目 录
第一章 癌症疼痛概述..................................................................................................1
第一节 疼痛及癌症疼痛的定义 ......................................................................2
一、疼痛定义.....................................................................................................2
二、癌症疼痛定义.............................................................................................2
第二节 癌症疼痛流行病学 ................................................................................4
第三节 癌症疼痛发病机制 ................................................................................6
一、癌症疼痛产生的分子学机制.....................................................................7
二、癌症疼痛的病理生理学机制.....................................................................8
三、癌症疼痛的病因学机制.............................................................................9
第四节 癌症疼痛评估 .......................................................................................10
一、癌症疼痛的评估原则...............................................................................10
二、评估内容...................................................................................................12
三、疼痛范围的评估及分级...........................................................................13
第五节 癌症疼痛患者及家属的健康教育 ..................................................19
一、癌症疼痛患者的健康教育.......................................................................20
二、癌症疼痛患者家属的健康教育...............................................................21
第六节 癌症疼痛治疗原则 ..............................................................................22
一、病因治疗...................................................................................................23
二、药物治疗...................................................................................................23
三、非药物治疗...............................................................................................24
第七节 癌症疼痛的药物治疗 .........................................................................24
一、非甾体抗炎药...........................................................................................24
二、阿片类镇痛药...........................................................................................27
三、辅助用药...................................................................................................30
XIV
第八节 癌症疼痛微创治疗...............................................................................33
参考文献.....................................................................................................................37
第二章 癌症疼痛神经阻滞及射频毁损术............................................39
第一节 蝶腭神经节阻滞及射频毁损术 ......................................................39
一、引言...........................................................................................................39
二、适应证及禁忌证.......................................................................................40
三、术前准备及评估.......................................................................................40
四、手术操作方法...........................................................................................40
五、不良反应及并发症...................................................................................42
六、处理原则及注意事项...............................................................................42
第二节 舌咽神经阻滞及射频毁损术............................................................43
一、引言...........................................................................................................43
二、适应证及禁忌证.......................................................................................44
三、术前准备及评估.......................................................................................45
四、手术操作方法...........................................................................................45
五、不良反应及并发症...................................................................................46
六、处理原则及注意事项...............................................................................47
第三节 三叉神经节及分支射频毁损术.......................................................47
一、引言...........................................................................................................47
二、适应证及禁忌证.......................................................................................48
三、术前准备及评估.......................................................................................48
四、手术操作方法...........................................................................................49
五、不良反应及并发症...................................................................................52
六、处理原则及注意事项...............................................................................53
第四节 星状神经节阻滞及射频毁损术.......................................................53
一、引言...........................................................................................................53
二、适应证及禁忌证.......................................................................................54
三、术前准备及评估.......................................................................................54
四、手术操作方法 ......................................................................................... 55
五、不良反应及并发症...................................................................................56
六、处理原则及注意事项...............................................................................56
目 录
XV
第五节 颈脊神经后内侧支阻滞及射频毁损术 ........................................57
一、引言...........................................................................................................57
二、适应证及禁忌证.......................................................................................58
三、术前准备及评估.......................................................................................59
四、手术操作方法...........................................................................................59
五、不良反应及并发症...................................................................................60
六、处理原则及注意事项...............................................................................61
第六节 脊髓前外侧柱毁损术 .........................................................................61
一、引言...........................................................................................................61
二、适应证和禁忌证.......................................................................................62
三、术前准备和评估.......................................................................................63
四、手术操作方法...........................................................................................63
五、不良反应及并发症 ................................................................................. 64
六、处理原则及注意事项...............................................................................65
第七节 胸脊神经背根神经节阻滞及射频毁损术 ...................................66
一、引言...........................................................................................................66
二、适应证及禁忌证.......................................................................................68
三、术前准备及评估.......................................................................................68
四、手术操作方法...........................................................................................68
五、不良反应及并发症...................................................................................69
六、处理原则及注意事项...............................................................................69
第八节 胸交感神经阻滞及射频毁损术 ......................................................70
一、引言...........................................................................................................70
二、适应证及禁忌证.......................................................................................71
三、术前准备及评估.......................................................................................72
四、手术操作方法...........................................................................................72
五、不良反应及并发症...................................................................................74
六、处理原则及注意事项...............................................................................75
参考文献.....................................................................................................................75
第三章 癌症疼痛内脏神经的毁损术....................................................78
第一节 内脏大小神经阻滞及毁损术 ...........................................................79
一、交感及内脏大小神经解剖.......................................................................79
二、适应证及禁忌证.......................................................................................80
三、手术操作方法...........................................................................................81
四、手术操作流程...........................................................................................81
五、不良反应及并发症...................................................................................85
六、处理原则及注意事项...............................................................................86
第二节 腹腔神经丛阻滞及毁损术.................................................................86
一、腹腔神经丛解剖.......................................................................................86
二、适应证及禁忌证.......................................................................................88
三、手术操作流程...........................................................................................88
四、不良反应及并发症...................................................................................90
五、处理原则及注意事项...............................................................................91
第三节 上腹下神经丛毁损阻滞治疗盆腔癌症疼痛 ..........................91
一、上腹下神经丛解剖基础...........................................................................92
二、上腹下神经丛毁损阻滞的适应证及禁忌证...........................................93
三、上腹下神经丛毁损的操作方法...............................................................93
四、并发症.......................................................................................................97
