左侧内脏大神经切断术治疗胰源性疼痛(附17例报告)

目的探讨左侧内脏大神经切断术治疗胰源性疼痛的治疗效果。方法2002年1月~2004年12月行左侧内脏大神经切断术17例,其中晚期胰腺癌12例,慢性胰腺炎4例(其中1例合并胰管结石),胃癌侵及胰腺1例。结果以视觉模拟评级法进行疼痛评分,术前平均为(9.32±0.45)分,术后平均为(1.56±0.87)分,差异有显著意义(P<0.01)。患者术前均需服用止痛药物止痛,术后感觉疼痛明显缓解或消失,无需止痛药物止痛。术后除出现轻度腹胀外,未出现腹泻及心血管系统功能紊乱等并发症。结论经腹腔左侧内脏神经切断术治疗胰源性腹痛疗效确切,并发症少,操作简单。     

经腹行左侧内脏大神经切断术治疗难治性胰源性腹痛15例的临床观察

进展期的胰腺癌、反复发作的慢性胰腺炎和一些少见的上腹部腹膜后肿瘤常可引起反复发作、难以控制的上腹部和(或 )腰背部疼痛。本文就经腹行左侧内脏大神经切断术治疗难治性胰源性腹痛的问题作一介绍。一、临床资料我科于 1998年 10月～ 1999年 6月共为 15例患者行左侧内脏大神经切断术 (ｔｒａｎｓｈｉａｔａｌｌｅｆｔｓｐｌａｎｃｈｎｉｃｅｃｔｏｍｙ ,ＴＬＳ) ,其中男 10例 ,女 5例 ,年龄为 33～ 6 8岁 ;15例患者中 14例为晚期恶性肿瘤 (ＰＴＮＭ ,ＩＶ期 ) ,1例为慢性炎症 ;11例为胰源性疾病 ,余 4例的疾病解剖部位与胰头相邻 ,均受腹…     

经尿道前列腺电汽化术对性功能的影响

我院于 2 0 0 0年 11月～ 2 0 0 2年 8月对 5 0例良性前列腺增生 (BPH)病人进行了经尿道前列腺电汽化术 (transurethralvaporizationoftheprostate ,TU VP) ,并进行了手术前后的性功能调查 ,共 30例病人获得了完整资料 ,报告如下。1　资料与方法1.1　一般资料　 5 0例BPH病人 ,年龄 5 0～ 85岁 ,平均 70 .2岁 ;病程 1～ 15年 ,平均 3.6年。所有病人均有BPH症状 ,直肠指检前列腺为Ⅱ～Ⅲ度 ,经腹超声检查前列腺重约为 2 1～ 73g ,平均 4 2 g。IPSS症状评分为 (2 6± 2 .6 )分 ,生活质量评价为 (5 .5±0 .5 )分 ,最大尿流率为 (7.0± 4…     

阴茎背神经切断术治疗早泄

目的评价阴茎背神经切断术治疗早泄的效果。方法自1997~2006年门诊早泄患者19例行阴茎背神经切断术治疗早泄。局麻下于阴茎背侧距冠状沟0.5~1cm处做2~3cm横切口,切开深筋膜,暴露左右两侧之阴茎背神经,并切除部分神经分支。记录患者手术前后阴道内射精潜伏时间和夫妻双方性交满意度。结果19例患者术前平均阴道内射精潜伏时间和性交满意度分别为(1.01±0.58)min(0.10~1.90min)和(14.89±6.08)%(5%~25%),术后平均射精潜伏期和性交满意度分别为(4.14±2.99)min(0.40~9.10min)和(57.47±28.28)%(10%~87%),手术前后相比P<0.01。19例中15例有效,有效率为78.95%,4例无效,2例出现术后轻度局部疼痛,1周后缓解。结论阴茎背神经切断术是一种治疗早泄的有效方法,适用于治疗年轻且不合并ED的患者。     

