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Objective To evaluate the efficacy and safety of CT-guided percutaneous celiac plexus block (NCPB) using 25 G controllable curved needle together with 22 G straight needle in treating refractory carcinomatous upper abdominal pain. Methods A total of 18 patients with advanced refractory carcinomatous upper abdominal pain were enrolled in this study. The carcinomatous upper abdominal pain failed to the three-step analgesic therapy. Guided by CT scan, percutaneous injection of ethanol with a 25 G controllable curved needle to destroy celiac plexus was carried out in all patients. According to WHO pain relief standards, the relieving degree of pain was evaluated before NCPB and 2 weeks, one, 2, 3 and 6 months after NCPB. The results were analyzed. Results The technical success rate was 100%. The short-term (within 2 weeks) efficacy rate was 88.8%and the complete remission rate was 38.8%. The long-term (over 3 months) efficacy rate was 50% and the complete remission rate was 20%. No severe complications occurred. Conclusion For refractory carcinomatous upper abdominal pain, CT-guided percutaneous celiac plexus block is a simple, safe and effective treatment.
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<p><b>BACKGROUND</b>Vertebral pedicular metastasis in lung cancer patients are common. This is a preliminary study on methods and clinical application of percutaneous pediculoplasty in the treatment of vertebral pedicular osteolytic metastasis of lung cancer.</p><p><b>METHODS</b>Percutaneous pediculoplasty was performed in 5 lung cancer patients with osteolytic metastasis in 7 vertebral pedicles, 2 cases occurred in thoracic vertebral pedicles and 3 cases occurred in lumbar vertebral pedicles, 2 cases had two loci involved. Under Multislice helical CT guidance, 2.5-5mL of polymethylmethacrylate mixture (ratio of polymer, moner, ultrafluid iodinated oil was 20g:10mL:3mL) had been injected into pathologic pedicles step by step after successful puncture using 13G needle. All cases had been followed-up in 2-5 months.</p><p><b>RESULTS</b>All cases had been successfully punctured. Pain relieved in all 4 cases to some extent after percutaneous pediculoplasty. Two cases had bone-cement leakage, 1 case with leakage into intervertebral foramen which led to nerve radicular pain, the pain disappeared 3 days later after intravenous mannitol and lower dose dexamethasone drips, and another 1 case with minor leakage into vertebral canal but without clinical symptoms. No spondyloptosis occurred in all cases after follow-up.</p><p><b>CONCLUSIONS</b>CT-guided percutaneous pediculoplasty is a minimal injured, effective and safe method for osteolytic vertebral pedicular metastasis of lung cancer.</p>
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Objective Clinical investigation of treatment of osteoporotic vertebral compression fractures by unilateral kyphoplasty.Methods After Surgical intervention of sixteen vertebral compression fractures by unilateral kyphoplasty,then investigate the changes of height and Cobb angle of vertebral bodies.Results All surgical procedures were finished safely.The mean height of the anterior and media vertebral bodies was 1.8?0.3cm,1.4?0.4cm preoperatively and 2.2?0.4cm、2.3?0.3cm postoperatively;the Cobb angle was decreased from 28.4??10.2? preoperatively to 19.2??4.5? postoperatively.The mean absolute value of the difference in height between right and left side of the vertebral bodies was 0.1cm in this group.Conclusions The kyphosis is improved and the operative time is reduced by unilateral kyphoplasty.Though this result is satisfied,more clinical studies are needed to be done for authenticating the effect of unilateral kyphoplasty on the treatment of vertebral compression fractures in the future.
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Objective To discuss the value of CT guided biopsy of the retroperitoneal lymph nodes for diagnosis.MethodsTotally 18 patients with enlarged retroperitoneal lymph nodes underwent CT-guided biopsy in our hospital between June 2006 and June 2007.Results The results of CT were identified by the pathological examination in 94.4%(17/18) of the patients.The operation time of the biopsy was 20 to 40 minutes.CT scan was performed for 3 to 6 times(mean,4.1) during the procedure.No severe complications occurred in this series.Conclusion CT-guided biopsy of enlarged retroperitoneal lymph nodes is a safe and effective diagnostic method.
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Objective To explore the methods and clinical application of percutaneous pediculoplasty in the treatment of vertebral pedicular osteolytic metastases.Methods Percutaneous pediculoplasty was performed in 18 patients with (23 Vertebral pedicles ) osteolytic metastases,3 cases localized in thoracic vertebral pedicles and 15 cases in lumbar vertebral pedicles,and two vertebral pedicles involved in 5 cases . Under Multislice helical CT guidance ,2.5～5ml of polymethylmethacrylate ( PMMA ) mixture (ratio of polymer,moner,ultrafluid iodinated oil was 20g:10ml:3ml) was injected into pathologic pedicles in step by step after successful puncture using 11-13G needles. All cases had been followed for 1～18 months.Results All cases were successful punctured. Pain relieved in all cases after percutaneous pediculoplasty.7 cases had cement leakage,among them,cement leaked into tumor tissue in 5 cases(2 cases with leakage into intervertebral foremen),nerve radicular pain occurred in one case,the pain disappeared 3 days later after intravenous mannitol and lower dose dexamethasone drips;the cement leaked into vertebral canal a little without clinical symptom in one case.Conclusion CT-guided percutaneous pediculoplasty is a minimally effective and safe method for osteolytic vertebral pedicular metastases in treatment of pain and enhancement of spinal stability.
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Objective To investigate the clinical efficacy of percutaneous vertebroplasty (PVP)for vertebral metastases.Methods 40 cases with 46 vertebral body metastases underwent PVP under the guidance of fluoroscopy or CT.The analgesic effect,vertebral body stability and complications after operation were observed.Results The successful rate of puncture was 100%.The pain relief was demonstrated in all cases(complete relief in 30 cases,partial relief in 8 cases,mld relief in 2 cases) after operation 1 to 3 days.All involved vertebral bodies had good stability.Imaging analysis demonstrated that the metastatic area was completely well-distributed filling and reinforce by polymethymethacrylate(PMMA) in 26 vertebra of 24 cases.The other 20 vertebral of 16 cases were great part filled by PMMA.There were no severe complications both during operation and post-operation.The treating effect was satisfying in the following 1 to 3 months.Conclusion PVP is one of the efficacious way to alleviate pain of vertebral metastases,and it can reinforce the stAbility of involved vertebral body.