五、处理原则及注意事项...............................................................................97
第四节 奇神经节神经阻滞和毁损术............................................................98
一、奇神经节的解剖.......................................................................................98
二、适应证及禁忌证.......................................................................................98
三、手术操作方法...........................................................................................99
四、不良反应及并发症.................................................................................102
五、处理原则及注意事项.............................................................................102
参考文献...................................................................................................................102
第四章 癌症疼痛椎体成形术...............................................................106
第一节 引言 .........................................................................................106
第二节 癌症疼痛椎体成形术的适应证与禁忌证 ............................107
一、适应证 ....................................................................................................107
二、禁忌证 ....................................................................................................107
第三节 手术操作技术方法 .................................................................108
一、经皮椎体成形术 ....................................................................................108
二、经皮椎体后凸成形术 ............................................................................113
第四节 骨水泥椎体成形术并发症 .....................................................117
第五节 并发症预防及处理原则..........................................................118
一、脊神经（根）、脊髓损伤预防 ..............................................................118
二、胸膜、血管损伤预防 ............................................................................118
三、骨水泥注射相关的并发症 ....................................................................118
第六节 术后管理与注意事项 .............................................................120
参考文献 ..................................................................................................121
第五章 癌症疼痛自控镇痛...................................................................122
第一节 引言 .........................................................................................122
第二节 患者自控静脉镇痛 .................................................................123
一、适应证 ....................................................................................................123
二、禁忌证 ....................................................................................................123
三、操作方法 ................................................................................................123
四、不良反应及并发症 ................................................................................125
五、处理原则 ................................................................................................126
第三节 患者自控硬膜外/蛛网膜下隙镇痛 .....................................127
一、适应证 ....................................................................................................128
二、禁忌证 ....................................................................................................128
三、操作方法 ................................................................................................129
四、不良反应及并发症 ................................................................................131
五、处理原则 ................................................................................................132
六、药物中毒 ................................................................................................133
七、戒断反应 ................................................................................................133
八、效果不佳 ................................................................................................133
九、药物选择 ................................................................................................134
十、感染 ........................................................................................................134
十一、操作不当 ............................................................................................134
第四节 患者自控皮下镇痛 .................................................................134
一、适应证 ....................................................................................................135
二、禁忌证 ....................................................................................................135
三、操作方法 ................................................................................................135
四、不良反应及并发症 ................................................................................137
五、处理原则 ................................................................................................137
第五节 患者自控神经丛镇痛 .............................................................137
一、适应证 ....................................................................................................137
二、禁忌证 ....................................................................................................138
三、操作方法 ................................................................................................138
四、不良反应及并发症 ................................................................................141
五、处理原则 ................................................................................................141
第六节 患者自控镇痛常用药物及其组合 ........................................143
第七节 患者自控镇痛的优点及常用术语 ........................................144
一、患者自控镇痛的优点 ............................................................................144
二、患者自控镇痛常用术语 ........................................................................145
参考文献 ..................................................................................................146
第六章 鞘内药物输注系统半植入术...................................................147
第一节 引言 .........................................................................................147
第二节 解剖基础 .................................................................................148
第三节 半植入药物输注系统组成 ....................................................150
第四节 适应证及禁忌证 .....................................................................151
一、适应证 ....................................................................................................151
二、禁忌证 ....................................................................................................152
第五节 操作方法 .................................................................................152
一、术前评估 ................................................................................................152
二、术前准备 ................................................................................................153
三、手术操作 ................................................................................................155
第六节 不良反应、并发症及处理原则 ............................................160
一、药物不良反应及处理原则 ....................................................................160
二、手术操作相关并发症及处理原则 ........................................................161
三、长期使用并发症及处理原则 ................................................................162
参考文献 ..................................................................................................163
第七章 鞘内药物输注系统永久植入术...............................................165
第一节 引言 .........................................................................................165
第二节 患者选择标准、适应证与禁忌证 ........................................166
一、患者选择标准 ........................................................................................166
二、鞘内药物输注系统植入适应证 ............................................................166
三、鞘内药物输注系统植入禁忌证 ............................................................167
第三节 术前测试 .................................................................................167
第四节 鞘内药物应用 .........................................................................170
第五节 手术操作步骤 .........................................................................171
第六节 术后并发症处理与预防策略 ................................................177
第七节 鞘内药物输注系统治疗进展及展望 ....................................180
参考文献 ..................................................................................................181
第八章 癌症疼痛脊髓电刺激治疗.......................................................183
第一节 引言 .........................................................................................183
一、脊髓电刺激治疗癌症疼痛现状 ............................................................183
二、脊髓电刺激治疗神经病理性癌痛 ........................................................184
第二节 适应证与禁忌证 .....................................................................186
一、适应证 ....................................................................................................186
二、禁忌证 ....................................................................................................186
第三节 患者评估及术前准备 .............................................................187
一、患者评估 ................................................................................................187
二、术前准备 ................................................................................................189
第四节 手术操作方法 .........................................................................189
一、脊髓电刺激的测试术 ............................................................................189
二、经皮穿刺脊髓电刺激永久植入术 ........................................................194
三、单纯脉冲发生器的永久植入术 ............................................................199
第五节 不良反应及并发症 .................................................................201
一、电极移位 ................................................................................................201
二、脊髓和神经损伤或脑脊液漏 ................................................................202
