内镜超声引导下腹腔神经丛阻滞在晚期腹部肿瘤所致癌性腹痛中的应用

目的:评价内镜超声引导下腹腔神经丛阻滞对晚期腹部肿瘤患者的止痛作用.方法:对12例晚期腹部肿瘤患者行内镜超声引导下腹腔神经丛阻滞.在内镜超声引导下,将细针穿刺到腹腔神经丛区域并注射无水酒精.术前和术后分别填写视觉疼痛类比量表(VAS)进行评分,评估疗效.结果:所有患者均成功进行了腹腔神经丛阻滞,并且没有并发症发生.12例患者术后腹痛缓解有效率达83%.并且疗效能持续较长时间.结论:内镜超声引导下腹腔神经丛阻滞是治疗晚期腹部肿瘤腹痛较有效、安全的方法.     

内镜超声引导下腹腔神经丛阻滞术治疗胰腺癌痛的护理

目的探讨内镜超声引导下腹腔神经丛阻滞术治疗胰腺癌痛的临床护理。方法选择符合内镜超声引导下腹腔神经丛阻滞术治疗胰腺癌痛适应证的患者14例，运用护理程序实施整体护理。结果手术成功率为100％。14例穿刺者未发生任何远期并发症。结论内镜超声引导下腹腔神经丛阻滞术能够安全有效地缓解胰腺癌痛，并发症少，安全性好，而手术前后的精心整体护理是手术成功的关键。     

1例内镜超声引导下腹腔神经丛阻滞治疗胰腺癌疼痛的护理

内镜超声引导下腹腔神经丛阻滞与传统采用在CT、X线引导下经背侧穿刺和体表超声引导下经腹腔穿刺来进行腹腔神经丛阻滞,由于腹腔神经丛与胃腔仅一壁之隔,穿刺距离近,定位更准确,损伤和并发症减少,其操作简单,患者痛苦小.故内镜超声引导下腹腔神经丛阻滞治疗最适于治疗晚期胰腺癌的腹痛,是晚期胰腺癌安全、高效、经济的镇痛方法[1].     

超声内镜引导下腹腔神经丛阻滞加溶瘤病毒瘤内注射治疗晚期胰腺癌的护理

[目的]总结超声内镜引导下腹腔神经丛阻滞加溶瘤病毒瘤内注射治疗晚期胰腺癌的护理措施。[方法]对8例胰腺癌病人在充分的术前评估和准备下密切配合操作医生进行超声内镜引导下溶瘤病毒瘤内注射后又将丁哌卡因及无水乙醇注入腹腔神经丛,术后做好饮食、活动、营养支持、预防和处理不良反应及并发症等方面的护理。[结果]8例病人治疗均获成功,疼痛评分明显降低,术后腹泻、腹痛、流感样症状、醉酒样表现等不良反应均较轻,经处理后很快好转,无一例并发出血、穿孔、胰瘘、急性胰腺炎、感染。[结论]加强晚期胰腺癌病人行超声内镜引导下腹腔神经丛阻滞加溶瘤病毒瘤内注射治疗的护理是治疗成功的保证。     

CT引导下腹腔神经丛阻滞联合介入化疗治疗胰腺癌疼痛的初步临床研究

胰腺癌晚期顽固性上腹痛、腰背痛,一般止痛药物及全身化疗效果不佳,严重影响患者的生活质量.CT引导下腹腔神经丛阻滞术(CT-guided celiac plexus neumlysis,CT-CPN)向腹腔神经丛注射无水酒精,使腹腔神经丛变性、毁损,可起到阻滞神经、缓解疼痛的作用,是缓解晚期胰腺癌所致的腹痛、背痛安全有效的方法,联合介入化疗能明显提高疼痛的缓解率,改善生活质量.我们于2001年开展此项工作,现报道如下.     

