腹腔神经丛毁损术治疗晚期胰头癌疼痛

Analgesia on pancreatic carcinoma with destruction of celiac ganglion

目的介绍腹腔神经丛毁损术治疗晚期胰头癌疼痛的方法,并探讨其效果。方法将2002年5月至2008年5月成都军区总医院收治的晚期胰头癌病人90例,按年龄、病种及病情基本接近的原则分为两组:腹腔神经丛毁损组(46例)和非毁损组(44例)。两组均行姑息减黄处理;毁损组在术中或在B型超声、CT引导下行腹腔神经丛穿刺,注入无水酒精20ml。观察两组病人术后并发症发生情况、疼痛缓解率、复发率及综合评价其临床受益反应。结果毁损组46例手术无穿刺失败,成功率100%;无严重并发症;疼痛评分(VAS)与术前比较差异有统计学意义(P<0.01);疼痛完全缓解率71.9%,部分缓解率21.9%,无效6.2%;疼痛复发率仅13.3%;临床受益反应情况较非毁损组明显增强(P<0.05)。结论腹腔神经丛毁损术具有很高的安全性,能显著减轻胰腺癌性疼痛,并提高病人生存质量。

Objective To detect the therapeutic effects of destruction of celiac ganglion on patients with advanced pancreatic carcinoma pain. Methods Ninety patients with advanced pancreatic head cancer diagnosed by our hospital from May 2002 to May 2008 were divided into two groups： celiac plexus damage group（ n = 46） and the control group （n = 44）. The patients in celiac plexus damage group were injected with the absolute alcohol in palliative treatment such as operation or PTCD, and those in control group only underwent operation or PTCD. A follow-up was conducted to observe the complications, pain remission rate, relapse rate and clinical benefit response（CBR）. Results In celiac plexus damage group, there was significant difference in VAS before and after operation（P〈0. 01）. Pain complete remission rate was 71.9 %, pain partial remission was 21.9 %,and ineffective rate was 6. 2 %. The pain recurrence rate was only 13. 3%. As compared with control group, the CBR was significantly enhanced in celiac plexus damage group （P〈0. 05）. Conclusion Destruction of celiac ganglion with high security can significantly reduce the pain of pancreatic cancer and improve the quality of life of patients.