛阻滞治疗上腹部癌痛的护理

对33例CT导向下腹腔神经丛阻滞治疗上腹部癌痛患者的护理进行了总结分析，认为术前作好包括心理护理在内的充分准备，术中积极协助术者与患者的配合，密切观察术中、术后的并发症及副作用，是手术成功的关键。     

CT导向腹腔神经丛阻滞治疗上腹部顽固性癌性疼痛的临床应用

近 10 a来 ,国内外已越来越多的运用 CT导向腹腔神经丛阻滞 (NCPB)治疗上腹部肿瘤的顽固性疼痛 [1 ,2 ] ,特别是胰腺癌所致上腹疼痛 [3]。我院近 4 a来对 2 6例上腹部或伴有背部顽固性癌性疼痛的患者根据各自的情况选择不同的方法进行了 CT导向下的 NCPB治疗 ,取得了较好的止痛效果。现报告如下。1　对象和方法1.1　对象　本组 2 6例均经临床、手术病理或 CT、MR等多方面检查确诊为中晚期癌症患者 ,男 17例 ,女 9例 ,年龄 4 2～ 78岁 ,平均 5 4 .5岁。其中胰腺癌 8例 ,肝癌 7例 ,胆管癌 3例 ,胃癌5例 ,结肠癌 3例。 10例伴有后腹膜淋…     

CT引导下经皮腹腔神经丛阻滞治疗晚期癌痛

目的：为了提高腹腔神经丛穿刺的成功率，减少穿刺中的并发症，扩大治疗范围，增强治疗效果。方法：应用CT引导下经皮腹腔神经丛穿刺，注入无水酒精，治疗上腹部癌痛。结果：CT引导下经腹腔神经丛穿刺20例，均一次穿刺成功，治疗后临床观察及随访，有效率95%，优良率85%。未发现一例血管、脏器损伤或其他并发症的发生。结论：CT引导下腹腔神经丛阻滞治疗上腹部癌痛，可清晰地分辨出腹腔神经丛及邻近血管、脏器的位置，观察肿瘤对周围淋巴的浸润情况，设计好进针途径、穿刺点、深度角度、避免穿刺时对血管、脏器的损伤，同时可以观察到针尖位置，准确地将药液注射到脚后间隙内，扩散到腹腔神经丛周围。     

CT引导下腹腔神经丛毁损术治疗慢性顽固性腹部癌痛

目的：观察CT引导下腹腔神经丛毁损性阻滞对顽固性腹部癌痛的镇痛效果及患者生活质量的影响。方法：74例顽固性腹部癌症疼痛患者，在CT引导监视下经背侧入路经皮穿刺腹腔神经丛无水乙醇阻滞治疗。结果：治疗后一周内全部患者疼痛减轻或消失。在治疗后第7、14、30、60天，患者的疼痛评分、疼痛缓解率、生活质量均明显改善，大多数患者临终前无痛或仅轻度疼痛。治疗过程中和治疗后未发生严重并发症。结论：CT引导下腹腔神经丛阻滞治疗顽固性腹部癌痛的疗效确切，安全性高．     

CT引导下腹腔神经丛阻滞术治疗顽固性癌痛的护理

本文通过对27例顽固性癌痛病人行腹腔神经丛阻滞术,术前加强心理护理,完善术前准备,术中注意病人与术者的配合,术后密切观察并发症的发生,使25例病人疼痛消失或明显缓解,取得了满意疗效。     

CT引导下腹腔神经丛双针法阻滞术治疗癌性腹痛的护理

总结CT引导下腹腔神经丛双针法阻滞术治疗癌性腹痛的护理。认为护理重点是治疗前对患者做好心理护理,进行俯卧位耐受训练,完善器械、药品准备;治疗中保持患者体位舒适,加强病情观察,维持输液管道通畅;治疗后密切观察患者病情变化,按医嘱对症处理,可确保患者安全。39例中31例完全停服止痛药、8例减量维持。     

CT引导下腹腔神经丛毁损性阻滞治疗顽固性胰腺癌痛的临床观察

目的：观察CT引导下腹腔神经丛毁损性阻滞对顽固性胰腺癌痛的镇痛效果、并发症及对患者生活质量的影响。方法：46例顽固性胰腺癌症疼痛患者，在CT引导监视下经背侧入路经皮穿刺，行腹腔神经丛无水酒精阻滞治疗。结果：治疗后1周内全部患者疼痛减轻或消失。在治疗后第7、14、30、60、90天，患者的疼痛评分、疼痛缓解率、生活质量均明显改善，大多数患者临终前无痛或仅轻度疼痛。治疗过程中和治疗后未发生严重并发症。结论：CT引导下腹腔神经丛阻滞治疗顽固性胰腺癌痛的疗效确切，安全性高。     