CT引导下腹腔神经丛毁损性阻滞治疗顽固性胰腺癌痛的临床观察

目的：观察CT引导下腹腔神经丛毁损性阻滞对顽固性胰腺癌痛的镇痛效果、并发症及对患者生活质量的影响。方法：46例顽固性胰腺癌症疼痛患者，在CT引导监视下经背侧入路经皮穿刺，行腹腔神经丛无水酒精阻滞治疗。结果：治疗后1周内全部患者疼痛减轻或消失。在治疗后第7、14、30、60、90天，患者的疼痛评分、疼痛缓解率、生活质量均明显改善，大多数患者临终前无痛或仅轻度疼痛。治疗过程中和治疗后未发生严重并发症。结论：CT引导下腹腔神经丛阻滞治疗顽固性胰腺癌痛的疗效确切，安全性高。     

腹腔神经丛阻滞治疗晚期胰腺癌疼痛的观察及护理

总结15例晚期胰腺癌疼痛患者经内镜超声引导下腹腔神经丛阻滞治疗的观察及护理。准确评估疼痛,治疗前做好器械及患者准备,治疗时密切观察病情变化,治疗后加强并发症的观察与护理。15例患者治疗后疼痛症状明显改善,总有效率为93．3％,无护理并发症发生。     

CT引导腹腔神经丛毁损术联合~(125)I粒子植入治疗晚期胰腺癌疼痛

目的:观察CT引导下腹腔神经丛毁损联合125I粒子植入对晚期胰腺癌疼痛的治疗效果。方法:169例晚期胰腺癌患者,在CT引导下行腹腔神经丛乙醇毁损联合胰头病灶植入125I粒子治疗,分别采用视觉模拟评分法(visual analogue scale,VAS)和CT检查评估患者的疼痛情况及胰腺病灶的变化。结果:在治疗后5天、15天、1个月和3个月,患者的疼痛评分和疼痛缓解率明显改善,部分患者治疗后3个月的病灶明显缩小,治疗过程和治疗后未发生严重的并发症。结论:CT引导上腹腔神经丛毁损联合125I粒子植入治疗晚期胰腺癌的癌性疼痛的疗效确切,安全性高。     

内镜超声介导下腹腔神经丛阻滞治疗晚期胰腺癌顽固性疼痛患者的护理

报道了8例晚期胰腺癌顽固性腹痛患者行内镜超声引导下腹腔神经丛阻滞术治疗的护理。认为内镜微创治疗晚期胰腺癌疼痛具有疗效好、损伤小的优点,做好术前心理护理,消除悲观和恐惧;术中积极主动配合、及时沟通,正确处理术中的不良反应及术后并发症,做好术后一过性疼痛的护理:对提高手术的安全性及成功率起到了重要作用。     

CT引导下腹腔神经丛毁损术治疗慢性顽固性腹部癌痛

目的：观察CT引导下腹腔神经丛毁损性阻滞对顽固性腹部癌痛的镇痛效果及患者生活质量的影响。方法：74例顽固性腹部癌症疼痛患者，在CT引导监视下经背侧入路经皮穿刺腹腔神经丛无水乙醇阻滞治疗。结果：治疗后一周内全部患者疼痛减轻或消失。在治疗后第7、14、30、60天，患者的疼痛评分、疼痛缓解率、生活质量均明显改善，大多数患者临终前无痛或仅轻度疼痛。治疗过程中和治疗后未发生严重并发症。结论：CT引导下腹腔神经丛阻滞治疗顽固性腹部癌痛的疗效确切，安全性高．     

内镜超声无水酒精注射腹腔神经丛治疗上腹部癌痛

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。全部病例注射后止痛药用量减少。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。     

Endoscopic ultrasound-guided fine-needle injection

With the development of linear array echoendoscopes and the ability to perform endoscopic ultrasound (EUS)-guided fine-needle aspiration, the delivery of therapeutic agents with fine-needle injection (FNI) emerged. EUS-guided FNI is an attractive delivery system because of its minimal invasiveness and low complication rate. This approach is effective in performing celiac plexus neurolysis for pain relief in patients with pancreatic cancer. The most exciting area of interest involves the delivery of antitumor agents in patients with locally advanced cancer, such as cancer of the pancreas or esophagus. The involvement of EUS-guided FNI in tumor therapy adds a host of potential new applications that continue to swing the pendulum of EUS from a diagnostic to a therapeutic modality.     

