New Computed Tomography--guided Percutaneous Interventional Techniques:clinical Application And Correlative Study

Percutaneous nonascular interventional therapy is not systemat- ic in China as it has been used in few projects and cases. The present ar- ticle reports our studies on three projects using CT-guided percuta- neous interventional techniques in an attempt to promote CT-guided percutaneous non-vascular interventional therapy in a deeper and more extensive way by using microtraumatic means to solve some difficult clinical problems and relieve pains of patients. Part â… . Clinical study on the use of percutaneous CT uided neu- rolytic celiac plexus block Objective To evaluate analgesic effect of CT-guided neurolytic celiac plexus block (NCPB) in patients with refractory and obstinate ab- dominal pain of cancer accompanied with extensive swelling of post- peritoneal lymph nodes that are fused into masses and invade and enve- lope the neurolytic celiac plexus. Methods The subjects were 53 termi- nal stage cancer patients (male 31, female 22; age range :34-71 with a mean of 47) with extensive swelling of post-peritoneal lymph nodes that are fused into masses, all of whom had severe abdominal pain that was persistent and radiated to the back. Of the 53 patients, 5 had re- ceived radiation therapy but responded poorly. In this study, 25 patients ?? received celiac plexus block with the needle tip positioned into masses fused by lymph nodes and the remaining 28 received the conventional celiac plexus block with the needle tip positioned anterior to diaphrag- matic crura. Both groups received additional splanchnic nerve block with the needle tip positioned posterior to diaphragmatic crura. The analgesic effect was classified into three grades: Grade 0, showing no analgesic effect and there was no change in degree of pain before and after the pro- cedure; Grade â… , showing mild analgesic effect, though a certain amount of analgesics was needed; Grade â…¡: showing marked analgesic effect as compared with the previous condition, though analgesics were used oc- casionally; Grade â…¢: showing complete relief of pain without using analgesics. Results The analgesic effect of the group treated by celiac plexus block with the needle tip positioned into masses fused by lymph nodes was better than the group treated by the conventional celiac plexus block with the needle tip positioned anterior to diaphragmatic crura 2 weeks and 1, 2, 3 and 4 months after treatment, showing signif- icant difference between the two groups. The 4-month death rate of the group treated by celiac plexus block with the needle tip positioned into masses fused by lymph nodes was lower than that of the group treated by the conventional celiac plexus block with the needle tip posi- tioned anterior to diaphragmatic crura, showing significant difference between the two groups. The lymph nodes of the group treated by celiac plexus block with the needle tip positioned into masses fused by lymph nodes shrank markedly, whereas those of the group treated by the con- ventional celiac plexus block with the needle tip positioned anterior to diaphragmatic crura did not show shrinkage but became larger in varying degrees with progression of time. Conclusion The analgesic effect of ?? the conventional celiac plexus block with the needle tip positioned ante- rior to diaphragmatic crura for refractory and obstinate abdominal pain of cancer accompanied with...