Slavik E, Ivanović S
Institute of Neurosurgery, Clinical Medical Center, Belgrade.
Acta Chir Iugosl. 2004;51(4):15-23. doi: 10.2298/aci0404015s.
The management of cancer pain represents a difficult diagnostic and therapeutic problem for the clinician. In a multidisciplinary approach to the management of cancer pain, neurosurgical methods are an essential part of the therapy. Frequently, patients with advanced cancer suffer from an increasing pain, requesting ever-higher dosage of narcotics, and finally seeming to respond only to high dosage of intravenous narcotics. Gradually, the opioids produce less satisfactory analgetics effects an more serious side manifestations. These patients can be considered for surgical management of pain. Historically, surgery for cancer pain began with destructive procedures (neurectomy, rhizotomy, sympathectomy), often referred to as ablative. In past two decades, with the help of the current knowledge of cancer pain mechanisms and some of the technological developments, such as microsurgical and stereotactic techniques, computerized tomography and magnetic resonance imaging, the majority of ablative procedures have been replaced by new methods. Among them a few are selectively and minimally ablative (microsurgical spinothalamic cordotomy, dorsal root entry zone operation, limited midline myelotomy) and the others ones are neuroaugumentative operations (deep brain structures and spinal cord stimulation, drug-delivery systems).
癌症疼痛的管理对临床医生来说是一个困难的诊断和治疗问题。在癌症疼痛管理的多学科方法中，神经外科方法是治疗的重要组成部分。晚期癌症患者经常遭受越来越严重的疼痛，需要不断增加麻醉药品的剂量，最终似乎只对高剂量的静脉麻醉药有反应。逐渐地，阿片类药物产生的镇痛效果越来越不令人满意，副作用也越来越严重。这些患者可以考虑进行疼痛的手术治疗。从历史上看，癌症疼痛手术始于破坏性手术（神经切除术、神经根切断术、交感神经切除术），通常称为切除性手术。在过去的二十年里，借助当前对癌症疼痛机制的了解以及一些技术发展，如显微外科和立体定向技术、计算机断层扫描和磁共振成像，大多数切除性手术已被新方法取代。其中一些是选择性和微创切除性手术（显微外科脊髓丘脑束切断术、背根入区手术、有限的中线脊髓切开术），其他的是神经增强手术（深部脑结构和脊髓刺激、药物输送系统）。
