| BackgroundPain is the excruciating and most common symptoms for patients with cancer. It occurs in 75% of patients with cancer when the disease reaches an advanced stage, and its frequency of severe pain is 50%. Patients with advanced pelvic malignant tumor may frequently experience intractable pain, and the character of pain may be very complex because of special neurotomia. Severe pain usually affects the patient's quality of life. Therefore, the therapy is important for pelvic cancer pain relief, especially in integration therapy of advanced pelvic tumor. Optimal palliation of pain to maximize the quality of life is of primary importance to the patients and their families.Various methods can be used to relieve the pelvic cancer pain. While, drug treatment is still the mainstay for the management of cancerpain. Regular drug therapy controls cancer pain in 70-90% of patients. For the patients who developed poor response to oral opioids due to the progression of disease or experienced untoward side effects, there should be other methods to manage pain. Small volume of alcohol and phenol may be injected intrathecally into the vertebral canal to permanently or semipermanently destroy nerve roots, especially, neurolytic drug is injected into subarachnaid space to selectively destroy sensory nerve. Thus, it can interrupt the nociceptive pathways from tumor-related-area to central nervous system. This method can alleviate pain for a long time. However, it is difficult to control the concentration and quantity of alcohol or phenol. The lower extremity dysfunction simultaneously easily occurs with pain palliation. Several studies have documented the efficacy of sympathetic blocks for relief of chronic pain. Coeliac plexus block is indicated in pain due to intra-abdominal cancer, and neurolytic blocks of the superior hypogastric plexus are also effective in controlling pelvic visceral cancer pain .The viscera of the pelvic are supplied by pelvic nerve plexus, it is composed of presacral nerve (superior hypogastric plexus) belong to systema nervorum sympathicum, sacral splanchnic nerves and pelvic splanchnic nerves. The superior hypogastric plexus (presacral plexus) is aretroperitoneal structure located bilaterally at the lower third of the L5 vertebral body and upper third of the S1 vertebral body proximity, in front of the bifurcation of the abdominal aorta, and between the two common iliac arteries. The third and fourth visceral nerves from lumbar ganglion contribute fibers for the formation of the superior hypogastric plexus. After exchang neurone in the inferior mesenteric plexus, the superior hypogastric plexus divides into the right and left hypogastric nerves and descends to contribute to the inferior hypogastric (pelvic) plexus, which gives off branches to the ureteral, spermatic, vesical, haemorrhoidalis or iliac plexuses. Hence, early to 1986, presacral neurectomy was used to control chronic pelvic pain. But its application was limited by the high technique and trauma. In 1990 Plancarte et al. reported a successful blockage of superior hypogastric plexus for the treatment of chronic pelvic pain and cancer pain. It is an efficient, relatively simple, and repeatable method for visceral pain alleviation. Neurolytic superior hypogastric plexus block alleviates cancer pain, improves the quality of life or prevents its deterioration and allows pain control with low analgesic consumption, thus reducing the incidence of undesirable side effects due to the chronic use of opioids. Up to now, there's not yet correlated report 1 in China, we try to use this method for patients pelvic pain in our hospital.ObjectiveIn this study, we have performed superior hypogastric plexus block using a posterior trans-intervertebral disc approach under CT guidance, and evaluate its therapeutic effect and safety in patients diagnosed with pelvic pain because of cancer, give the patients an alternative for the treatment of intractable pelvic pain.Materials and MethodsTwenty-three patients who suffered uncontrolled, incapacitating pelvic cance... |
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