神经调节器永久性植入治疗间质性膀胱炎合并盆底疼痛四例报告

目的探讨间质性膀胱炎合并盆底疼痛进行骶神经电刺激神经调节治疗的疗效。方法2004年11月至2005年12月,采用美国国立糖尿病、消化病和肾病研究所(NIDDK)制定的标准诊断间质性膀胱炎合并盆底疼痛者4例,并接受永久性神经调节器植入。结果4例经永久性神经调节器植入后,分别随访3-8个月,排尿日记24 h平均尿量由治疗前90-110(96．3±9．3)ml升至治疗后的192～212(201．0±9．2)ml,P<0．05),24 h排尿次数由治疗前的15-25(20．3±4．1)次降至7～12(9．8±2．2)次(P<0．05),夜尿次数由治疗前的8～11(9.8±1.5)次降至治疗后3-6 (4．3±1．3)次(P<0．05),排尿疼痛评分由治疗前的7～10(8．8±1．5)分降至治疗后的1～4(1．8±1．5)分(P<0．01);O'Leary-Sant间质性膀胱炎指数评分由治疗前的均为满分(36分)降至治疗后的8 -11(9．3±1．5)分(P<0．01)。膀胱疼痛和盆底疼痛症状明显缓解,尿频症状也明显改善。结论骶神经电刺激神经凋节治疗是治疗间质性膀胱炎合并盆底疼痛有效、安全的治疗手段。     

后腹腔镜手术切除肾上腺节细胞神经瘤疗效观察

目的 :探讨后腹腔镜微创手术治疗肾上腺节细胞神经瘤的适应证和可行性。方法 :采用后腹腔镜手术治疗肾上腺节细胞神经瘤患者 5例 ,其中左侧肾上腺节细胞神经瘤 2例 ,右侧 3例。结果 :5例后腹腔镜手术全部获得成功 ,4例肾上腺肿瘤为单发 ,1例为多发 (4个肿瘤 ) ;肿瘤最大直径 2 .5～ 8.0 (4 .2± 1.8)cm ;手术时间35～ 10 5 (5 9± 2 7)min ,估计出血量 10～ 30 (19± 7)ml,术后镇痛剂吗啡用量 0～ 2 0 (8± 8)mg ,2例未用镇痛剂 ;排气、恢复进食时间 1～ 3(1.4± 0 .5 )d ;术后住院时间 4～ 7(5 .4± 1.5 )d。无围手术期并发症发生。结论 :后腹腔镜手术切除肾上腺节细胞神经瘤是安全可行的 ,能充分体现腹腔镜手术创伤小、恢复快的优点。肾上腺节细胞神经瘤是腹腔镜手术很好的适应证。     

经皮椎体后凸成形术治疗疼痛性椎体血管瘤的临床疗效

目的 探讨经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗疼痛性椎体血管瘤(vertebral hemangioma,VH)的临床疗效.方法 回顾性分析2008年1月至2016年8月于我科行PKP治疗VH的病人的临床资料.本组30例中,男6例,女24例,平均年龄为(62.0±12.6)岁;血管瘤位于胸椎18例、腰椎9例、胸椎合并腰椎多发者3例,共累计34个椎体,其中2个椎体血管瘤合并椎体压缩骨折.应用疼痛视觉模拟量表(visual analogue scale,VAS)评估病人疼痛情况,采用Oswestry功能障碍指数(Oswestry disability index,ODI)评估病人的生活质量,并记录术后并发症.结果 本组病人均顺利完成手术,其中双侧穿刺28个椎体,单侧穿刺6个椎体,平均随访时间为(14.77±4.98)个月.两组病人术前、术后24 h、术后1个月及末次随访时的VAS评分分别为(5.63±1.52)分、(1.31±1.06)分、(0.88±0.82)分、(0.69±0.58)分;各时间点的ODI分别为(61.09±18.95)%、(21.72±10.57)%、(12.66±9.10)%、(9.31±5.60)%,两组病人术后的VAS评分及ODI均较术前明显下降,与术前比较,差异均有统计学意义(P均<0.05).术后4例椎体出现椎旁骨水泥渗漏,无临床症状;1例病人术后8个月因骨质疏松出现邻近椎体骨折,再次行PKP术;1例92岁病人术后1年自然死亡.术后影像学资料未显示有VH复发.结论 对于无神经压迫、以疼痛为主要症状的VH,PKP具有良好的安全性和治疗效果,且对合并椎体压缩性骨折的VH病人同样有效.     

