Slavik E, Ivanović S, Grujisić D, Djurović B, Nikolić I
Institute of Neurosurgery, Beograd, Serbia and Montenegro.
J BUON. 2005 Apr-Jun;10(2):223-6.
Advances in cancer treatment continue to lengthen survival among cancer patients. As patients live longer, the need for effective pain control has gained increased importance for improving quality of life. In patients who do not respond to all available conservative methods of therapy for cancer pain, surgical methods have been applied; one of them is the open high thoracic spinothalamic chordotomy.
We present a group of 86 patients suffering from nociceptive cancer pain, caused by compression of lumbosacral plexus. All patients were treated by microsurgical open high thoracic spinothalamic chordotomy. These patients did not respond to any available conservative treatment.
Immediately after surgery 68 (79%) patients had total pain relief. Of the remaining 18 (21%) patients, significant pain relief was achieved in 9 (10%), while in the remaining 9 patients this procedure had no effect. After a 6-month follow-up, total pain relief remained in 62 (72%) and significant pain relief in 10 (17%) of the patients. From 62 of patients with well-defined unilateral pain treated by "moderately deep" chordotomy, total pain relief was achieved in 53 (85%), lasting for 6 months in 49 (79%) of them.
These results show that microsurgical chordotomy can achieve total control of intractable cancer pain in the majority (79%) of patients, especially in those with well-defined unilateral pain (85%), indicating the usefullness of this surgical approach in the treatment of nociceptive cancer pain.
癌症治疗的进展持续延长癌症患者的生存期。随着患者寿命延长，有效控制疼痛对于提高生活质量变得愈发重要。对于对所有可用的癌症疼痛保守治疗方法均无反应的患者，已应用手术方法；其中之一是开放性高位胸段脊髓丘脑束切断术。
我们报告一组86例因腰骶丛受压而遭受伤害感受性癌痛的患者。所有患者均接受了显微外科开放性高位胸段脊髓丘脑束切断术治疗。这些患者对任何可用的保守治疗均无反应。
术后即刻，68例（79%）患者疼痛完全缓解。其余18例（21%）患者中，9例（10%）疼痛明显缓解，而其余9例患者此手术无效。6个月随访后，62例（72%）患者疼痛仍完全缓解，10例（17%）患者疼痛明显缓解。在62例经“中度深部”脊髓丘脑束切断术治疗的明确单侧疼痛患者中，53例（85%）疼痛完全缓解，其中49例（79%）持续缓解6个月。
这些结果表明，显微外科脊髓丘脑束切断术可使大多数（79%）患者的顽固性癌痛得到完全控制，尤其是明确单侧疼痛的患者（85%），表明这种手术方法在治疗伤害感受性癌痛方面是有用的。
