cpn-内镜下腹腔神经节阻滞术.pptVIP

EUS- guided Plexus Block/Neurolysis (CPN) INTRODUCTION ?Pain related to pancreatic cancer and chronic pancreatitis is often poorly controlled. Celiac plexus neurolysis (CPN) is a chemical splanchnicectomy of the celiac plexus, which ablates the afferent nerve fibers that transmit pain from intra-abdominal viscera. CPN is most commonly used to palliate pain from pancreatic cancer but has also been used for relieving pain in chronic pancreatitis. METHODS FOR PERFORMING CPN CPN can be performed percutaneously, surgically, or under endosonographic guidance. It is most commonly performed computed tomographic guidance during which absolute alcohol is injected into the celiac plexus. ? Endosonographic (EUS) guidance offers the most direct access to the celiac plexus of all the CPN techniques short of surgical intervention. The celiac ganglia are located at the origin of the celiac artery, which is easily identified at endosonography. The relative proximity of the celiac ganglia to the posterior gastric wall ensures an accurate passage of the injecting needle into the ganglia, thereby minimizing the risk of complications and potentially increasing the effectiveness of the block. ? Technique EUS CPN performed for the palliation of pancreatic cancer pain appears to be as safe and effective as CPN performed by other techniques. An advantage of the EUS approach is that it can be performed while staging and obtaining biopsies of the tumor. TECHNIQUE ?Patients are hydrated with intravenous normal saline (500 to 1000 cc) prior to the procedure. Under direct EUS visualization, a ultrasound aspiration needle primed with normal saline is placed immediately adjacent and anterior to the aorta at the level of the celiac trunk. After injecting 3 cc of saline to clear the needle, an aspiration test is performed. If no blood is obtained, 5 mL of 2 percent lidocaine is injected. The aspiration test is repeated and if no blood return occurs, 15 mL absolute alcohol is injected. COM