经腹腔镜胸交感神经节切断术治疗晚期胰腺癌疼痛的麻醉处理

晚期胰腺癌常伴剧痛。我院采用腹腔镜经胸行内脏交感神经切断术治疗晚期胰腺癌疼痛病人 6例 ,男、女各 3例 ,年龄 30～ 70岁 ,平均 5 3岁 ,体重 40～ 5 8ｋｇ ,术前均诊断为晚期胰腺癌 ,伴肝转移 3例。根据ＷＨＯ推荐的视觉模拟评分(ＶＡＳ)分级判断癌痛程度 (0为无痛 ,0～ 3为     

髂腹下神经切除术对腹股沟疝术后慢性疼痛患者的影响

目的探讨髂腹下神经切除术对腹股沟疝修补术后慢性疼痛患者的影响。 方法收集2014年7月至2016年7月,广东省人民医院640例腹股沟疝患者的临床资料,运用腹股沟前入路行Lichtenstein无张力疝修补术,以手术日期确定是否切除髂腹下神经并将入组患者均分为试验组和对照组。试验组患者在术中接受髂腹下神经切除术,而对照组未行神经切除,2组术后治疗及护疼痛水平。 结果本组患者均顺利完成手术。术中试验组切除髂腹下神经患者348例,对照组未切除髂腹下神经患者292例。试验组的患者平均手术时间为（50±12.5）min,平均住院时间为（1.8±0.6）d;理方法相同。随访6个月后应用疼痛数字评价量表（numerical rating scale,NRS）,比较2组患者的对照组平均手术时间为（49±14.3）min,平均住院时间为（1.9±0.8）d,2组在住院平均手术时间和住院时间比较,差异无统计学意义（P>0.05）。2组术后随访6个月,试验组NRS评分0分214例,1分53例,2分54例,3分25例,4分2例,5分及5分以上0例。对照组NRS评分0分93例,1分86例,2分32例,3分68例,4分9例,5分及5分以上4例。以3分为界试验组≤3分346例,>3分2例;对照组≤3分279例,>3分13例,2组以3分为界NRS评分比较,差异有统计学意义（P<0.05）。 结论髂腹下神经切除能够在不增加手术时间及住院时间的情况下,显著减少术后慢性疼痛的发生。     

脊柱截骨术治疗创伤僵硬性胸腰段后凸畸形的解剖与临床研究

目的探讨经椎弓根椎体楔形截骨术治疗创伤僵硬性胸腰段后凸畸形的安全性和有效性。方法解剖研究中将16具新鲜胸腰段脊柱标本按不同脊柱截骨术分为3组,A组：脊柱开放-闭合截骨术,B组：经椎弓根椎体楔形截骨术,C组：改良经椎弓根椎体楔形截骨术（截骨包括上位椎间盘后半部分）。测量截骨前后Cobb角的变化、椎体高度和椎体前缘高度的变化。临床研究中共26例患者,其中男性18例,女性8例,平均36岁。受伤至本次手术时间3个月～11年,平均25个月。入院前治疗包括非手术治疗9例,手术治疗17例。神经损伤程度按照Frankel分级：A级10例,B级2例,C级10例,D级2例,E级2例。本组病例均有不同程度的腰背部疼痛,VAS评分平均4．5分（2．5～6．0分）。后凸角20°～75°,平均35°。根据后凸角大小选择行后路经椎弓根椎体楔形截骨术或改良椎体楔形截骨术。结果解剖研究胸腰段标本中A组平均纠正（38．0±2．5）°,B组（36．0±3．6）°,C组（49．0±2．0）°。A组椎体高度平均增加（13．8±1．4）mm,椎体前缘增加（30．2±2．5）mm,而B、C组椎体高度平均短缩（2．8±0．8）mm和（3．8±0．7）mm,前缘增加（25．0±1．2）mm和（2．2±0．9）mm。临床研究患者均获随访,随访时间10个月～6年,平均12．5个月,患者获得满意减压和后凸畸形矫正,术后后凸角度平均为10．8°（0°～40°）,脊柱后凸畸形平均矫正24°。50％患者的神经功能得到了不同程度恢复,全瘫患者恢复率为30％,主要是感觉功能恢复,而不全瘫患者的恢复率为64．3％,感觉和运动功能均有恢复。腰背部疼痛有不同程度好转,VAS评分平均2．3分（1．0～3．5分）。结论创伤僵硬性胸腰段后凸畸形患者可以选择经椎弓根椎体楔形截骨术或改良经椎弓根椎体楔形截骨术。术后可获得满意的减压效果和后凸畸形纠正,神经功能有不同程度恢复,腰背部疼痛有不同程度好转。     

