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[目的]观察CT引导经椎间盘穿刺法行内脏与腹腔神经丛阻滞对胰腺癌晚期癌性疼痛的疗效。[方法]48例晚期胰腺癌伴有上腹部癌性疼痛的患者,随机分为两组,在CT引导下分别行腹腔神经丛(N组)或经椎间盘穿刺行内脏神经(S组)无水乙醇毁损性阻滞。记录术前(T0)、术后1d(T1)、15d(T15)、30d(T30)、60d(T60)、90d(T90)VAS评分,评估疗效;记录两组并发症和毒副作用。[结果]各组内术后T1～T90时的VAS评分均较T0时降低(P<0.01),S组在T60、T90时较N组同期降低(P<0.05)。术后第1d,S组与N组显效率分别为87.5%和83.3%,随时间延长疗效均逐渐降低,至T90时分别为60.0%和42.9%。两组在治疗及随访期间均未发生严重并发症。[结论]内脏神经阻滞应用于晚期胰腺癌癌性疼痛的治疗,其远期疗效优于腹腔神经丛阻滞。CT引导下经椎间盘穿刺法行内脏神经阻滞,操作方便,安全有效。
[Objective] To observe the curative effect of CT-guided intervertebral disc puncture on visceral and celiac plexus block on advanced cancer pain of pancreatic cancer. [Methods] Forty-eight patients with advanced pancreatic cancer with upper abdominal cancer pain were randomly divided into two groups. CT guided celiac plexus (N group) or intervertebral disc puncture of visceral nerve (S group) without water Ethanol damage block. The VAS scores were recorded before operation (T0), 1d (T1), 15d (T15), 30d (T30), 60d (T60) and 90d (T90) after operation. The complication and side effects were recorded. [Results] The VAS scores at T1 ~ T90 in each group were significantly lower than those at T0 (P <0.01), while those in S group were lower than those of N group at T60 and T90 (P <0.05). On day 1 postoperatively, the apparent effective rates of group S and group N were 87.5% and 83.3%, respectively. The curative effect gradually decreased with time, reaching 60.0% and 42.9% respectively at T90. No serious complications occurred in both groups during treatment and follow-up. [Conclusion] Visceral nerve block is used in the treatment of cancer pain in advanced pancreatic cancer, and its long-term curative effect is better than that of celiac plexus block. CT-guided intervertebral disc approach visceral nerve block, easy to operate, safe and effective.