Ochiai Y, Ishii S, Takahashi S, Mizobuchi S, Fukushima T, Katayama H, Irisawa M
Department of Anesthesiology, Kure Mutual Aid Hospital.
Masui. 1992 Dec;41(12):1961-5.
We investigated appropriate puncture site, angle of needle entry, and the distance of the insertion for CT monitored celiac plexus block using CT photograms on prone position in sixteen patients with gastrointestinal diseases. In retrocrural approach during CT monitored celiac plexus block, the average distances of puncture sites to midline were 3.84 cm on the right and 4.06 cm on the left, and the average needle angles were 74.1 degrees on the right and 76.9 degrees on the left. The average depths from the puncture site to marked position in retrocrural space were 7.88 cm on the right and 7.85 cm on the left. The rates of predicted organ puncture when needle is inserted 7 cm lateral to the midline of the spinal process were 43.8 percent in the right lung, 12.5 percent in the left lung, 56.2 percent in the right kidney and 68.8 percent in the left kidney. From these results, we found high possibilities of organ injuries using the conventional technique for celiac plexus block. We conclude that we could perform celiac plexus block more safely and surely using the retrocrural approach by CT monitoring, as serious complications are avoidable by viewing ideal puncture course on CT photographs.
我们利用十六例胃肠道疾病患者俯卧位的CT照片，研究了CT引导下腹腔神经丛阻滞的合适穿刺部位、进针角度和进针深度。在CT引导下腹腔神经丛阻滞的经膈脚途径中，穿刺点至中线的平均距离右侧为3.84cm，左侧为4.06cm；平均进针角度右侧为74.1度，左侧为76.9度。穿刺点至膈脚间隙标记位置的平均深度右侧为7.88cm，左侧为7.85cm。当在棘突中线外侧7cm处进针时，预测的器官穿刺率为：右肺43.8%，左肺12.5%，右肾56.2%，左肾68.8%。从这些结果中，我们发现使用传统技术进行腹腔神经丛阻滞时器官损伤的可能性很高。我们得出结论，通过CT监测采用经膈脚途径可以更安全、更确切地进行腹腔神经丛阻滞，因为通过观察CT照片上的理想穿刺路径可以避免严重并发症。