Increasing the efficacy of a celiac plexus block in patients with severe pancreatic cancer pain.

The purpose of this study was to evaluate the technical possibilities of placing a catheter near the celiac plexus for performance of a celiac plexus block, and to study the efficacy of repeated neurolytic celiac plexus blocks with alcohol in patients with advanced pancreatic cancer pain resistant to opioid treatment. In 12 patients, a neurolytic celiac plexus block with alcohol, administered via an indwelling celiac catheter, was performed. To evaluate the efficacy, visual analog scale scores were recorded every day. Quality of life scores were registered before and 4 weeks following the procedure. Alterations in opioid consumption, and the time between the diagnosis of pancreatic cancer and the performance of the block, were registered. All patients were followed until they died. Two patients remained without pain after the first neurolytic celiac plexus block. In all other patients a second block was administered which provided only temporary relief. Additional intermittent administration of bupivacaine through the catheter was necessary to provide adequate pain relief in these patients. Quality of life increased significantly during the treatment. Opioid consumption decreased significantly in all patients. Our study indicates that a neurolytic celiac plexus blockade with alcohol results in a significant but short-lasting analgesic effect. The use of a celiac catheter improves the long-term management of pancreatic cancer pain.     

超声引导下经皮穿刺植入放射性125I粒子治疗腹部恶性肿瘤

目的探讨超声引导下经皮穿刺植入放射性¹²⁵I粒子治疗腹部恶性肿瘤的临床效果。 方法选取2014年1月至2016年12月在吉林大学中日联谊医院诊治的142例腹部恶性肿瘤患者,其中,42例肝癌,53例胰腺癌,27例腹膜后原发肿瘤,20例腹腔转移癌。均行超声引导下放射性¹²⁵I粒子腹部肿瘤内植入术,统计术前疼痛者,判断术后缓解程度。CT对比手术前后肿瘤长径,并随访有无手术相关并发症。 结果（1）疼痛缓解有效率：87.35%（肝癌85.71%,胰腺癌90.00%,腹膜后肿瘤85.00%,腹腔转移癌84.62%）;（2）肿瘤局部控制有效率：76.06%（肝癌83.33%,胰腺癌73.58%,腹膜后肿瘤70.37%,腹腔转移癌75.00%）;（3）并发症：15例发热、腹腔积液及腹胀各5例、2例胃潴留（一过性）。发生率：19.01%（肝癌19.05%,胰腺癌18.87%,腹膜后肿瘤18.52%,腹腔转移癌20.00%）。 结论对于丧失手术切除机会的腹部恶性肿瘤患者而言,超声引导经皮穿刺放射性¹²⁵I粒子肿瘤内植入术可有效缓解疼痛、较好控制肿瘤的局部生长,并发症少,疗效肯定。超声作为其影像学引导手段,有实时显示、操作简便、定位准确等优势,值得推广应用。     

超声引导下腹腔神经丛毁损治疗上腹部癌痛的安全性和有效性

目的 评估超声引导下腹腔神经丛毁损（CPN）治疗上腹部癌痛的安全性和有效性。方法 对15例进展性上腹部癌痛患者行超声引导下CPN,利用视觉模拟量表（VAS）评分进行评估,记录CPN治疗前和治疗后即刻、1天、1周、1个月、3个月患者疼痛程度,并进行统计学分析。结果 2例因治疗前评估无安全穿刺路径而被剔除。成功实施超声引导下CPN治疗13例。治疗后13例患者VAS评分明显低于治疗前（P<0.05）。治疗过程中无严重并发症发生。3例发生穿刺部位疼痛,24 h后缓解;2例肠蠕动增快而出现腹泻;1例出现恶心、呕吐;1例术后出现低血压。结论 超声引导下CPN安全有效,可作为微创治疗上腹部癌痛的方法之一。     

