利用傳統旁側方式合併背中側經椎間盤方式的上下腹腔神經叢阻斷術治療慢性骨盆腔癌症疼痛 －－病例報告

Combined Classic Posterolateral Approach and Posteromedian Transdiscal Approach of Superior Hypogastric Plexus Block for the Pelvic Cancer Pain - a Case Report

上腹下神經叢阻斷（Superior hypogastric plexus block）對於頑固型骨盆腔惡性腫瘤疼痛是一種有效的治療方式，我們提出一個成功控制55歲女性罹患小腸癌伴隨骨盆腔轉移頑固型疼痛的病歷報告。這個病人有腹脹、噁心、嘔吐和嚴重的左下腹悶痛等症狀，口服及皮下注射嗎啡的治療效果不佳。在經過傳統旁側方式合併背中側經椎間盤方式的上下腹腔神經叢阻斷術（總共使用10ml mixture composed of 0.2% Chirocaine, phenol 10% and contrast medium），病人疼痛視覺量比類表（Visual Analogue Scale）由8～9分降至0分。六個月後的追蹤顯示，病人在口服低劑量嗎啡（25mg/day）情況下，疼痛視覺量比類表依然分數＜3。

The superior hypogastric plexus block (SHPB) is an effective treatment for intractable pelvic cancer pain. We report a successful management experience of a 55 year-old female with small bowel cancer and recurrent pelvic metastasis. This patient complained of abdominal fullness, nausea, vomiting and severe left lower quadrant (LLQ) abdominal dull pain. Oral and subcutaneous morphine pain control was insufficient. After SHBP with combine classic posterolateral approach and posteromedian transdiscal approach(totally using 10 ml mixture composed of 0.2% Chirocaine, phenol 10% and contrast medium), the Visual Analogue Scale (VAS) decreased from 8-9 to 0. During the period of 6 months follow up with oral morphine (25/day), the patient felt satisfied and VAS still <3.