Hwang Shiuh-Lin, Lin Chih-Lung, Lieu Ann-Shung, Kuo Tai-Hung, Yu Kwong-Leung, Ou-Yang Fu, Wang Shen-Nien, Lee King-Teh, Howng Shen-Long
Division of Neurosurgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
J Pain Symptom Manage. 2004 Jan;27(1):79-84. doi: 10.1016/j.jpainsymman.2003.05.005.
The purpose of this study was to demonstrate the existence of a newly recognized midline posterior column pathway that mediates the perception of visceral pain resulting from hepatobiliary or pancreatic cancer. A punctate midline myelotomy (PMM) of T(3) level was performed in 6 patients who experienced severe visceral pain caused by hepatobiliary or pancreatic cancer. Preoperatively, the pain was refractory to strong opioids. Clinical efficacy of PMM was evaluated by comparing patient pain rating on a visual analogue scale. Follow-up periods ranged from 2-18 weeks after operation. All 6 patients had immediate pain relief after operation. Although the pain recurred from 2-12 weeks later in 3 patients, the severity of recurrent cancer pain markedly decreased. No adverse neurological sequelae were observed. Our results of high thoracic PMM offer clinical support for the concept that neurosurgical interruption of midline visceral pain pathway can effectively control severe visceral pain without causing adverse neurological sequelae in patients with hepatobiliary or pancreatic cancer.
本研究的目的是证实一种新发现的中线后柱通路的存在，该通路介导由肝胆或胰腺癌引起的内脏痛觉。对6例因肝胆或胰腺癌而遭受严重内脏痛的患者实施了T(3)水平的点状中线脊髓切开术（PMM）。术前，疼痛对强效阿片类药物无效。通过比较患者在视觉模拟量表上的疼痛评分来评估PMM的临床疗效。术后随访时间为2至18周。所有6例患者术后疼痛均立即缓解。虽然3例患者在术后2至12周疼痛复发，但复发性癌痛的严重程度明显降低。未观察到不良神经后遗症。我们高位胸椎PMM的结果为以下概念提供了临床支持，即对于患有肝胆或胰腺癌的患者，神经外科手术阻断中线内脏痛通路可有效控制严重内脏痛且不引起不良神经后遗症。
