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ENGLISH ABSTRACT
阴部神经脉冲射频消融术联合阴部神经阻滞治疗阴部神经痛的临床疗效和安全性评价
丁俊云
叶乐
杨雨
方洪伟
王祥瑞
作者及单位信息
·
DOI： 10.3760/cma.j.issn.1673-4378.2019.02.008
Clinical efficacy and safety of a combined therapy of pulsed radiofrequency and pudendal nerve block in pudendal neuralgia patients
Ding Junyun
Ye Le
Yang Yu
Fang Hongwei
Wang Xiangrui
Authors Info & Affiliations
Ding Junyun
Department of Anesthesiology, South Campus, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200025, China
Ye Le
Department of Anesthesiology, South Campus, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200025, China
Yang Yu
Department of Anesthesiology and Intensive Care Unit, Dongfang Hospital, Shanghai Tongji University, Shanghai 200120, China
Fang Hongwei
Department of Anesthesiology and Intensive Care Unit, Dongfang Hospital, Shanghai Tongji University, Shanghai 200120, China
Wang Xiangrui
Department of Anesthesiology and Intensive Care Unit, Dongfang Hospital, Shanghai Tongji University, Shanghai 200120, China
·
DOI： 10.3760/cma.j.issn.1673-4378.2019.02.008
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摘要

目的探讨阴部神经脉冲射频消融术（pulse radiofrequency, PRF）联合阴部神经阻滞（pudendal nerve blockade, PNB）治疗阴部神经痛的临床疗效和安全性评价。

方法将80例阴部神经痛患者按电脑数字表法随机分为脉冲射频+阴部神经阻滞组（PRF+PNB组）和阴部神经阻滞组（PNB组），每组40例。PRF+PNB组患者行阴部神经PRF联合PNB治疗，PNB组行PNB治疗。于术后1、14、30、90 d对患者进行VAS评分随访，于术后第3个月行HPQ-9评分和疗效评估，并记录所有手术相关并发症。

结果本次试验共77例患者完成了随访，PNB组39例，PRF+PNB组38例。术后1 d时，两组患者VAS评分较术前均降低（ P<0.05），且组间差异无统计学意义（ P>0.05）。术后14、30、90 d时PRF+PNB组VAS评分低于PNB组（ P<0.05）。术后90 d时，PRF+PNB组患者健康问卷（Patient Health Quwstionnaire-9, HPQ-9）评分低于PNB组（ P<0.05），PRF+PNB组术后90 d有效率达92.1%，PNB组有效率为35.9%。两组均未随访观察到严重的不良反应。

结论与单纯的PNB相比，阴部神经PRF联合PNB治疗，能够更长效地缓解阴部神经痛患者的疼痛症状，并对患者抑郁情绪有所改善，且不增加术后不良事件发生。

阴部神经痛;脉冲射频;射频消融术;阴部神经阻滞;超声引导
ABSTRACT

ObjectiveTo investigate the clinical efficacy and safety of the combined therapy of pulsed radiofrequency (PRF) and pudendal nerve block (PNB) in pudendal neuralgia patients.

MethodsEighty patients diagnosed with pudendal neuralgia were randomly divided into a PRF+PNB group and a PNB group. The PRF+PNB group underwent both PRF and PNB, while the PNB group received PNB alone. All the patients were followed up to evaluate the Visual Analog Scale (VAS) scores and the Patient Health Quwstionnaire-9 (HPQ-9) scores on the postoperative 1, 14, 30 d and 90 d after surgery. All the surgical complications were recorded.

ResultsA total of 77 patients were followed up, including 39 patients in the PNB group and 38 patients in the PRF+PNB group. On the 1 d after surgery, both groups presented remarkably reduced VAS scores compared with pre-operative levels ( P<0.05), without statistical difference between the two groups( P>0.05). However, compared with the PNB group, the PRF+PNB group showed marked decreases in the VAS scores on 14, 30 d and 90 d after surgery( P<0.05). Furthermore, the PRF+PNB group showed marked lower HPQ-9 scores than the PNB group ( P<0.05) in 90 d after operation. The 90 d effective rate was 92.1% for the PRF+PNB group and 35.9% for the PNB group. No severe adverse events were observed in either group.

ConclusionsCompared with PNB treatment alone, the combined therapy of pudendal nerve PRF and PNB is effective to relieve pain in patients with pudendal neuralgia in a longer period of time and improve patients′ depression symptoms, without postoperative adverse events.

Pudendal neuralgia;Pulse radiofrequency treatment;Radiofrequency ablation;Pudendal nerve block;Ultrasound guidance
Wang Xiangrui, Email: .modefc.ab36186iurgnaix
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引用本文

丁俊云,叶乐,杨雨,等. 阴部神经脉冲射频消融术联合阴部神经阻滞治疗阴部神经痛的临床疗效和安全性评价[J]. 国际麻醉学与复苏杂志,2019,40(2)：135-139.

DOI:10.3760/cma.j.issn.1673-4378.2019.02.008

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阴部神经痛是一种涉及阴部神经病变的神经病理性疾病。根据国际阴部神经病变协会统计，阴部神经痛在一般人群的发生率大约是1/10万 [ 1 ]。阴部神经痛是由阴部神经炎症、压迫、牵拉等因素引起的疼痛，它可能与分娩、盆腔手术、剧烈运动、骶髂关节异常或与年龄有关的变化相关 [ 2 ]。目前临床的治疗方法包括药物治疗、阴部神经阻滞（pudendal nerve blockade, PNB）、阴部神经减压术、植入脉冲发生器的神经调节、射频消融术和脊髓电刺激等，然而理想疗效的治疗方案尚未统一。连续射频消融术（continuous radiofrequency, CRF）在临床应用中已经超过25年，是一种经皮微创的疼痛治疗技术，由于并发症少、定位准确、副作用少、作用显著以及复发率低等诸多优点被广泛应用于临床治疗中，成为目前治疗疼痛的重要方法之一 [ 3 ]。脉冲射频消融术（pulse radiofrequency, PRF）是一种新型的神经调节技术，相比传统的CRF更安全 [ 4 ]。虽然PRF的具体作用机制尚不清楚，但目前的文献支持电磁场的介入，能够达到神经调节作用。
本课题组的前期临床治疗结果和最近的文献表明，PRF在治疗顽固性神经病理性疼痛疾病方面可能有效。在此，我们研究单纯PNB与PRF联合PNB两种治疗方案对阴部神经痛的临床疗效和安全性。
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王祥瑞，Email： mocdef.3ab6186iurgnaix
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