CT引导下经骶孔神经脉冲射频治疗会阴痛的临床研究

Clinical study of CT-guided pulsed radiofrequency of nerves through sacral foramen for perineal pain

摘要:

目的：观察CT引导下经骶孔神经脉冲射频治疗会阴痛的临床疗效及安全性。方法：本研究采用前瞻性研究方法，选择2017年8月至2021年8月符合入选标准的会阴痛患者40例，年龄25～81岁。用随机数字表法分为试验组（经骶孔神经脉冲射频组）(n=20）和对照组（经坐骨棘阴部神经脉冲射频组）(n=20）。记录两组患者治疗前、术后1天、2 周、1个月、3个月的视觉模拟评分（visual analogue scale, VAS）、小便次数、匹兹堡睡眠质量指数（pittsburgh sleep quality index, PSQI）和医院抑郁焦虑量表（hospital anxiety and depression scale, HAD）评分，用有效率和显效率评定临床疗效。结果：对照组有1例未完成随访，最终试验组20例(n=20），对照组19例(n=19）。两组病人VAS、PSQI、HAD评分、小便次数对比，术前差异无统计学意义（P＞0.05），术后各时间点均较术前降低，且试验组较对照组降低更明显，差异均有统计学意义（P＜0.05）。两组病人治疗有效率均较高，但试验组术后各时间点显效率均比对照组高，差异有统计学意义(P＜0.05)。结论: 经骶孔神经脉冲射频治疗会阴痛，既能迅速和较长时间缓解会阴区疼痛，还能改善睡眠、情绪和排尿等内脏功能。

Abstract:

Objective：Observe the clinical study of CT-guided pulsed radiofrequency of nerves through sacral foramen in the treatment of perineal pain. Methods：In this prospective study, 40 patients with perineal pain who met the inclusion criteria from August 2017 to August 2021, aged 25-81 years, were selected. The patients were randomly divided into experimental group (pulsed radiofrequency group of nerves through the sacral foramen) (n=20) and control group (pulsed radiofrequency group via sciatic spinous nerve) (n=20). Visual analogue scale (VAS), number of urine, pittsburgh sleep quality index (PSQI) and hospital anxiety and depression scale (HAD) were recorded before treatment, 1 day, 2 weeks, 1 month, and 3 months after surgery. Total response rate (the percentage of patients with more than 25% pain relief in the total number of patients in the group), significant efficiency (the percentage of patients with more than 50% pain relief in the total number of patients in the group). Results: One patient in the control group did not complete the follow-up, and 20 patients in the experimental group (n=20) and 19 patients in the control group (n=19). There was no significant difference in VAS, PSQI, HAD score and number of urine between the two groups before operation (P > 0.05), but the postoperative time points were lower than those before operation, and the decrease was more significant in the experimental group than that in the control group, the differences were statistically significant (P < 0.05). The effective rate of the two groups was higher, but the efficiency of the experimental group was higher than that of the control group at each time point after operation, and the difference was statistically significant (P < 0.05). Conclusion: The treatment of perineal pain by sacral nerve pulse radiofrequency can not only relieve perineal pain quickly and for a long time, but also improve visceral function such as sleep, mood and urination.