Transaortik çölyak pleksus bloğu: Bilgisayarlı tomografi simülasyon çalışması

Öz

Amaç: Transaortik çölyak pleksus bloğu (ÇPB), kronik üst karın ağrısında kullanılmakta olan bir tedavi yöntemidir. İşlem öncesi teknik parametrelerin bilinmesi, blok sırasında hekime kolaylık sağlar. Bu amaçla, çalışmamızda transaortik ÇPB'yi bilgisayarlı tomografi (BT) ile simüle ettik ve böylece ana teknik parametreleri ve komplikasyon riskini belirlemeyi amaçladık.

Yöntem: Bu, gözlemsel bir çalışmaydı. 100 hastanın, transaksiyel, ince kesit, abdomino-pelvik BT görüntüleri incelendi. Aort duvar kalsifikasyonu, trombüs ve anevrizma varlığı gibi morfolojik bozukluklar kaydedildi. Her bir görüntüde, lomber bölgede, orta hattan yedi cm solda iğne giriş yolağı çizildi. Sonrasında, görüntülerde oluşan organ penetrasyonları, iğne giriş açıları ve deriden iğne ucuna olan mesafeler kaydedildi. Ek olarak, transaortik geçişle çölyak pleksusa ulaşamadığımız hastalarda başarılı enjeksiyon için uygun giriş mesafesini ve açısını ölçtük.

Bulgular: Tanımlanmış seviye ve mesafeye göre BT ile simüle edilmiş görüntülerde hastaların %73'ünde aort içerisinden geçiş sağlayabildik. Ortalama iğne giriş açısı ve giriş noktasından iğne ucuna olan mesafe sırasıyla 23,33 (3,36)°, 15,25 (1,20) cm ve böbrek penetrasyon oranı %6,9 idi. Aorta erişemediğimiz % 27 hastada yapılan yeni ölçümde, orta hattan ortalama iğne giriş mesafesi, ortalama iğne giriş açısı ve giriş noktasından hedef noktaya olan ortalama mesafe sırasıyla, 10,08 (1,25) cm, 34,04 (5,43)° ve 17,09 (1,32) cm idi. Bu hastalarda böbrek penetrasyon oranı ise %44,4’tü.

Sonuç: Transaortik ÇPB tekniğinde, her zaman, başarılı şekilde aort penetrasyonu sağlanamaz. Erişim açısı ve mesafesi arttırıldığında, transaortik geçiş sağlanabilir, ancak organ hasar riski önemli ölçüde artar.

Anahtar Kelimeler

• Çölyak pleksus bloğu,Bilgisayarlı tomografi,Transaortik,Sempatik ganglion bloğu

Transaortic celiac plexus block: A computed tomography simulation study

Abstract

Aim: Transaortic celiac plexus block (CPB) is a traditional treatment method in chronic upper abdominal pain. Knowing the technique parameters before the procedure provides convenience to the physician during the block. For this purpose, we simulated the transaortic CPB with computed tomography (CT) and thus aimed to determine the main technical parameters and the risk of complications.

Methods: This study was an observational study. We analyzed one hundred, transaxial, thin section, abdominopelvic CT images and recorded morphological disturbances such as the presence of aortic mural calcification, thrombus, and aneurysm. We drew a needle insertion pathway on each of the images, at left, seven cm away from the midline in the lumbar region. Subsequently, we recorded the penetrated organs, the needle entry angle, and the distance from the skin to the needle tip. Also, we measured the appropriate entry distance and angle for successful injection in patients that we could not provide transaortic access.

Results: In the CT-simulated images, according to defined level and distance, we could reach the aorta in 73% of the patients. The mean needle entry angle and the distance from the entry point to the needle tip was 23.33 (3.36)°, 15.25 (1.20) cm, respectively, and kidney penetration was 6.9%. We were able to access aorta in remaining 27% of patients with a mean distance of needle entry point from the midline, a mean needle entry angle, and a mean distance from the entry point to the needle tip, 10.08 (1.25) cm, 34.04 (5.43)°, and 17.09 (1.32) cm, respectively. The kidney penetration rate was 44.4% in these patients.

Conclusion: In the transaortic technique used for the CPB, successful aortic penetration is not always achieved. When the access angle and distance are increased, aortic transition can be achieved, but the risk of organ injury significantly increases.

Keywords

• Celiac plexus block,Computed tomography,Transaortic,Sympathetic ganglion block

Kaynakça

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