利用電腦斷層指引的經皮化學性腰交感神經阻斷術：技術報導與結果

CT-Guided Percutaneous Chemical Lumbar Sympathectomy: Technical Note and Outcome

本研究是利用電腦斷層指引，對於有適應症的病人，施行經皮化學性腰交感神經阻斷衛，評估其可行性與效果。以往用外科手術施作腰交感神經阻斷術，其死亡率約7%'主要是死於術後的肺炎。從2001年12月至2003年12月，16位病人接受19次治療，其中5位男性，11位女性，平均年酸53.9歲﹔13位接受單側，3位接受階段性雙側治療。電腦斷層定位腰交感神經阻斷術，對所有患者均無技巧上的問題，也沒有遇到重大的併發症。大部分患者注射完，會有短暫性的背部疼痛感，但此現象三天內會消失。其中1位有單側會陰肢神經痛（ge凶tofemoralneuralgia），但此情況在一個月之內消失。電腦斷層定位腰交感神經阻斷術並無死亡的案例。30天早期追蹤，有6患肢非常滿意，7患肢滿意，4患肢可接受：長期追蹤，有9患肢非常滿意，7患肢滿意，3患肢可接受。總結：化學性的腰交感神經阻斷術，經皮穿刺，注射化學藥物，比較不侵犯性，是可以降低死亡率。傳統上是以螢光屏機來操作，但可能有許多的併發症。利用電腦斷層掃描的指引，可以明確地看見入針的軌道與針尖的位置，避免併發症。

Lumbar sympathectomy may be performed surgically, but this has a reported mortality rate of up to 7 percent. Percutaneous chemical lumbar sympathectomy has been advocated to decrease the mortality. Our goal of this study was to evaluate the feasibility of the technique guided by computerized tomography (CT) scan and to determine the therapeutic value of this therapy. From December 2001 to December 2003, 16 patients underwent 19 percutaneous chemical lumbar sympathectomies using CT guidance for the various accepted indications. There were 5 male patients and 11 female patients, with a mean age of 53 .9 years (range: 21 to 85 years). Thirteen patients underwent unilateral procedures (5 on the right and 8 on the left), and three patients underwent staged bilateral procedures. Six patients (6/16) had previously undergone back surgeries. We have followed up our patients for at least 12 months (12-36 months, mean 20.6 months) after this procedure. Needle puncture was possible without difficulty in all patients. There was no operative death. Transient back pain or soreness was seen in most patients, with recovery in the following 3 days. One patient with plantar hyperhidrosis achieved persistent anhidrosis. Another patient had neuritic pain in the genitofemoral distribution and he recover in a month. Other reported complications were not seen. Six limbs had very satisfied, 7 had satisfied, 4 had fair, and none had unsatisfied early outcome. Regarding late outcome, 9 limbs were very satisfied, 7 were satisfied, 3 were fair, and none was unsatisfied with this procedure. In summary, we describe a simple and modified technique guided by CT to localize the acute placement of the needle tip prior to injection of a neurolytic agent. It is a safe, effective, reproducible and reliable technique and accurate needle placement is readily demonstrated using CT scan.