CT-guided percutaneous neurolytic celiac plexus block technique

Up to now, the studies in the world have demonstrated that CT-guided percutaneous neurolytic celiac plexus block (PNCPB) is an invaluable therapeutic modality in the treatment of refractory abdominal pain caused by cancer. Its efficacy of pain relief varied in reported studies. The main technical considerations which would affect the analgesic effects on abdominal pain included the patients’ cooperation, needle entry approaches, combined use of blocking approaches, localization of the target area, dosage of the blocker, and so on. A success of PNCPB depends greatly on close cooperation with patients. The patient should be educated about the purpose and steps of the procedure, and trained of breathing in and breathing hold. The needle entry can be divided into the posterior approach and the anterior approach. The former one is the most commonly used in clinical practice, but the latter one is rarely used except in the cases that the posterior approach becomes technically difficult. Bilateral multiple blocking of celiac plexus and splanchnic nerves is often required to achieve optimal analgesia. The needle entry site, insertion course, and depth should be preselected and simulated on CT monitor prior to the procedure in order to ensure an accurate and safe celiac plexus block. The magnitude of analgesic effect is closely related to the degree of degeneration and necrosis of the celiac plexus. Maximally filling with blocker in the retropancreatic space is an indication of sufficient blocking. We also provided an overview of indications and contraindications, preoperative preparations, complications and its treatment of PNCPB.     

Celiac plexus block for pancreatic cancer pain: factors influencing pain, symptoms and quality of life

Neurolytic celiac plexus block (NCPB) is claimed to be an effective method of pain control for pancreatic cancer pain. However, the factors that may influence long-term analgesia, adverse effects, and quality of life after performing NCPB have never been determined. In a prospective multicenter study, 22 patients who underwent NCPB were followed until death. Numerous parameters other than pain and symptom intensity were evaluated, including age, gender, initial site of cancer, sites of pain, possible peritoneal involvement, technique, and oncologic interventions. Indices were calculated to determine the opioid consumption ratio (EAS) and the trend of opioid escalation (OEI). NCPB was effective in reducing opioid consumption and gastrointestinal adverse effects for at least 4 weeks. In the last four weeks prior to death, there was the typical trend of increasing symptom intensity common to the terminal cancer population. None of the factors studied influenced the analgesic effectiveness of NPCB. NPCB, performed by skilled clinicians, regardless of the technique chosen, is a safe and useful means that should be considered as an adjuvant to common analgesic regimens at any stage, as it may allow the reduction of the visceral component of pancreatic pain that may prevail in certain phases of the illness. The analgesic and symptomatic effect of NCPB is presumably advantageous for about four weeks. A possible factor interfering with long-term outcome includes the capacity of cancer to involve the celiac axis, which can distort the anatomy and prevent neurolytic spread, or modify the pain mechanisms. Outcomes are strongly based on individual variation.     

连续膈肌脚后间隙阻滞治疗顽固性上腹部癌痛疗效观察

目的:观察连续膈肌脚后间隙神经阻滞对顽固性上腹部癌性疼痛的疗效。方法:71例中晚期上腹部癌痛患者,随机分单次腹腔神经丛阻滞(NCPB)组(N组)、连续膈肌脚后间隙神经阻滞组(C组)和单独镇痛药物组(D组)。观察治疗前、后1周、1、2、4、6个月视觉模拟评分(VAS),吗啡用量和生存质量(QOL)及相关并发症情况。结果:3组治疗前后VAS评分均显著降低(P<0.01),1周至4个月,N组、C组低于D组(P<0.05),第6个月时,N组、D组差异不显著(P>0.05)。治疗后1—6个月疗效优良率D组低于N组、C组(P<0.05)。N组、C组治疗后吗啡用量低于D组,QOL均明显提高(P<0.01)。结论:神经阻滞联合镇痛药物优于单独药物治疗。连续膈肌脚后神经阻滞远期疗效及QOL改善优于单次NCPB治疗,可安全应用于临床治疗。     

