癌性内脏痛的脊髓手术治疗研究

摘要

目的:研究癌性内脏痛的脊髓手术治疗.方法:6例癌性内脏痛,男4例,女2例,单纯腹腔痛1例,单纯盆腔痛2例,腹腔痛合并盆腔痛3例.平均年龄58.6岁,平均疼痛病程14个月.脊髓后正中点状切开术(punctate midline myelotomy,PMM)在全麻下进行,手术节段为胸2节段4例,胸7和胸8各1例.术前和术后采用直观模拟疼痛量表(the visual analog scale,VAS)和McGill疼痛问卷量表(the McGill pain questionnaire,MPQ)对患者进行疼痛评分,将术后不同时间的VAS、MPQ评分与术前的评分进行比较,采用小样本自身配对t检验.结果:5例患者术后疼痛完全消失,1例疼痛显著缓解,随访5个月～20个月,直至患者死亡,术后不同时间的VAS评分和MPQ评分较术前降低均有显著性差异(P＜0.01).术后有2例仍需每天肌注吗啡5mg～ 10mg,另4例不再使用吗啡.术后出现暂时性双下肢轻度麻木、深感觉减退,无严重并发症发生.结论:PMM是治疗腹腔和盆腔癌性内脏痛的安全有效的新术式.%Objective: A study focused on punctate midline myelotomy (PMM) for the treatment of visceral cancer pain. Methods: Six patients with visceral cancer pain were treated by PMM, including two cases of pelvic pain, one case of celiac pain and three cases of both pelvic and celiac pain. The PMM was successfully performed at T2, T7 or T8 level of the spinal cord. The visual analog scale (VAS) and the McGill pain questionnaire (MPQ) were used for preoperative and postoperative evaluation of each patient's pain status. Statistical analyses were conducted using paired-samples t test. Results: All of the six cases of visceral cancer pain had immediate pain relief after surgery. Follow-up periods ranged from 5 to 20 months, until the patient died. The postoperative pain scale reduced significantly (P < 0.01). Only minor transient side effects appeared. Conclusion: Due to its simplicity, safety and high effectiveness, PMM maybe is one new surgical procedure for visceral cancer pain.