CT引导下经皮穿刺内脏大小神经毁损术治疗晚期胰腺癌疼痛
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摘要
目的观察CT引导下经皮穿刺内脏大小神经毁损术治疗晚期胰腺癌疼痛的有效性及安全性。方法对30例晚期胰腺癌疼痛患者行CT引导下经皮穿刺内脏大小神经毁损术,采用CTCAE v3.0分级标准评价患者术中及术后住院期间气胸、顽固性低血压、腹泻等不良反应情况,术后1周进行疗效评价。分别于术前及术后1周、1个月、3个月进行视觉模拟评分(VAS),并记录吗啡日用量。结果对30例均顺利完成手术,术中及术后住院期间均未发生气胸、顽固性低血压或心律失常,仅6例出现Ⅰ、Ⅱ度腹泻,对症处理后均好转。30例中,术后1周临床治愈5例、疗效显著21例、有效4例;26例(26/30,86.67%)疼痛缓解程度>50%(临床治愈及疗效显著)。术后1周、1个月及3个月患者VAS及吗啡日用量均较术前降低(P均<0.05),且术后3个月VAS高于术后1周(t=-3.14,P<0.01)。结论 CT引导下经皮穿刺内脏大小神经毁损治疗晚期胰腺癌疼痛疗效确切,且安全性较高。
Objective To explore the effect and safety of CT-guided percutaneous splanchnic nerves block in treatment of advanced pancreatic cancer pain. Methods Thirty patients with advanced pancreatic cancer pain were treated with CT-guided percutaneous splanchnic nerves block. The complications, such as pneumothorax, intractable hypotension, diarrhea, during operation and hospitalization were evaluated using CTCAE v3.0 grading system, and the clinical efficacy was evaluated 1 week after operation. Visual analogue pain scale(VAS) and daily dosage of morphine were assessed before operation and 1 week, 1 month and 3 months after operation, respectively. Results Percutaneous splanchnic nerves block were successfully completed in all 30 patients without pneumothorax, intractable hypotension or arrhythmia during operation and hospitalization. Ⅰ or Ⅱ diarrhea occurred in 6 cases and then cured after symptomatic treatment. There were 5 cases of clinical cure, 21 cases of obvious effect, 4 cases of effective effect 1 week after operation. Postoperative pain relief more than 50% was observed in 26 patients(26/30, 86.67%). VAS and daily dosage of morphine were significantly reduced at 1 week, 1 month and 3 months after treatment compared with those pre-operation(all P<0.05). And VAS at 3 months after treatment was higher than that at 1 week after treatment. Conclusion CT-guided percutaneous splanchnic nerves block has definite efficacy and high safety in treatment of advanced pancreatic cancer pain.
Objective To explore the effect and safety of CT-guided percutaneous splanchnic nerves block in treatment of advanced pancreatic cancer pain. Methods Thirty patients with advanced pancreatic cancer pain were treated with CT-guided percutaneous splanchnic nerves block. The complications, such as pneumothorax, intractable hypotension, diarrhea, during operation and hospitalization were evaluated using CTCAE v3.0 grading system, and the clinical efficacy was evaluated 1 week after operation. Visual analogue pain scale(VAS) and daily dosage of morphine were assessed before operation and 1 week, 1 month and 3 months after operation, respectively. Results Percutaneous splanchnic nerves block were successfully completed in all 30 patients without pneumothorax, intractable hypotension or arrhythmia during operation and hospitalization. Ⅰ or Ⅱ diarrhea occurred in 6 cases and then cured after symptomatic treatment. There were 5 cases of clinical cure, 21 cases of obvious effect, 4 cases of effective effect 1 week after operation. Postoperative pain relief more than 50% was observed in 26 patients(26/30, 86.67%). VAS and daily dosage of morphine were significantly reduced at 1 week, 1 month and 3 months after treatment compared with those pre-operation(all P<0.05). And VAS at 3 months after treatment was higher than that at 1 week after treatment. Conclusion CT-guided percutaneous splanchnic nerves block has definite efficacy and high safety in treatment of advanced pancreatic cancer pain.
