Ferreira Filipa, Pedro Ana
Medical Oncology, Hospital São Francisco Xavier - Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.
Pain Unit, Hospital Prof. Dr. Fernando Fonseca, Lisbon, Portugal.
Case Rep Oncol. 2020 Jan 20;13(1):29-34. doi: 10.1159/000505181. eCollection 2020 Jan-Apr.
Cancer-related pain is a very prevalent problem in all stages, with 10% of patients requiring invasive techniques for adequate pain management. Ganglion impar neurolysis has been used in the treatment of pelvic-perineal pain with efficacy and rare complications, but only a few case or series reports in cancer patients have been published. We report the case of a patient presenting with an ovarian carcinoma (FIGO stage IIIC), who had several disease relapses at the colorectal transition and need for palliative colic prosthesis. She presented later with anorectal pain associated with a rectovaginal fistula, which had an important impact on the activities of her daily life. She was submitted to two ganglion impar neurolyses, which resulted in improved pain control for a total of 5 months, an important improvement in her quality of life, and reduction of opioid consumption. The authors aim to alert to the importance of pain control and to address the fourth step of the WHO analgesic ladder as an option for cancer patients, including palliative patients.
癌症相关疼痛在各个阶段都是一个非常普遍的问题，10%的患者需要采用侵入性技术来进行充分的疼痛管理。奇神经节神经溶解术已被用于治疗盆腔 - 会阴疼痛，疗效显著且并发症罕见，但关于癌症患者的病例或系列报道仅有少数发表。我们报告了一例患有卵巢癌（国际妇产科联盟IIIC期）的患者，该患者在结直肠移行处多次复发疾病，需要姑息性结肠造口术。她后来出现了与直肠阴道瘘相关的肛门直肠疼痛，这对她的日常生活活动产生了重大影响。她接受了两次奇神经节神经溶解术，疼痛控制得到改善，总共持续了5个月，生活质量有了显著提高，阿片类药物的消耗量也有所减少。作者旨在提醒人们注意疼痛控制的重要性，并将世界卫生组织镇痛阶梯的第四步作为癌症患者（包括姑息治疗患者）的一种选择。