Thoracoscopic splanchnicectomy for pain control in patients with unresectable carcinoma of the pancreas

Background: Intractable pain is the most distressing symptom in patients suffering from unresectable pancreatic carcinoma. Palliative interventions are justified to relieve the clinical symptoms with as little interference as possible in the quality of life. The purpose of this study was to examine the efficacy and safety of thoracoscopic splanchnicectomy for pain control in patients with unresectable carcinoma of the pancreas. Methods: Between May 1995 and April 1998, 24 patients (14 men and 10 women) with a mean age of 65 years (range, 30–85) suffering from intractable pain due to unresectable carcinoma of the pancreas underwent 35 thoracoscopic splanchnicectomies. All patients were opiate-dependent and unable to perform normal daily activities. Subjective evaluation of pain was measured before and after the procedure by a visual analogue score. The following parameters were also evaluated: procedure-related morbidity and mortality, operative time, and length of hospital stay. Results: All procedures were completed thoracoscopically, and no intraoperative complications occurred. The mean operative time was 58 ± 22 min for unilateral left splanchnicectomy and 93.5 ± 15.6 min for bilateral splanchnicectomies. The median value of preoperative pain intensity reported by patients on a visual analogue score was 8.5 (range, 8–10). Postoperatively, pain was totally relieved in all patients, as measured by reduced analgesic use. However, four patients experienced intercostal pain after bilateral procedures, even though their abdominal pain had disappeared. Complete pain relief until death was achieved in 20 patients (84%). Morbidity consisted of persistent pleural effusion in one patient and residual pneumothorax in another. The mean hospital stay was 3 days (range, 2–5). Conclusions: We found thoracoscopic splanchnicectomy to be a safe and effective procedure of treating malignant intractable pancreatic pain. It eliminates the need for progressive doses of analgesics, with their side effects, and allows recovery of daily activity. The efficacy of this procedure is of major importance since life expectancy in these patients is very short. Received: 23 December 1999/Accepted: 6 January 2000/Online publication: 12 July 2000     

Clinical evaluation of transhiatal bilateral splanchnicotomy for patients with intractable supramesenteric pain

Although a transhiatal bilateral splanchnicotomy (TBS) has many advantages, it has not been widely employed as an effective minimal invasive therapy for intractable supramesenteric pain. Furthermore, the effects of TBS have not yet been clearly evaluated. Between 1995 and 1997, TBS was performed on 11 patients with intractable epigastric and/or flank pain due to unresectable pancreatic cancer, chronic pancreatitis, or an unknown cause. The effect of TBS on the pain was evaluated using a novel simple pain score and pain reduction percentage scaled on the basis of the medication and the judgments by patients themselves, respectively. The detection and cutting of the bilateral great splanchnic nerves were easily performed in all of the patients using common flexible chondrocostal retractors. The evaluation of the TBS effect using the pain score clearly demonstrated the early and late mean postoperative pain score (1.1±0.9 and 1.4±1.2: mean ±SD) to be significantly (P=0.0002 andP=0.002, respectively) lower than the preoperative pain score (3.5±0.7). Furthermore, the mean postoperative pain reduction percentage (85%±13%) evaluated by those patients was also significantly different (P<0.0001). The present study showed no significant complications for TBS, except for minor complications such as the transient fall of blood pressure and reparable pleural damage. Interestingly, a longterm follow-up revealed that no complications related to the splanchnicotomy were observed. These results indicate that TBS is a useful treatment for patients with intractable supramesenteric pain caused by cancer as well as benign diseases.     

