内镜超声引导下腹腔神经丛阻滞术对初诊为晚期胰腺癌患者的止痛作用

Analgesic Effect of Endoscopic Ultrasonography Guided Celiac Plexus Neurolysis in Newly Diagnosed Advanced Pcreatic Cncer Ptients

目的 回顾分析内镜超声引导下腹腔神经丛阻滞术（EUS—CPN）对初诊为晚期胰腺癌的止痛效果。方法对8例初诊为胰腺癌患者应用EUS—CPN，在腹腔干发出处上方临近的组织内用一针法无水乙醇注射或植入125I放射线粒子。于术前、术后1周、1月时VAS法作疼痛评分，评分减少I〉3和〈3分别定义为疼痛缓解和无缓解。记录并发症。结果8例患者均经EU下穿刺活检确诊为晚期胰腺癌。7例接受一针法无水乙醇注射，1例在腹腔干旁和胰腺肿瘤内分别植入2粒和18粒放射线粒子。术前疼痛评分中有6例为重度疼痛，2例为中度疼痛；术后I周评估，6例（75％）疼痛明显缓解；1月后评价，7例（875％）患者轻度疼痛，仅1例患者为中度疼痛。患者术前VAS疼痛评分为8．0±1．51，术后1周VAS疼痛评分为5．1±1．64，与术前相比差异显著（P〈0．01），术后1个为2．9—1．13，与术前相比差异非常显著（P〈0．01）。结论EUS-CPN对初诊为晚期胰腺癌的患者有较好的止痛作用。

Objective To retrospectively analyze analgesic effect of endoscopic uhrasonography-guided celiac plexus neurolysis （EUS-CPN） in newly diagnosed advanced pancreatic cancer patients. Methods Guided by endoscopic uI trasonog- raphy, dehydrate absolute alcohol was injected into celiac plexus that lies on the origin of the celiac trunk which arises from the front of aorta by oneinjection method, or seeds were implanted into the same place and pancreatic tumor. The abdominal pain was evaluated by the visual analogue score （VAS） before the procedure and at oneweek,one month after the procedure. Relieve the pain was defined as decrease of VAS ≥3. All patients were closely monitored for complications after the procedure. Results 8 patients （male 4 ,femal 4） aged 48 -77 years （M, 63 ≥9.6 years ） were diagnosed with advanced pancreatic cancer by EUS-FNA . Seven patients received dehydrate absolute alcoholinjeetion and patient was implanted with seeds. VAS before the procedure ,6 patients with7 pain, and 2 patients with moderate pain;One week after EUS-CPN, pain in 6 patients （75%） had been remitted significantly. One month after EUS ,7 patients （87.5%） experience mild pain occasionally, only I patient suffered moderate pain. VAS before the procedure, 1 week after and Imonths after the procedure was 8.0 ± 1.51,5.1 ± 1.64,2.9 ≥1.13 respectively, and had significantly difference before and after EUSCPN （ P 〈 0.01 ）. Conclusion EUSCPN has favorable analgesic effect in newly diagnosed advanced pancreatic cancer patients.