Kanpolat Yucel, Ozdemir Mevci, Al-Beyati Eyyub
President of the Turkish Academy of Sciences, Emeritus, Ankara University, Faculty of Medicine, Department of Neurosurgery, Ankara, Turkey.
Turk Neurosurg. 2013;23(1):81-7. doi: 10.5137/1019-5149.JTN.6980-12.0.
Lung cancer is the leading cause of cancer-related mortality worldwide. Pain is a common problem in these patients, yet inadequate or dissatisfactory management is prevalent.
Between 1987 and 2012, 224 patients with intractable pain were treated with computerized tomography (CT)- guided cordotomy. Among them, 210 had intractable pain due to malignancies. The majority of the cases were diagnosed as pulmonary malignancies (108 patients). Sixty-seven were pulmonary carcinoma, 26 mesothelioma and 15 Pancoast tumors.
After cordotomy, 98.13% of cancer patients reported initial pain relief. Minimum and maximum preoperative scores of the Karnofsky Performance Scale were 20 and 70, versus postoperative scores of 40 and 90 (p < 0.001). The median preoperative VAS score was 8 (6-9). On the first postoperative day, the score dropped sharply to 0 (0-8) (p < 0.001). In this selected series of 108 percutaneous cordotomy procedures, as well as in the total series of 224 patients, there was no mortality or major morbidity.
CT-guided percutaneous cordotomy is an effective procedure that should be used in the treatment of cancer-related pain problems. We suggest that cordotomy should be preferred as soon as possible in patients who fail to respond to the classic analgesic therapy.
肺癌是全球癌症相关死亡的主要原因。疼痛是这些患者的常见问题，但管理不足或不尽人意的情况普遍存在。
1987年至2012年期间，224例顽固性疼痛患者接受了计算机断层扫描（CT）引导下的脊髓前侧柱切断术治疗。其中，210例因恶性肿瘤导致顽固性疼痛。大多数病例被诊断为肺部恶性肿瘤（108例患者）。67例为肺癌，26例为间皮瘤，15例为潘科斯特瘤。
脊髓前侧柱切断术后，98.13%的癌症患者报告最初疼痛缓解。卡诺夫斯基功能状态量表术前最低和最高评分分别为20分和70分，术后评分分别为40分和90分（p < 0.001）。术前视觉模拟评分（VAS）中位数为8分（6 - 9分）。术后第一天，评分急剧降至0分（0 - 8分）（p < 0.001）。在这组108例经皮脊髓前侧柱切断术以及224例患者的总系列中，无死亡或严重并发症发生。
CT引导下经皮脊髓前侧柱切断术是一种有效的手术方法，应用于治疗癌症相关疼痛问题。我们建议，对于经典镇痛治疗无效的患者，应尽早选择脊髓前侧柱切断术。