Thoracoscopic splanchnicectomy for “small” duct chronic pancreatitis: Case selection by differential epidural analgesia

Management of patients with intractable pain from “small duct” chronic pancreatitis has been difficult, often resulting in narcotic addiction and/or malnutrition from major pancreatic resection. Recently, denervation of sympathetic pain afferents from the pancreas by surgical splanchnicectomy has shown promise in relieving pain while preserving residual pancreatic function. However, results from surgical splanchnicectomy have been mixed in large part because of patient selection. Differentiating actual pancreatic pain from “pancreatic” pain caused by drug-seeking behavior, psychogenic diseases, or various somatically innervated conditions is clinically challenging at best. Between 1992 and 1996, twenty-two patients with 20 prior pancreatic operations, “small duct” chronic pancreatitis, and “pancreatic” pain requiring narcotics were evaluated. Each underwent differential epidural analgesia (DEA) using the following standard techniques: placebo, low-dose (sympathetic), and high-dose (somatic) blocks. Pain perceptions were recorded before and after DEA using a visual analogue scale (VAS). Six demonstrated a greater than 50% decrease in VAS pain after placebo injection and were eliminated from further study. In the remaining 16 patients, pain relief only occurred with sympathetic or somatic blockade. Greater and lesser splanchnicectomy (surgical splanchnicectomy) was performed 27 times in these 16 patients (11 bilateral, 6 synchronous) (5 unilateral; 2 right and 3 left) using thoracoscopic techniques in 14 patients and open thoracotomy in two. No significant surgical or anesthetic complications were encountered. Surgical splanchnicectomy resulted in an overall significant reduction in preoperative VAS scores (8.25 to 4.18; P <0.05). Ten of 13 patients with DEA-predicted sympathetic pain experienced a greater than 50% decrease in VAS after surgical splanchnicectomy, but only two had complete relief. None of the three patients with DEA-predicted somatic pain were benefited by splanchnicectomy. During an average follow-up of 23.3 months, initial good results from surgical splanchnicectomy were maintained in 8 of 10 patients. The following conclusions were reached: (1) surgical splanchnicectomy is a safe, often effective technique for amelioration of intractable pain from “small duct” chronic pancreatitis and (2) DEA is a promising approach for identifying patients most likely to respond to surgical splanchnicectomy. Presented at the Thirty-Eighth Annual Meeting of The Society for Surgery of the Alimentary Tract, Washington, D.C., May 11–14, 1997.     

Thoracoscopic splanchnicectomy for pain control in irresectable pancreatic cancer

AIM: Disabling pain for many patients with irresectable pancreatic cancer is poorly managed and can remain a significant problem until death. The aim of this study was to evaluate the safety and efficacy of thoracoscopic splanchnicectomy for pain control in patients with irresectable pancreatic cancer. PATIENTS AND METHODS: Thirteen patients suffering from intractable pain due to irresectable pancreatic cancer underwent 15 attempted thoracoscopic splanchnicectomy procedures. All patients were opiate dependent. Right-sided splanchnicectomy was performed for a dominantly right-sided pain, whereas a centralized, bilateral, or left-sided pain was managed by left splanchnicectomy. If pain recurred, patients were offered to have the procedure repeated on the contralateral side. RESULTS: Thoracoscopic splanchnicectomy procedure was a technical failure because of pleural adhesions in 1 patient. Fourteen (10 left- and 4 right-sided) thoracoscopic splanchnicectomies were successfully completed in 12 patients. Immediate pain relief was achieved in all 12 patients after unilateral thoracoscopic splanchnicectomy. Pain relief persisted until death in 8 patients and until the latest postoperative follow-up visit at 5 months in 1 patient. Two patients required a contralateral procedure for pain recurrence. A 3rd patient had a recurrent pain but refused contralateral intervention. Except for the latter, none of the patients required opioids. CONCLUSION: Thoracoscopic splanchnicectomy is a safe, simple, and effective minimally invasive procedure. It offers a substantial relief of pain in patients with unresectable pancreatic cancer.     

