腹部顽固性癌痛的腹腔神经丛消融治疗

Celiac plexus ablation for intractable abdominal cancerous pain

腹痛是腹部肿瘤患者最常面临的也是最影响生活质量的问题。世界卫生组织提出的癌痛三阶梯管理原则可解决大部分患者的癌痛问题,但该治疗原则下存在20%~30%治疗失败的顽固性癌痛患者。许多医师主张将针对该类患者的介入性疼痛管理作为癌痛管理的第四级阶梯。腹腔神经丛消融技术是其中的代表。然而,该技术在临床上并不普及,存在许多问题尚未达成共识,术后短期复发问题也亟待解决。近年来腹腔神经丛消融技术得到进一步发展。本文对腹腔神经丛消融术的解剖原理、现有的化学消融及射频消融技术、有效性及安全性和术后复发的病理学基础做一综述。期望能有助于介入性疼痛管理方法在癌痛治疗中的推广与发展。

Abdominal pain is the most common problem in patients with abdominal tumors, it is also the biggest cause affecting the quality of life of patients. The three-step management principle in dealing with cancerous pain, which is put forward by World Health Organization, can solve the problem of cancerous pain in most patients, but even following this treatment principle, 20%-30% of patients with refractory cancerous pain will still fail to response. Many physicians advocate that to deal with this kind of interventional pain in such patients should follow the fourth step of cancerous pain management, among which the celiac plexus ablation is the representative treatment method. However, this technique has not been widely employed in clinical practice, and many ablation-related issues still need a consensus reached by experts, and also the problem of postoperative early recurrence needs to be solved as soon as possible. In recent years, the technique of celiac plexus ablation has been quickly developed. This paper aims to make a comprehensive review about celiac plexus ablation technique, focusing on the anatomical principles related to ablation,current available techniques of chemical ablation and radiofrequency ablation, clinical efficacy and safety,and pathological basis of postoperative recurrence. It is hoped that this article will be helpful for the further promotion and development of interventional pain management methods in the treatment of cancerous pain.