Hagihara Shintaro, Abe Yoichiro, Godai Kohei, Enohata Kyo, Matsunaga Akira
Department of Anesthesiology and Pain Medicine, Kagoshima University Hospital, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan.
Department of Pain Clinic, NTT Medical Center Tokyo, 5-9-22 Higashigotanda, Shinagawa, Tokyo, 141-8625, Japan.
JA Clin Rep. 2023 Aug 2;9(1):48. doi: 10.1186/s40981-023-00639-3.
Postmastectomy pain syndrome involves persistent neuropathic and sympathetically maintained neuropathic pain that can be improved using a thoracic sympathetic ganglion block. However, conventional fluoroscopic procedures pose technical difficulties and are associated with potential severe complications. We report the use of C-arm fluoroscopic cone-beam computed tomography to enhance procedural success and treatment safety.
Three women diagnosed with postmastectomy pain syndrome and experiencing persistent pain underwent C-arm fluoroscopic cone-beam computed tomography-assisted ethanol neurolytic thoracic sympathetic ganglion block. Pain severity decreased substantially after the procedure. The therapeutic effects were sustained for 12 months in cases 1 and 2 and for 5 months in case 3. All patients experienced a remarkable decrease in allodynia and hyperalgesia intensities.
C-arm fluoroscopic cone-beam computed tomography-assisted neurolytic thoracic sympathetic ganglion block offers a valuable alternative for managing otherwise intractable postmastectomy pain syndrome before considering more invasive techniques.
乳房切除术后疼痛综合征涉及持续性神经性疼痛和交感神经维持性神经性疼痛，可通过胸交感神经节阻滞来改善。然而，传统的透视检查程序存在技术困难，并伴有潜在的严重并发症。我们报告了使用C形臂透视锥束计算机断层扫描来提高手术成功率和治疗安全性。
三名被诊断为乳房切除术后疼痛综合征且经历持续性疼痛的女性接受了C形臂透视锥束计算机断层扫描辅助乙醇神经溶解胸交感神经节阻滞。术后疼痛严重程度大幅降低。病例1和病例2的治疗效果持续了12个月，病例3持续了5个月。所有患者的异常性疼痛和痛觉过敏强度均显著降低。
在考虑采用更具侵入性的技术之前，C形臂透视锥束计算机断层扫描辅助神经溶解胸交感神经节阻滞为治疗难治性乳房切除术后疼痛综合征提供了一种有价值的替代方法。
