以X光透視導引肋間神經射頻熱凝治療末期肺癌頑固性肋下疼痛──案例報告

Fluoroscopy-Guided Radiofrequency Thermocoagulation of Intercostal Nerves for Management of Subcostal Pain in a Patient with Advanced Lung Cancer

癌症病患的生活品質往往因為疼痛而不佳。當口服止痛藥物無法有效控制疼痛或者病患無法忍受這類止痛藥物的副作用時，侵入性的治療也許就是另一種可行之道。適當的神經阻斷術往往能夠達到止痛效果及減少口服止痛藥物的劑量。我們報告一位72歲男性病患，過去被診斷為非小細胞肺癌（T2N3M1），最近三個月以來飽受右下肋疼痛所苦。最初，給予Ultracet 37.5/325 mg/tab （Tramadol/Acetaminophen）一日三次服用下，可以獲得有效的疼痛控制。三個月後，疼痛的情況加劇且頻率增加尤其是在姿勢變換或咳嗽時。即便使用高劑量的嗎啡（120mg/d）合併Imipramine（30mg/d）仍然無法有效控制疼痛。考慮病患肺功能狀況不佳，且診斷性的神經阻斷術治療有不錯成效下，我們安排以X光透視導引針對右側第11及12肋間神經做射頻熱凝治療。術後，疼痛程度及睡眠品質均有顯著的改善。

The quality of life in cancer patients is always negatively affected by pain. Patients whose pain cannot be controlled by oral analgesics or those who are not tolerate with the side effects of medications could be good candidates for interventional therapy. An appropriate neural blockade may decrease their need for oral analegesics. Here, we reported a 72-year-old man with advanced non-small cell lung carcinorma (T2N3M1), who suffered from persisted right subcostal dull pain for 3 months. Initially, the pain was adequately controlled with oral Ultracet (Tramadol 37.5mg/Acetaminophen325mg) three times a day. However, sharp pain developed particularly during change of position or coughing 3 months later, and was no longer managed by high-dose morphine (120 mg/d) and imipramine (30 mg/d). Due to the severely compromised pulmonary function and positive response to the diagnostic neural blockade, a fluoroscopy-guided radiofrequency thermocoagulation in the right T11-T12 intercostal nerves was performed. The levels of pain and quality of sleep were significantly improved following the intervention.