CT引导下责任脊神经根射频热凝治疗肺癌体壁转移性疼痛

目的：观察CT引导下椎间孔穿刺责任脊神经根射频热凝姑息性治疗肺癌体壁转移性疼痛的安全性及镇痛效果。 方法：经正规三阶梯口服给药2周仍不能有效镇痛的肺癌体壁转移性疼痛患者 16例,结合患者主诉与CT扫描所见转移灶部位确定疼痛责任脊神经,CT引导下用射频针穿刺至相应脊神经所在椎间孔的上1/3,0.5mA电流高（50Hz）、低（2Hz）频电生理测试出患者原疼痛区感觉异常和/或相应区域肌肉抽动后行95度300秒射频消融。以射频热凝前后疼痛视觉模拟评分(VAS )和口服药剂量变化来评价治疗后1h、1周、1月、3月及6月的镇痛效果,并观察有无治疗相关并发症。 结果：16例患者共52个责任脊神经所在的椎间孔均由CT引导下将穿刺针穿刺至椎间孔的上1/3,其中43个责任脊神经能被 0.5mA的高低频电刺激测试出异感,9个经调整针尖位置后测出异感;射频热凝后所有患者疼痛视觉模拟评分均降低,其中有7例患者完全停服止痛药;另9例患者仍需给予口服阿片类止痛药维持镇痛效果,但剂量显著降低。所有患者原疼痛区皮肤感觉减退,有轻度麻木,无椎管内出血、穿刺处感染及疼痛区皮肤萎缩、坏死事件发生。 结论：CT引导下椎间孔穿刺责任脊神经根射频热凝可安全、有效地姑息性治疗癌性体壁痛,可作为癌痛治疗WHO“三阶梯”方案的有效补充。

CT-guided foraminal puncture for the palliative treatment of lung cancerous body wall pain by radiofrequency thermocoagulation of the responsible spinal nerve root

Objective: To observe the safety and analgesic effect for palliative treatment of cancer body wall pain by CT-guided foraminal puncture radiofrequency thermocoagulation of responsible spinal nerve root Methods: Based on sixteen patients with metastatic pain in the body wall of advanced tumor who could not be effectively analgesic by regular three-step oral administration were enrolled, and the responsible spinal nerve was determined by combining the patient''s complaint with the location of the metastatic lesion seen by CT, under the guidance of CT, radiofrequency needle was used to puncture the upper 1/3 of the foramina where the corresponding spinal nerve was located. High (50Hz) and low (2Hz) frequency electrophysiological tests of 0.5mA current showed paresthesia in the original pain area and/or muscle convulsions in the corresponding area. Radiofrequency thermocoagulation was performed at 95° for 300 seconds. The analgesic effect was evaluated by visual analogue scale (VAS) before and after radiofrequency thermocoagulation and the dose change of oral medication at 1 hour, 1 week, 1 month, 3 months and 6 months after treatment, and the treatment-related complications observed would be happened or not. Results: A total of 52 responsible spinal nerves in 16 patients were punctured to the upper 1/3 of the foramen under the guidance of CT. Among them, the paresthesia of 43 responsible spinal nerves could be detected by 0.5mA high and low frequency electrical stimulation, and the same of 9 were detected after adjusting the position of the needle tip. After radiofrequency thermocoagulation, the visual analogue score of pain decreased in all patients, and 7 patients of them stopped taking painkillers completely. The other 9 patients still needed to be given oral opioid painkillers to maintain the analgesic effect, but the dose was significantly low. All patients had skin hypoesthesia and mild numbness in the original pain area. There was no bleeding in the spinal canal, infection at the puncture site, skin atrophy and necrosis in the pain area. Conclusion: CT-guided foraminal radiofrequency thermocoagulation of responsible spinal nerve roots is safe and effective in the palliative treatment of cancer wall pain, and can be used as an effective supplement to the WHO "three-step" program for cancer pain treatment.