引文
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[5] Nagels W, Pease N, Bekkering G, et al. Celiac plexus neurolysis for abdominal cancer pain: A systematic review. Pain Med, 2013,14(8):1140-1163.
[6] Yan BM, Myers RP. Neurolytic celiac plexus block for pain control in unresectable pancreatic cancer. Am J Gastroenterol, 2007,102(2):430-438.
[7] Zhang S, Liang F, Tannock I. Use and misuse of common terminology criteria for adverse events in cancer clinical trials. BMC Cancer, 2016,16:392.
[8] Puli SR, Reddy JB, Bechtold ML, et al. EUS-guided celiac plexus neurolysis for pain due to chronic pancreatitis or pancreatic cancer pain: A meta-analysis and systematic review. Dig Dis Sci, 2009,54(11):2330-2337.
[9] Polati E, Luzzani A, Schweiger V, et al, The role of neurolytic celiac plexus block in the treatment of pancreatic cancer pain. Transplant Proc, 2008,40(4):1200-1204.
[10] Chen M, Yu H, Sun S, et al, Clinical research of percutaneous bilateral splanchnic nerve lesion for pain relief in patients with pancreatic cancer under X-ray guidance. Int J Clin Exp Med, 2015,8(11):20092-20096.
[11] 李顺,廖丽君,张达颖,等.CT引导下经皮穿刺胸腔入路内脏大小神经阻滞术治疗胰腺癌疼痛的疗效研究.中国疼痛医学杂志, 2014,20(5):337-340.
[12] Deumens R, Bozkurt A, Meek MF, et al, Repairing injured peripheral nerves: Bridging the gap. Prog Neurobiol, 2010,92(3):245-276.
[2] Jemal A, Bray F, Center MM, et al. Global cancer statistics. CA Cancer J Clin, 2011,61(2):69-90.
[3] D'Haese JG, Hartel M, Demir IE, et al. Pain sensation in pancreatic diseases is not uniform: The different facets of pancreatic pain. World J Gastroenterol, 2014,20(27):9154-9161.
[4] Kuhlmann KF, de Castro SM, Wesseling JG, et al. Surgical treatment of pancreatic adenocarcinoma; actual survival and prognostic factors in 343 patients. Eur J Cancer, 2004,40(4):549-558.
[5] Nagels W, Pease N, Bekkering G, et al. Celiac plexus neurolysis for abdominal cancer pain: A systematic review. Pain Med, 2013,14(8):1140-1163.
[6] Yan BM, Myers RP. Neurolytic celiac plexus block for pain control in unresectable pancreatic cancer. Am J Gastroenterol, 2007,102(2):430-438.
[7] Zhang S, Liang F, Tannock I. Use and misuse of common terminology criteria for adverse events in cancer clinical trials. BMC Cancer, 2016,16:392.
[8] Puli SR, Reddy JB, Bechtold ML, et al. EUS-guided celiac plexus neurolysis for pain due to chronic pancreatitis or pancreatic cancer pain: A meta-analysis and systematic review. Dig Dis Sci, 2009,54(11):2330-2337.
[9] Polati E, Luzzani A, Schweiger V, et al, The role of neurolytic celiac plexus block in the treatment of pancreatic cancer pain. Transplant Proc, 2008,40(4):1200-1204.
[10] Chen M, Yu H, Sun S, et al, Clinical research of percutaneous bilateral splanchnic nerve lesion for pain relief in patients with pancreatic cancer under X-ray guidance. Int J Clin Exp Med, 2015,8(11):20092-20096.
[11] 李顺,廖丽君,张达颖,等.CT引导下经皮穿刺胸腔入路内脏大小神经阻滞术治疗胰腺癌疼痛的疗效研究.中国疼痛医学杂志, 2014,20(5):337-340.
[12] Deumens R, Bozkurt A, Meek MF, et al, Repairing injured peripheral nerves: Bridging the gap. Prog Neurobiol, 2010,92(3):245-276.