Computed Tomography-guided Celiac Plexus Block for Treatment of Intractable Upper Abdominal Pain

對於胰臟癌和慢性胰臟炎的病人，我們評估電腦斷層導引腹腔神經叢阻斷術，用在治療上腹部嚴重疼痛的效果。6位病人有嚴重的上腹部疼痛，臨床上認定為源自於腹腔神經節的疼痛。因此，他們接受了電腦斷層導引腹腔神經叢阻斷術。我們依據對比劑在腹腔動脈區域的顯影，來評估酒精溶液的分佈情形。疼痛緩解效果的主觀認定，分成由1+（無效果）到4+（完全緩解）等4個等級。另外，我們也比較治療前後，止痛藥物的使用劑量，來客觀地評估疼痛緩解的效果。有4個病人是胰臟癌，另外2個病人是慢性胰臟炎。他們都成功地接受了酒精的注射治療。6個病人當中，有1個病人的疼痛立刻得到了相當不錯的緩解(3+)。另外5個病人效果更好，疼痛得到立即的、完全的緩解(4+)。有3個病人，他們疼痛緩解的效果，隨著時問而減弱。另外3個病人，其疼痛緩解的效果，則維持得比較久。全部的病人，在做完腹腔神經叢阻斷術以後，他們原先使用的麻醉藥或麻醉性止痛藥，都明顯地減少了。在這些病人當中，沒有人發生神經方面的併發症。對於胰臟癌和慢性胰臟炎的病人，電腦斷層導引腹腔神經叢阻斷術是安全又有效的方法，用來控制上腹部的嚴重疼痛。因為它能長期有效地緩解疼痛，減少了藥物的使用、同時也減少了藥物引起的不良作用，因而可以防止病人生活品質的惡化。

關鍵字

電腦斷層導引；腹腔神經叢阻斷術；疼痛

並列摘要

The purpose of this study was to evaluate the therapeutic result of CT; guided celiac plexus block (CPB) for managing intractable upper abdominal pain due to pancreatic carcinoma or chronic pancreatitis. CT-guided CPB was performed in 6 patients with severe epigastric pain evaluated clinically to be of celiac ganglion origin. Evaluation of the alcohol solution spread was based on the presence of the contrast medium around the celiac area. A subjective evaluation of the degree of pain relief was graded from 1+ (no change) to 4+ (complete relief). An objective evaluation was also obtained by comparing average daily analgesic usage before and after the procedure. Ethanol injection was performed successfully in 4 patients with pancreatic carcinoma and in 2 patients with chronic pancreatitis. One of the 6 patients had considerable (3+) relief of pain immediately, while 5 had complete (4+), immediate pain relief. The pain relief effectiveness gradually decreased in 3 patients, while in the other 3 the pain relief was more longlasting. Narcotic analgesics and/or general anesthetics consumption was significantly lower after the CPB procedure in all patients. No neurologic complications were observed in these patients. CT-guided CPB is a safe and effective method of pain control in patients with severe upper abdominal pain caused by pancreatic carcinoma or chronic pancreatitis. It may prevent deterioration in quality of life by the long-lasting analgesic effect, reducing drug administration and drug-related adverse effects.

並列關鍵字

Computed tomography CT, guidance ； Celiac plexus block ； Pain

國際替代計量

Computed Tomography-guided Celiac Plexus Block for Treatment of Intractable Upper Abdominal Pain

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