开放式磁共振导引下腹腔神经丛阻滞毁损术的应用

目的：介绍开放式磁共振导引下进行腹腔神经丛阻滞术的方法步骤及对其安全性、有效性的评价。方法：在严格按照手术室要求装置的MR手术室内，采用ipath200介入操作光学导引系统结合Phillips公司0.23T开放式MR成像仪，对12例中晚期恶性肿瘤（胰腺癌4例，肝癌4例，食管癌2例，胃癌1例，肾癌1例）伴严重顽固性上腹部疼痛的患者行腹腔神经丛阻滞术，其中对5例伴有腹膜后淋巴结广泛转移的患者采用经皮穿入淋巴结内阻滞术及化疗粒子置入术。并分别于术前、术后当天及术后1～2月对疼痛程度进行评价。结果：所有患者均成功准确地穿刺至靶点，无严重并发症发生。MR实时、准确地监控了阻滞毁损药物的弥散范围和程度。11例患者疼痛明显缓解，仅1例患者无效。结论：介入磁共振引导下腹腔神经丛阻滞术是一种安全、有效的方法，同时可进行化疗粒子置入术，具有止痛和治疗的双重效果。

Open MR-guided celiac plexus blocking surgery

Objective:To study the procedure of open MRguided celiac plexus blocking surgery and to evaluate its effect.Methods: MR-guided celiac plexus blocking surgery was performed on 12 patients with late stage cancer due to severe chronic abdominal pain.Five patients accompanied with extensive retroperitoneal lymph nodes involving into masses were subjected to surgeries in which needle tips and chemotherapy particles were inserted into the lymph nodes.The degree of pain relief was evaluated before and after the procedure.Results: All patients were successfully localized,targeted and treated under MRI guidance.MRI displayed the ethanol distribution throughout the celiac plexus.Eleven patients felt obvious relief and only one experienced no effect at all.Conclusion: MR-guided placement of the needle is an accurate,safe and effective technique for celiac plexus blocking surgery.