合併超音波暨X光會陰神經注射治療-案例報告

Combined ultrasound-fluoroscopic guide pudendal nerve injection therapy

會陰神經痛為在會陰神經支配區域的疼痛，在女性主要的症狀包括陰道、肛門、外陰、會陰部的疼痛。這些症狀常會隨著坐姿而加劇、站姿而減輕，並且隨著時間進展在一日中逐漸變嚴重。本病歷報告為一位44歲女性病患因反覆會陰疼痛無法以藥物治療緩解而接受合併超音波暨X光導引之會陰神經注射治療。藉由雙重影像導引的方式：在超音波導引下，我們可以辨識許多解剖構造如陰部神經、動脈、骶棘韌帶（sacrospinous ligament）、與韌帶（sacrotuberous ligament）等，而精確的將注射針定位。接著藉由X光導引的方式確認注射藥水浸潤阿爾科克氏管（Alcock's canal）。藉由這個方式，在治療後的8周追蹤期間內病人的疼痛得到有效的緩解。

Pudendal neuralgia is a painful neuropathic condition, involving the dermatome of the pudendal nerve. In women, primary symptoms are commonly experienced in vaginal, anal, vulva, clitoral, and perineal regions. We present a case of a 44 y/o female who suspected to have pudendal neuralgia. She was successfully treated by pudendal nerve block guided by combination of ultrasound and fluoroscopy. By using dual image guiding technique, we introduced the needle precisely by visualizing anatomical landmarks such as the internal pudendal artery, nerve, the sacrospinous ligament(SSL) and sacrotuberous ligament(STL) under ultrasound guiding. Then we did hydrodissection and confirmed the injectate spread through the Alcock's canal by fluoroscopy with enhancement of the contrast. With the combination of the two skills, we can take advantage of both skills. The patient reported a reduction in pain by 60 80% with an excellent improvement of quality of life during follow-up 8 weeks later.