内镜超声引导下腹腔神经丛阻滞联合局部化疗在胰腺癌长期镇痛治疗中的研究

Study of endoscopic ultrasound-guided celiac plexus neurolysis combined with local chemotherapy for pancreatic cancer pain

目的评价内镜超声引导下腹腔神经丛阻滞联合局部注射化疗对进展期胰腺癌患者的长期镇痛作用。方法选择无手术指征进展期胰腺癌患者23例,在内镜超声引导下行腹腔神经丛阻滞联合局部注射化疗,治疗后随访20周,通过视觉疼痛类比量表(VAS)评分、每周镇痛药注射次数、肿瘤最大径等指标评价治疗效果。结果23例胰腺癌患者均成功进行了腹腔神经丛阻滞和局部化疗,未出现严重并发症。治疗后患者疼痛明显缓解,第4周视觉疼痛类比量表评分下降69.1%(P<0.05),而治疗后第20周仍下降52.9%。疼痛的缓解与肿瘤的部位及大小无关。镇痛药物的应用次数在治疗前后差异无显著性意义。局部化疗后肿瘤最大径无明显变化。结论内镜超声引导下腹腔神经丛阻滞联合局部化疗控制进展期胰腺癌疼痛长期疗效确切,安全性好。

Objective To evaluated the effect of endoscopic ultrasound （EUS） guided celiac plexus neuro[ysis combined with local chemotherapy on abdominal pain associated with pancreatic cancer. Methods Twenty-three patients with painful and inoperable pancreatic cancer were evaluated at before and 20 weeks after EUS celiac plexus neurolysis combined with local chemotherapy. The data of pain scores （VAS scores） ,morphine use,and diameters of tumor and other indexes were collected. Results VAS scores were lower （ P〈0. 05） 4 weeks after EUS celiac plexus neurolysis combined with local chemotherapy, and the effect sustained for 20 weeks. The effects were similar for various tumor sites and diameters. There were no major complications. Conclusions EUS-guided celiac plexus neurolysis combined with local chemotherapy is effective and safe in longterm control of abdominal pain associated with pancreatic cancer.