CT引导内脏与腹腔神经丛阻滞治疗上腹癌痛的比较

目的：观察CT引导下内脏与腹腔神经丛毁损性阻滞对上腹癌痛的镇痛效果比较。方法：48例顽固性上腹部癌症重度疼痛患者，随机分两组，在CT引导下分别行腹腔神经丛（Ｆ组）或内脏神经丛（Ｎ组）无水乙醇毁损阻滞治疗。观察两组镇痛效果、疼痛缓解程度及不良反应。结果：治疗后即刻全部患者疼痛减轻或消失。在治疗后第3、7、15、30、60、90天，患者的疼痛评分、疼痛程度均明显改善，两组间无显著差异，治疗过程中和治疗后未发生严重并发症。结论：内脏神经丛阻滞可取得与腹腔神经丛阻滞一致的效应，操作方便、疗效确切、安全性高，可供临床选择。     

Early Ultrasound‐Guided Neurolysis for Pain Management in Gastrointestinal and Pelvic Malignancies: An Observational Study in a Tertiary Care Center of Urban India

Abstract: Patients with advanced gastrointestinal and pelvic malignancies commonly present with pain of varying severity. In a majority of these patients, pain can be effectively managed using an integrated systemic pharmacological approach with oral morphine being the cornerstone of treatment. However, with escalating doses, intolerable side effects of oral morphine may lead to patient dissatisfaction. When oral pharmacotherapy fails to adequately address the issue of pain or leads to insufferable side effects, neurolytic blocks of the sympathetic axis are usually used for pain alleviation. As these blocks may reduce oral analgesic requirement, a reevaluation of their timing is merited. This article presents our hospital‐based in‐patient palliative care unit experience with early ultrasonography‐guided neurolysis of celiac plexus, superior hypogastric plexus and ganglion impar. Of the 44 patients we studied, 20 underwent celiac plexus neurolysis, 18 superior hypogastric plexus neurolysis, and 6 ganglion impar neurolysis. Their pain was being managed with oral morphine before neurolysis, but only 11.4% patients required oral morphine for satisfactory pain control, 2 months after neurolysis. The mean Visual Analog Scale score before block placement was 5.64 ± 0.69 and fell to 2.25 ± 1.33 at 2 months post neurolysis (P < 0.001). We suggest that bedside ultrasonography‐guided sympathetic axis neurolysis may be employed early in patients with incurable abdominal or pelvic cancer. Its use as a first‐line intervention for achieving pain control with minimal complications warrants further consideration and investigation. ?     

Celiac Plexus Block for Treatment of Pain Associated with Pancreatic Cancer: A Meta‐Analysis

Pancreatic ductal adenocarcinoma has a high rate of neural invasion (80 to 100%) and can be associated with moderate to severe pain in pancreatic cancer. Treatment of pain with celiac plexus blockage (CPB) combined with the three‐step ladder utilization of pharmaceutical analgesics following WHO guidelines is used, but the evidence in randomized controlled trials is inconsistent. This meta‐analysis identified and compared seven randomized control trials of pain relief from pancreatic cancer, by treatment with medical management alone to celiac plexus blockade with medical management. While no evidence of potential publication bias was detected, group size and statistical power may account for some of the inconsistent conclusions. The combined CPB groups had a significantly lower pain score at 4 weeks, but significance was not maintained at 8 weeks. The combined CPB groups required significantly less drug use compared to the combined control groups treated with pharmaceutical analgesics.     

Endoscopic ultrasound-guided celiac neurolysis

Intractable abdominal pain commonly develops in patients with pancreatic cancer. Oral pharmacologic therapy is ineffective for many patients and side effects commonly occur. Celiac neurolysis (CN) is sometimes performed to enhance pain relief. Percutaneous approaches were initially described, with endoscopic ultrasound (EUS)-guided CN more recently introduced. There is uncertainty regarding the efficacy and role of CN in managing pancreatic cancer pain, but CN should still be considered in this difficult-to-treat cohort of patients. EUS-guided approaches may be favored when EUS is otherwise indicated for diagnostic or staging purposes. When EUS is not otherwise indicated, percutaneous approaches are likely favored.