内镜超声引导下腹腔神经丛阻滞术治疗胰腺癌所致癌性腹痛的临床研究

A prospective study of endoscopic ultrasound-guided celiac plexus neurolysis for pain management in patients with pancreatic carcinoma

目的前瞻性评价内镜超声引导下腹腔神经丛阻滞术缓解胰腺癌所致癌性腹痛的有效性及安全性。方法手术无法切除胰腺癌患者接受1至2次内镜超声引导下腹腔神经丛阻滞术，收集分析患者年龄、性别、术前腹痛病程、阿片类药物使用情况、肿瘤部位、治疗前后疼痛评分、治疗次数、术后疼痛缓解时间及生存时间。结果27例晚期胰腺癌患者纳入研究。术后疼痛评分低于术前，差异有统计学意义，81．5％患者术后疼痛缓解，中位镇痛持续时间56．0d[95％CI（17．1～94．9）]，可信区间与中位生存时间97．0d[95％C1（82．7～111．3）]重叠。术前腹痛病程、术前疼痛评分、治疗次数、阿片类药物使用情况、肿瘤部位对于镇痛持续时间长短均无显著影响（X^2=6．757，P=0．239）。1例患者术后出现一过性腹泻、发热，无严重并发症发生。结论内镜超声引导下腹腔神经丛阻滞术可安全有效地缓解晚期胰腺癌所致癌性腹痛，并未发现腹痛病程、术前疼痛评分、治疗次数、阿片类药物使用情况、肿瘤部位等临床因子影响镇痛效果及其维持时间。

Objective To prospectively assess the efficacy and safety of endoscopic ultrasoundguided celiac plexus neurolysis （EUS-CPN） in the management of pain caused by pancreatic carcinoma. Methods Patients with confirmed un-resectable pancreatic malignancy were treated with EUS-CPN once or twice. The data including age, gender, pain duration, opioid consumption, tumor location, pain scores before and after the procedure, number of treatment, duration of pain relief and survival time were collected. Results A total of 27 cases with cancerous abdominal pain were recruited. The median pain scores were significantly lower after EUS-CPN, and pain relief was obtained in 81.5% （95% CI, 66. 8% -96. 1% ） patients with a median duration of 56.0 days （95% CI, 17.1-94. 9） , whose confidence interval was compara- ble to that of survival time （97. 0 days, 95% CI, 82. 7-111.3）. No clinical factors could predict post-procedure duration of pain relief （X2 = 6. 757, P = 0. 239）. Procedure-related transient diarrhea and fever were noted only in 1 patient. No major complications occurred. Conclusion EUS-guided CPN is safe and effective in alleviating abdominal pain associated with pancreatic cancer, even at the late stage. Moreover, no clinical factor could predict post-procedure degree or duration of pain relief.