目的评价四维CT引导经皮穿刺行腹腔神经丛阻滞术,对腹腔恶性肿瘤伴有腹膜后淋巴结转移,并侵犯、包裹腹腔神经丛的顽固性癌痛的止痛效果以及安全性。方法 48例晚期癌症患者,均有严重的上腹部束带样疼痛、经影像学证实腹膜后淋巴结肿大。应用四维CT引导经皮穿刺对其腹腔神经丛阻滞治疗。结果治疗后24 h,2周,1、2、3个月的有效率分别为100%、96%、94%、90%和83%,治愈率分别为67%、64%、58%、52%和50%。围手术期无严重并发症。结论对恶性肿瘤伴有后腹膜淋巴结转移并侵犯、包裹腹腔神经丛的顽固性癌痛患者,采用四维CT引导腹腔神经丛阻滞术,可取得较好的止痛治疗效果,穿刺过程中实时监控,安全性高,具有较高的临床推广价值。 Objective To evaluate the analgesic efficacy and safety of four-dimensional computed tomography guided percutaneous celiac plexus block for peritoneal malignant tumors with retroperitoneal lymph node metastasis and invasive, intractable cancer pain wrapped with celiac plexus. Methods 48 cases of advanced cancer patients, all have a serious abdominal pain like upper abdomen, confirmed by imaging after retroperitoneal lymph nodes. Application of four-dimensional CT-guided percutaneous celiac puncture on celiac plexus block treatment. Results The effective rates at 24 h, 2 weeks, 1, 2 and 3 months after treatment were 100%, 96%, 94%, 90% and 83% respectively. The cure rates were 67%, 64%, 58%, 52 % And 50%. Perioperative no serious complications. Conclusion Four-dimensional CT-guided celiac plexus blockade is effective for the treatment of refractory cancer patients with malignant tumor accompanied with retroperitoneal lymph node metastasis and encroachment and encircling celiac plexus, which can achieve better analgesic effect, real-time monitoring during puncture, High security, with high clinical value.