Department of Radiology, St. Marianna University School of Medicine, Kanagawa, Japan.
Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan.
Diagn Interv Radiol. 2021 May;27(3):408-412. doi: 10.5152/dir.2021.20224.
We aimed to evaluate the effectiveness and safety of splanchnic nerve neurolysis (SNN) with angio-CT, a hybrid system combining computed tomography (CT) with X-ray fluoroscopy.
Thirty-three SNN procedures with angio-CT performed in 30 patients with severe epigastric cancer pain (11 males and 19 females; median age, 57 years; age range, 19-79 years) between January 2010 and July 2017 were retrospectively evaluated. The primary endpoints were the technical success and adverse event rates. The secondary endpoints included the clinical success rate, defined as a reduction in the numerical rating scale for pain score or a decrease in the consumption of analgesics on day 1 and at 1-2 weeks after the procedure; procedure time; the number of needle punctures; amount of ethanol required; and the distribution of contrast medium in the retrocrural space. These endpoints were compared with previous studies that did not employ the angio-CT system.
The technical success rate was 96.97%. There were two procedure-related adverse events (one retroperitoneal hemorrhage, one pneumothorax). The clinical success rates on day 1 and at 1-2 weeks after the procedure were 84.38% and 87.5%, respectively. The median procedure time was 60 minutes. The median number of needles used was 2. The median amount of ethanol used was 20 mL.
SNN under angio-CT is safe and effective, with excellent technical and clinical success rates and acceptable adverse event rates. These results are comparable with previous studies that did not involve angio-CT. However, the use of angio-CT allows for easier needle positioning and an earlier response to complications compared with conventional methods.
我们旨在评估血管 CT 引导内脏神经松解术（SNN）的有效性和安全性，该技术是一种将计算机断层扫描（CT）与 X 射线透视相结合的混合系统。
回顾性分析 2010 年 1 月至 2017 年 7 月期间 30 例患有严重上腹痛癌症患者（11 名男性，19 名女性；中位年龄 57 岁；年龄范围 19-79 岁）行 33 例血管 CT 引导 SNN 手术的资料。主要终点是技术成功率和不良事件发生率。次要终点包括临床成功率，定义为疼痛数字评分量表评分降低或术后第 1 天和第 1-2 周镇痛药消耗量减少；手术时间；针穿刺次数；所需乙醇量；以及对比剂在椎管后间隙的分布。将这些终点与未使用血管 CT 系统的既往研究进行比较。
技术成功率为 96.97%。有 2 例与手术相关的不良事件（1 例腹膜后出血，1 例气胸）。术后第 1 天和第 1-2 周的临床成功率分别为 84.38%和 87.5%。手术时间中位数为 60 分钟。使用的中位数针数为 2 枚。使用的中位数乙醇量为 20 毫升。
血管 CT 引导下 SNN 安全有效，具有优异的技术和临床成功率以及可接受的不良事件发生率。这些结果与未涉及血管 CT 的既往研究相似。然而，与传统方法相比，血管 CT 的使用可使针定位更容易，并能更早地应对并发症。
