Bhatnagar Sushma, Thulkar Sanjay, Dhamija Ekta, Khandelwal Indermohan, Nandi Rudranil, Chana Gaurav
Department of Onco-Anaesthesia and Palliative Medicine, Dr B R A Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, 110 029, India.
Department of Radiodiagnosis, Dr B R A Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, 110 029, India.
Indian J Gastroenterol. 2017 Jul;36(4):282-288. doi: 10.1007/s12664-017-0780-2. Epub 2017 Aug 22.
An interventional procedure like celiac plexus neurolysis (CPN) has a significant role in relieving intractable pain in patients with locally advanced abdominal malignancies. Ultrasound (USG) guidance enables performance of bedside CPN by real-time visualization of the needle trajectory. The objective of the study was to perform percutaneous USG-guided CPN and to verify technical outcomes of the procedure using a post-procedure CT scan.
Eleven eligible patients of advanced upper abdominal malignancies having a pain score of >3/10 on visual analog scale (VAS) were recruited to undergo CPN. A post-procedure CT scan was performed to evaluate technical outcomes of the procedure. Patients were evaluated for pain relief. They were followed up at the 1st, 4th, and 6th weeks after CPN.
Eleven patients underwent USG-guided CPN. The injected drug was visualized as an echogenic cloud in ultrasound in 7 out of 11 (64%) patients. In the remaining 4 patients, the echogenic cloud was not well formed. In the post-procedure CT scan, the spread of the drug was seen in all 11 patients. This spread was bilaterally symmetrical in 7 (64%) patients and asymmetrical or unilateral in 4 (36%) patients. All patients in the immediate post-procedure period and 91% of the patients during the 1st-, 4th-, and 6th-week follow up had improvement in their pain scores.
A post-procedure CT scan was useful in verifying the technical outcome of USG-guided CPN in patients with advanced upper abdominal malignancies.
腹腔神经丛毁损术（CPN）等介入手术在缓解局部晚期腹部恶性肿瘤患者的顽固性疼痛方面具有重要作用。超声（USG）引导能够通过实时可视化针道在床边进行CPN。本研究的目的是进行经皮USG引导下的CPN，并使用术后CT扫描验证该手术的技术效果。
招募了11例符合条件的晚期上腹部恶性肿瘤患者，其视觉模拟量表（VAS）疼痛评分>3/10，接受CPN。进行术后CT扫描以评估手术的技术效果。对患者的疼痛缓解情况进行评估。在CPN后的第1、4和6周对他们进行随访。
11例患者接受了USG引导下的CPN。在11例患者中的7例（64%），注入的药物在超声中显示为高回声云团。其余4例患者中，高回声云团形成不佳。在术后CT扫描中，11例患者均可见药物扩散。7例（64%）患者的药物扩散呈双侧对称，4例（36%）患者呈不对称或单侧扩散。所有患者在术后即刻以及在第1、4和6周随访期间，91%的患者疼痛评分均有改善。
术后CT扫描有助于验证USG引导下CPN在晚期上腹部恶性肿瘤患者中的技术效果。
