内镜超声无水酒精注射腹腔神经丛治疗上腹部癌痛  

ENDOSONOGRAPHY-GUIDED CELIAC PLEXUS NEUROLYSIS FOR UPPER ABDOMINAL CANCER PAIN

作　　者：杨秀疆[1] 任大宾[1] 谢渭芬[1] 刘苏[1] 陈伟忠[1] 蔡洪培[1] 沈建伟[1] 朱焱[1] 

机构地区：[1]上海长征医院消化内科,上海200003

出　　处：《实用临床医药杂志》2006年第1期16-18,共3页Journal of Clinical Medicine in Practice

摘　　要：目的 探讨内镜超声（EUS）引导下腹腔神经丛注射无水酒精对癌痛的治疗作用。方法 选择无法手术的癌痛病例记录疼痛分数，用纵轴式彩色EUS显示腹主动脉第1分支，在其两侧以超声针注射无水酒精。结果 胰腺癌29例、胆囊癌1例、胃癌3例、肝癌2例，18例有转移征象。注射前疼痛分数（0～10分级）：胰腺癌为（6．76±0．39）分、胆囊癌5，9分、胃癌（5．53±1．24）分、肝癌（4．92±2．31）分；注射后12周胰腺癌为（1．32±1．12）分、胆囊癌为1．30分、胃癌为（1，57±0.97）分、肝癌为（2.34±1.21）分。疼痛缓解时间最长持续7个月。全部病例注射后止痈药用量减少。12例注射后发生体位性低血压．腹泻10例；6例发生注射部位轻微渗血，用镜身压迫止血。全部病例无胰腺炎及穿孔发生，1例术后发热。结论 EUS-CPN能够安全有效缓解上腹部癌痛。Objective To evaluate the safety and efficacy of performing endosonographyguided celiac plexus neurolysis （EUS CPN） in patients with pain due to intra-upper abdominal malignancies. Methods This group included 29 patients with pancreatic carcinoma and 1 patient with gallbllader and 3 gastric carcinoma and 2 hepatic carcinoma. Using the linear array ultrasound endoscope and a needle catheter, transgastric injection of the celiac plexus with bupivacaine and 98 % dehydrated absolute alcohol was accomplished. Results Pain scores for pancreatic cancer and gallbladder as well as gastric cancer were 6.76 ± 0.39, 5.9, 5.53 ± 1.24 and 4.92 ± 2.31 respectively, prior to CPN. Pain scores were significantly lower compared with baseline 12 weeks after EUS CPN. At these follow-up intervals, all patients required less pain medication. Complications were minor and consisted of orthostasis in 12 patients and transient diarrhea in 10 patients and fever in 1 patient. Conclusion EUS CPN is a safe and effective method for improving pain control in patients with upper abdominal malignancy.

关 键 词：内镜超声 腹腔神经丛 胰腺癌 疼痛 

分 类 号：R735.9[医药卫生—肿瘤]