脊髓后正中点状切开术治疗顽固性癌性内脏痛

PUNCTATE MIDLINE MYELOTOMY FOR THE TREATMET OF INTRACTABLE VISCERAL CANCER PAIN

摘要:

目的：研究脊髓后正中点状切开术治疗顽固性癌性内脏痛的临床应用。方法：顽固性癌性内脏痛4例，平均疼痛病程10个月。全麻下行脊髓后正中点状切开术，胸：节段2例，胸。和胸。节段各1例。采用视觉模拟疼痛量表（VAS）和McGill疼痛问卷（MPQ）分别在术前和术后进行疼痛状况评分，同时记录手术前后患者使用镇痛剂的种类和最大剂量。将术后不同时间的VAS、MPQ与术前进行比较。结果：3例患者术后疼痛完全消失，1例疼痛显著缓解；随访5～13个月，直至患者死亡，术后不同时间的VAS和MPQ较术前降低均有显著性差异（P〈0．01）。术后有2例仍需每天肌注吗啡5—10mg，另2例不再使用吗啡。除暂时性双下肢轻度麻木、深感觉减退外，无严重并发症发生。结论：脊髓后正中点状切开术能有效治疗腹腔和盆腔顽固性癌性内脏痛，创伤小，疗效持久，并发症少。

Abstract:

Objective: To study the effectiveness of punctate midline myelotomy (PMM)for the treatment of intractable visceral cancer pain. Methods: PMM was performed in 4 patients with intractable visceral cancer pain, including one case of pelvic pain, one case of celiac pain and two cases of both pelvic and celiac pain. The PMM was successfully performed at the spinal cord T_2, T_7 or T_8 level. The visual analog scale (VAS) and the McGill pain questionnaire (MPQ) were used for the evaluation of preoperative and postoperative pain. Results: All 4 cases of visceral cancer pain had immediate pain relief after operation. In the follow-up periods ranging from 5 to 13 months, the postoperative pain was reduced significantly (P<0.01) as compared to the preoperation. No severe side effects occured. Conclusion: PMM is a simple, safe and highly effective method for treating intractable visceral pain.