Division of Abdominal Imaging and Intervention, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114, USA.
Radiographics. 2011 Oct;31(6):1599-621. doi: 10.1148/rg.316115526.
The celiac plexus is the largest visceral plexus and is located deep in the retroperitoneum, over the anterolateral surface of the aorta and around the origin of the celiac trunk. It serves as a relay center for nociceptive impulses that originate from the upper abdominal viscera, from the stomach to the proximal transverse colon. Celiac plexus neurolysis, with agents such as ethanol, is an effective means of diminishing pain that arises from these structures. Percutaneous imaging-guided celiac plexus neurolysis has been established as an invaluable therapeutic option in the management of intractable abdominal pain in patients with upper abdominal malignancy. The use of multidetector computed tomography (CT) for imaging guidance has superseded other modalities and allows direct visualization of the spread of the neurolytic agent in the antecrural space. Accurate depiction of the retroperitoneal anatomy and the position of the needle tip helps avoid crucial anatomic structures such as the pancreas, aorta, celiac artery, and superior mesenteric artery. Proper patient education, meticulous preprocedure planning, use of optimal multidetector CT techniques, adjunctive CT maneuvers, and postprocedure care are integral to successful celiac plexus neurolysis. Celiac plexus neurolysis does not completely abolish pain; rather, it diminishes pain, helping to reduce opioid requirements and their related side effects and improving survival in patients with upper abdominal malignancy.
腹腔神经丛是最大的内脏神经丛，位于腹膜后深部，主动脉前外侧表面和腹腔干起始部周围。它是来自上腹部内脏（从胃到近端横结肠）的伤害性冲动的中继中心。乙醇等药物的腹腔神经丛松解术是减轻这些结构引起的疼痛的有效方法。经皮影像引导的腹腔神经丛松解术已成为治疗上腹部恶性肿瘤患者顽固性腹痛的一种非常有价值的治疗选择。多排 CT（CT）用于影像引导已经取代了其他方式，并且可以直接观察到神经溶解剂在髂前区的扩散。准确描述腹膜后解剖结构和针尖位置有助于避免胰腺、主动脉、腹腔干和肠系膜上动脉等关键解剖结构。适当的患者教育、细致的术前规划、使用最佳的多排 CT 技术、辅助 CT 操作以及术后护理是成功进行腹腔神经丛松解术的关键。腹腔神经丛松解术并不能完全消除疼痛；而是减轻疼痛，有助于减少阿片类药物的需求及其相关副作用，并改善上腹部恶性肿瘤患者的生存。
