脑下垂体破坏治疗癌痛和非癌顽痛效果与内分泌变化相关性的研究

TREATING CANCER AND NON-CANCER PAIN WITH NEUROADENOLYSIS OF PITUITARY GLAND (NALP) AND RELATED CHANGES IN BLOOD HORMONE LEVEL

摘要:

目的：观察脑下垂体破坏治疗癌性疼痛和非癌顽固性疼痛的效果及与内分泌激素变化的相关性，并探讨可能的镇痛机制。方法：随机选择癌痛患者和非癌顽痛患者各10例，均用静吸复合全麻，在C型臂引导下进行脑下垂体破坏操作，分别于术前、术后1小时、术后1天晨、术后3天晨抽取肘静脉血，测定促肾上腺皮质激素（ACTH）、生长激素（GH）和促甲状腺激素（TSH）的水平，并用VAS法评定止痛效果。结果：（1）两组患者治疗后VAS评分均显著下降，但组间比较无显著性差异。（2）两组患者ACTH、GH、TSH在术后1小时明显升高，与术前相比有显著性差异，术后第1天晨开始下降，术后第3天晨基本降至术前水平。（3）激素变化与VAS评分无相关性。结论：脑下垂体破坏对癌痛患者和非癌顽痛患者均有良好的止痛效果。

Abstract:

Objective: To study the effects of NALP on cancer and non-carcer pain and observe changes of blood hormone level. Methods: Patients were divided into 2 groups at random, cancer pain group (n=10) and non-cancer pain group (n=10). Both received NALP under general anesthesia. With the guidance of digital C-arm X-ray, 7.5% phenol glycerine was injected into the pituitary. Venous blood were sampled at pre-operation, 1 h post-operation, the 1st and 3rd post-operative morning for plasma ACTH, GH, and TSH measurements. VAS was assessed at pre-operation and 72h post-operation. Results: (1) VAS of both groups decreased significantly after NALP; there was no significant difference between the two groups in VAS on the 3rd day after operation. (2) For both groups, ACTH, GH and TSH were increased significantly at 1h post-operation compared with pre-operation, decreased on the 1st day after NALP, and dropped to baseline level on the 3rd day. (3) There was no correlations between hormone level and VAS. Conclusion: NALP has satisfactory therapeutic effects for cancer pain as well as for non-cancer pain.