Masala Salvatore, Calabria Eros, Cuzzolino Alessandro, Raguso Mario, Morini Marco, Simonetti Giovanni
Department of Diagnostic and Molecular Imaging, Interventional Radiology and Radiation Therapy, University of Rome - Tor Vergata, Viale Oxford 81, 00133, Rome, Italy,
Cardiovasc Intervent Radiol. 2014 Apr;37(2):476-81. doi: 10.1007/s00270-013-0679-y. Epub 2013 Aug 21.
The purpose of our study was to evaluate the efficacy of computed tomography (CT)-guided percutaneous pulse-dose radiofrequency (PDRF) for the treatment of chronic pain in patients with pudendal neuralgia (PN) unresponsive to conservative approaches.
From March 2010 to January 2012, 30 patients with a diagnosis of PN were prospectively enrolled in the study, 18 women and 12 men (mean age 47 years). A 20-gauge cannula with a 10-cm length was placed under CT guide in the pudendal (Alcock's) canal. After the spindle was removed, a radiofrequency needle with a 5-mm active tip was introduced. The appropriate needle placement near the pudendal nerve, without an involvement of the vessels, was confirmed with an injection of 1-2 ml of contrast agent. PDRF was performed with 1,200 pulses at high voltage (45 V) with 20 ms duration followed by 480 ms silent phases.
Twenty-six patients completed the study. Procedural success was achieved in all patients. Mean VAS scores before PDRF was 9 ± 0.7. Patients had a great improvement in pain intensity after 1 week by PDRF (mean VAS scores 3.8 ± 1.7, p < 0.05), with a stabilization of the symptomatology in the following months (mean VAS scores 1.5 ± 1.1 at 6 months by PDRF, p < 0.05) and excellent results after 1 year by the procedure (mean VAS scores 1.9 ± 0.7, p < 0.05).
In our preliminary experience, CT-guided percutaneous PDRF should be recommended for treatment of PN because we evaluated the tolerability of this procedure with satisfactory and encouraging results.
本研究旨在评估计算机断层扫描（CT）引导下经皮脉冲剂量射频（PDRF）治疗对保守治疗无反应的阴部神经痛（PN）患者慢性疼痛的疗效。
2010年3月至2012年1月，前瞻性纳入30例诊断为PN的患者，其中女性18例，男性12例（平均年龄47岁）。在CT引导下将一根长10 cm的20号套管针置于阴部（阿尔科克氏）管内。拔出针芯后，插入一根尖端活性长度为5 mm的射频针。通过注射1 - 2 ml造影剂确认射频针在阴部神经附近放置合适且未累及血管。PDRF以1200个高压（45 V）脉冲进行，脉冲持续时间为20 ms，随后是480 ms的静息期。
26例患者完成研究。所有患者手术均成功。PDRF前平均视觉模拟评分（VAS）为9±0.7。PDRF后1周患者疼痛强度有显著改善（平均VAS评分3.8±1.7，p<0.05），在接下来的几个月症状稳定（PDRF后6个月平均VAS评分1.5±1.1，p<0.05），手术1年后效果良好（平均VAS评分1.9±0.7，p<0.05）。
根据我们的初步经验，CT引导下经皮PDRF治疗PN值得推荐，因为我们评估了该手术的耐受性，结果令人满意且鼓舞人心。
