高强度聚焦超声治疗对缓解胰腺癌疼痛的疗效观察  

Effect of HIFU on relieving the pain of advanced pancreatic cancer

作　　者：胡斌[1] 吕伟[2] 王丹[2] 赵玮[2] 周丁华[2] 

机构地区：[1]中国人民解放军总医院第一附属医院肝胆胰脾外科,北京100048 [2]中国人民解放军第二炮兵总医院肝胆外科,北京100088

出　　处：《肝胆胰外科杂志》2014年第2期105-108,共4页Journal of Hepatopancreatobiliary Surgery

基　　金：军队"十二五"面上项目(CWS12J083)

摘　　要：目的观察经高强度聚焦超声(HIFU)术后胰腺癌疼痛患者的癌痛缓解情况,评价HIFU消融治疗对缓解胰腺癌疼痛的安全性和有效性。方法选取2011年3月至2013年3月我院收治的中晚期胰腺癌患者60例,取HIFU术前和术后第1、7、15、30天为时间节点,采集空腹静脉血5 mL,用ELISA法检测前列腺素E2(PGE2)和降钙素基因相关肽(CGRP)的表达水平,并用视觉模拟评分法(VAS)对患者HIFU术前、后进行疼痛程度评分,然后用统计学方法分析HIFU术前、后各指标的变化有无差异。同时观察患者术前、后镇痛药物投放剂量的变化情况以及术后并发症出现情况。结果与HIFU术前比,患者外周血PGE2、CGRP的表达水平,术后第1天上升,术后第7、15、30较术前明显下降(P<0.05),疼痛感评分明显降低(P<0.05),镇痛药物投放剂量明显减少(P<0.05)。HIFU治疗术后有8例患者出现一过性血淀粉酶、脂肪酶升高,经禁食、抑酶等对症内科处理,随后降至正常;3例患者术后出现治疗区皮肤热损伤,以Ⅰ度和Ⅱ度烧伤为主,术后很快恢复;所有病例均未出现血糖异常、腹腔出血、胃肠穿孔等严重并发症。结论 HIFU是一种缓解胰腺癌患者疼痛较为安全、有效的方法。Objective To evaluate the safety and efficacy of high intensity focused ultrasound （HIFU） inrelieving the pain of advanced pancreatic cancer. Methods Sixty patients with advanced pancreatic cancer were chosen. The level of PGE2 and CGRP were tested by ELISA, and the VAS was recorded before HIFU treatment and on the 1st day, 7th day, 15th day and 30th day after HIFU treatment. The dose of analgesic drug and the complications were compared before and after HIFU treatment. Results The level of PGE2, CGRP and the VAS after HIFU treatment were decreased significantly （P〈0.05） than those before the treatment. The dose of analgesic drug after HIFU treatment was reduced significantly （P〈0.05）. The levels of serum amylase and lipase in 8 patients temporarily rose after HIFU treatment. And there was I or Ⅱ degree skin thermal damage in 3 patients. There was no pathoglycemia, intra-abdominal hemorrhage and gastric-intestinal perforation. Conclusion HIFU is safe and effective in relieving the pain of advanced pancreatic cancer.

关 键 词：高强度聚焦超声 胰腺癌 癌痛 前列腺素E2 降钙素基因相关肽 视觉模拟评分法 

分 类 号：R735.9[医药卫生—肿瘤]