不同剂量无水乙醇腹腔神经丛阻滞治疗上腹癌痛的疗效观察

目的 观察不同剂量无水乙醇腹腔神经丛阻滞术治疗晚期上腹部癌痛患者的疗效。方法 选取45例保守治疗无效的晚期上腹部癌痛患者,并随机分为15 ml无水乙醇组（A组）、20 ml无水乙醇组（B组）和25 ml无水乙醇组（C组）,每组15例,在CT引导下经前腹壁或背侧入路行经皮腹腔神经丛阻滞术,止痛效果分为0~Ⅲ级,分别于术后1个月、3个月时评价止痛效果。结果 随访观察3个月,1个月、3个月时20 ml和25 ml无水乙醇组有效率显著均高于15 ml无水乙醇组（P均<0.01）;而20 ml无水乙醇组与25 ml无水乙醇组有效率差异无统计学意义（P>0.05）,但25 ml无水乙醇组术后疼痛的患者数明显高于20 ml组。20 ml无水乙醇组术后1个月的有效率为93.33%（14/15）,3个月有效率为73.33%（11/15）,均未发生严重并发症。3组患者术后1个月与术后3个月疗效差异无统计学意义（P均>0.05）。结论 用20 ml无水乙醇腹腔神经丛阻滞治疗晚期上腹部癌痛是一种安全、有效的方法。     

超声引导下腹腔神经丛毁损治疗上腹部癌痛的安全性和有效性

目的 评估超声引导下腹腔神经丛毁损（CPN）治疗上腹部癌痛的安全性和有效性。方法 对15例进展性上腹部癌痛患者行超声引导下CPN,利用视觉模拟量表（VAS）评分进行评估,记录CPN治疗前和治疗后即刻、1天、1周、1个月、3个月患者疼痛程度,并进行统计学分析。结果 2例因治疗前评估无安全穿刺路径而被剔除。成功实施超声引导下CPN治疗13例。治疗后13例患者VAS评分明显低于治疗前（P<0.05）。治疗过程中无严重并发症发生。3例发生穿刺部位疼痛,24 h后缓解;2例肠蠕动增快而出现腹泻;1例出现恶心、呕吐;1例术后出现低血压。结论 超声引导下CPN安全有效,可作为微创治疗上腹部癌痛的方法之一。     

C型臂引导下腹腔神经丛阻滞治疗晚期胰腺癌疼痛的护理

总结36例C型臂引导下腹腔神经丛阻滞治疗晚期胰腺癌疼痛患者的护理,治疗前完善各项检查,治疗时密切观察病情变化及指导患者配合,及时发现并治疗乙醇样反应有助于治疗的顺利完成。     

Ultrasound‐Guided Paravertebral Neurolytic Block: A Report of Two Cases

Paravertebral block is commonly used in the treatment for acute and chronic pain. The duration of paravertebral block could theoretically be prolonged with neurolytic agents. We report two cases of ultrasound‐guided neurolytic paravertebral blocks in patients suffering from intense cancer‐related thoracic pain. Ultrasound was used to identify the space and plane of injection at the mid‐thoracic level. Absolute alcohol was used to block the nerves at different segments. The two patients had great pain relief. Neurolytic paravertebral block can be a useful technique in patients with intractable cancer pain. Because of the risk of complication, it is recommended that this technique should be limited to relief of intractable pain in cancer patients with a poor prognosis.     

Efficacy of coeliac plexus and splanchnic nerve blockades in body and tail located pancreatic cancer pain

Palliative treatment, pain therapy and quality of life (QOL) are very important in pancreatic cancer patients. We evaluated the pain relieving efficacy, side effects and effects on QOL of neurolytic coeliac plexus blockade (NCPB) and splanchnic nerves neurolytic blockade (SNB) in body and tail located pancreatic cancer. The study protocol was approved by the local ethics committee. Patients were randomly divided into two groups. Coeliac group; GC, N = 19 were treated with coeliac plexus blockade, whereas the patients in splanchnic group; GS, N = 20 were treated with bilateral splanchnic nerve blockade. The VAS values, opioid consumption and QOL (Patient satisfaction scale=PSS, performance status scale=PS) were evaluated prior to the procedure and at 2 weeks intervals after the procedure with the survival rates. The demographic features were found to be similar. The VAS differences (difference of every control's value with baseline value) in GS were significantly higher than the VAS differences in GC on every control meaning that VAS values in GS decreased more than the VAS values in GC. GS patients were found to decrease the opioid consumption significantly more than GC till the 6th control. GS patients had significant improvement in PS values at the first control. The mean survival rate was found to be significantly lower in GC. Two patients had severe pain during injection in GC and 5 patients had intractable diarrhoea in GC. Comparing the ease, pain relieving efficacy, QOL-effects of the methods, splanchnic nerve blocks may be an alternative to coeliac plexus blockade in patients with advanced body and tail located pancreatic cancer.