Garcea Giuseppe, Thomasset Sarah, Berry David P, Tordoff Simon
Department of Hepatobiliary and Pancreatic Surgery, The Leicester General Hospital, Leicester, United Kingdom.
ANZ J Surg. 2005 Aug;75(8):640-4. doi: 10.1111/j.1445-2197.2005.03486.x.
Splanchnic nerve block is a useful alternative to coeliac plexus block in the management of patients with chronic upper abdominal pain. The predictable relationship of the splanchnic nerves to other structures allows for accurate needle placement and hence a low risk of iatrogenic damage. Radiofrequency ablation (RFA) uses a high frequency alternating current to heat tissues leading to thermal coagulation. It produces predictable and accurate lesions and hence is useful alternative to more conventional phenol and alcohol neurolytic methods.
The present study examined a series of 10 patients undergoing percutaneous RFA splanchnic nerve blockade for chronic pancreatitis. Pain levels, anxiety, quality of life, daily activity, mood and interpersonal relationships were all assessed pre- and postprocedure, using a visual analogue score. Median follow-up was 18 months (range: 12-24 months). Statistical analysis was undertaken using non-parametric Wilcoxon matched pair analysis, statistical significance was set at the 95% confidence intervals.
Splanchnic nerve RFA not only led to a decrease in pain scores, opiate analgesia use and acute admissions for pain; but it also resulted in improvement of other parameters associated with long-term debilitating chronic pain, such as anxiety levels, daily activity, overall mood and general perception of health. There were no major complications. All changes observed were statistically significant.
Although preliminary data regarding RFA ablation of splanchnic nerves are encouraging, further trials are also needed comparing percutaneous splanchnic nerve ablation with opioid analgesia and coeliac plexus blockade.
在内科治疗慢性上腹部疼痛患者时，内脏神经阻滞是腹腔丛阻滞的一种有效替代方法。内脏神经与其他结构之间可预测的关系有利于准确地进行穿刺针定位，从而降低医源性损伤的风险。射频消融（RFA）使用高频交流电加热组织，从而导致热凝固。它能产生可预测且精确的损伤，因此是比更传统的酚和酒精神经溶解方法更有效的替代方法。
本研究检查了一系列10例因慢性胰腺炎接受经皮RFA内脏神经阻滞的患者。使用视觉模拟评分法在术前和术后评估疼痛程度、焦虑、生活质量、日常活动、情绪和人际关系。中位随访时间为18个月（范围：12 - 24个月）。采用非参数Wilcoxon配对分析进行统计分析，设定统计学显著性为95%置信区间。
内脏神经RFA不仅使疼痛评分、阿片类镇痛药物使用量及因疼痛而急诊入院的情况减少；而且还改善了与长期使人衰弱的慢性疼痛相关的其他参数，如焦虑水平、日常活动、总体情绪和对健康的总体认知。未出现重大并发症。观察到的所有变化均具有统计学显著性。
尽管关于内脏神经RFA消融的初步数据令人鼓舞，但还需要进一步试验，将经皮内脏神经消融与阿片类镇痛及腹腔丛阻滞进行比较。
