超声介入腹腔神经节毁损治疗胰腺癌疼痛_医学论文.docVIP

超声介入腹腔神经节毁损治疗胰腺癌疼痛_医学论文 超声介入腹腔神经节毁损治疗胰腺癌疼痛_医学论文 作者：汪 涛，田伏洲，蔡忠红，汤礼军，李 旭，石 力，陈 涛，邹 树 【摘要】 目的 探讨超声介导腹腔神经节毁损对胰腺癌疼痛患者的治疗作用。方法 97例胰腺癌疼痛患者采用B超引导经皮穿刺，于腹腔动脉干根部旁侧注入无水乙醇15ml，实施腹腔神经节化学性毁损。对比观察治疗前后疼痛的视觉模拟评分（VAS）、血清SP和β-EP以及T细胞亚群水平变化。结果 97例中仅1例穿刺失败，成功率99.0%，无严重并发症；VAS、血清SP和β-EP与术前比较差异有显著性（0.01，0.05，0.01）；疼痛完全缓解率54.2%，部分缓解率21.9%，轻度缓解率11.4%，无效12.5%，疼痛复发率仅10.7%，生存质量明显提高；与疼痛治疗前相比，胰腺癌疼痛患者的淋巴细胞T亚群水平显著上升（0.01）。结论 本微创技术具有很高的安全性，能显著减轻胰腺癌性疼痛并提高细胞免疫水平。 【关键词】 超声介入；疼痛治疗；胰腺癌；腹腔神经节 【Abstract】 Objective To detect the therapeutic effects of destruction of celiac ganglion on patients with pancreatic carcinoma with intractable pain.Methods 97 cases with advanced pancreatic carcinoma accepted splanchna destruction 15ml pure alcohol injection around celiac ganglion by ultrasound intervention.The varieties of VAS，serum SP、β-EP and T-lymphocyte subtypes level were compared between pre-therapy and post-therapy.Results Successful rate of puncture was 99.0%，with 1 loss.No serious complications such as acute pancreatitis，pancreatic fistula，bleeding or celiac infection in our study.VAS，serum SP level and β-EP level significantly changed after treatment （0.01，0.05，0.01），with complete relief rate 54.2%，partial relief rate 21.9%，inefficient rate 12.5% and recurrent rate only 10.7%.The T-lymphocyte subtypes level remarkably increased when compared with that of pre-therapy（0.01）.Conclusion Our study suggests that destruction of celiac ganglion by ultrasound guidance proves to be highly safe，and can evidently relieve pain and improve the cellular immune level on patients with advanced pancreatic carcinoma. 【Key words】 ultrasound intervention；analgesia；pancreatic carcinoma；celiac ganglion 胰腺癌是消化道的高度恶性肿瘤，一经发现，多为肿瘤晚期，失去根治性手术机会。70%以上患者伴有剧烈的疼痛，严重降低生存质量。我们在反复尸解熟悉胰腺神经解剖的基础上，结合自身技术优势，实施B超引导经腹穿刺、无水乙醇局部注射行腹腔神经节毁损以缓解胰腺癌疼痛的临床研究，现报告如下。 1 资料与方法 1.1 一般资料 本组97例，男64例，女33例，年龄38～79岁，平均56.1岁，体重41～78kg。临床资料见表1。胰腺癌诊断依据：72例手术证实，其中26例病理活检，见表2；25例经B超、CT或MRI两种或两种以上影像学结合临床诊断，其中10例伴有CA19-9升高。所有胰腺癌患者均表现出较剧烈的腹部及腰背部疼痛，疼痛性质及病例分布情