超声引导125I粒子腹腔神经节植入术治疗进展期胰腺癌疼痛的疗效分析

Clinical analysis of ultrasound-guided celiac ganglion irradiation with 125I seeds for pain control in local advanced pancreatic carcinoma

目的评价经腹超声引导下125I粒子腹腔神经节植入治疗不可切除及复发胰腺癌顽固性癌痛的疗效以及其安全性。方法对15例不能切除的胰腺癌患者及10例术后局部复发胰腺癌患者行经腹超声引导下125I粒子腹腔神经节植入术,术后每周随访1次,观察腹痛评分、镇痛药物的使用情况、患者生活质量评分并记录手术相关的并发症。结果所有患者均一次性手术成功,平均每例患者植入4枚粒子(2~8枚)。术后2周,患者的疼痛评分由平均7.56分降至3.36分(P<0.05),所需要麻醉药物的剂量由术前87.60 mg迅速减少到50.00 mg(P<0.05),随访过程中在其生存期内一直维持在较低水平,无1例出现进展;患者术后1个月、3个月的生活质量较术前明显好转;术后并发症分析胃潴留1例,腹泻2例,站立性晕厥1例,辅助治疗后消失。结论经腹超声引导下125I粒子腹腔神经节植入术,对缓解不可切除及复发胰腺癌顽固性癌痛安全有效。

Objective To evaluate the safety and efficacy of direct celiac ganglion irradiation with 125I seeds for pain management of unresectable and local recurrent pancreatic cancer.Methods This study enrolled 25 consecutive patients within 15 unresectable pancreatic head cancer patients and 10 local recurrent patients,who had moderate to severe pain resulting from biopsy-proven advanced pancreatic cancer.All patients underwent US-guided direct celiac ganglion irradiation with 125I seeds.Follow-up was conducted at least once weekly until death.Visual Analog Scale(VAS)score,mean analgesic consumption,quality of life(QoL)and procedure-related complications were evaluated during follow-up.Results All patients successfully underwent implantation at one attempt.The mean number of seeds implanted in the celiac ganglion per patient was 4(range 2-8).Two weeks later,the VAS score and mean analgesic consumption were significantly less than preoperative value.The overall quality of life of patients in one and three months after operation was significantly improved compared with that before treatment.No procedure-related deaths or major complications occurred.Only one suffers from gastric retention,Two suffer from diarrhea,and one suffers from standing syncope,All of them recovered by adjunctive therapy.Conclusions US-guided direct celiac ganglion irradiation with 125I seeds is safe and effective for alleviating refractory cancer pain due to unresectable and local recurrent pancreatic cancer.