Videothoracoscopic splanchnicectomy for intractable pain from adrenal metastasis

Splanchnicectomy has been known for years as a treatment for refractory pain in patients with pancreatic cancer or chronic pancreatitis. We report herein the performance of a videothoracoscopic left splanchnicectomy in a patient with a previous right pneumonectomy who suffered intractable pain from an irresectable left adrenal metastasis associated with metastatic retroperitoneal lymph nodes. Immediate pain relief was obtained, but abdominal pain of middle intensity recurred 6 weeks later. Although infrequently required, this procedure might be of value in some patients with refractory pain.     

Thoracoscopic splanchnicectomy for the relief of intractable abdominal pain

Video-thoracoscopic transthoracic splanchnicectomy has been applied to patients in the end stage of pancreas cancer who had intractable pain mediated through the splanchnic nerve in the left upper quadrant. The procedure is performed under general anesthesia in a right hemilateral position. Following the establishment of access to the thoracic cavity, the left splanchnic nerve is cut off at the level immediately above the aortic hiatus, through a small opening made in the pleura between the descending aorta and the vertebrae. All patients had immediate and complete relief of pain postoperatively. Only a transient drop in the mean arterial pressure was observed immediately after cutting off the nerve. No other detrimental effect of the procedure on the general condition was observed. No patients developed postoperative complications. The present method may, thus, be a treatment of choice directed toward the relief of intractable abdominal pain in selected patients with pancreatic cancer.     

Long-term results of bilateral thoracoscopic splanchnicectomy in patients with chronic pancreatitis

BACKGROUND: The management of pain in patients with chronic pancreatitis is difficult. The aim of this prospective study was to evaluate the early and long-term pain relief provided by bilateral thoracoscopic splanchnicectomy. METHODS: From August 1995 to August 1999, 44 patients with chronic pancreatitis underwent bilateral thoracoscopic splanchnicectomy. Data were collected prospectively. Thirty-six patients required opioids. Pain intensity was registered before operation and at regular intervals after surgery by means of a visual analogue scale (VAS). Use of analgesics (opioids; non-steroidal anti-inflammatory drugs and acetaminophen; no analgesics or aminocetophen) was noted before and after splanchnicectomy. Median follow-up was 36 (range 12-60) months. RESULTS: The procedure was technically successful in 40 patients. Thirty-six patients had no complications. Eleven of 24 patients who have been followed up for 24 months or more had a significantly reduced VAS score at 2 years (median (range) 8.5 (7-10) versus 2.5 (0-5); P < 0.01). The cumulative rate of pain relief was 46 per cent 48 months after splanchnicectomy. CONCLUSION: Bilateral thoracoscopic splanchnicectomy alleviated pain in patients with chronic pancreatitis. It was associated with a low morbidity rate and no deaths. Pain eventually recurred in approximately 50 per cent.     

Bilateral thoracoscopic splanchnicectomy with sympathectomy for managing abdominal pain in cancer patients

BACKGROUND: Simple interruption of splanchnic nerve can lead to incomplete transection of nerve fibers responsible for cancer-derived abdominal visceral because lots of neural communications exist. METHODS: From December 1999 to June 2005, a total of 21 cancer patients underwent bilateral thoracoscopic segmental resection of splanchnic nerve with sympathectomy for intractable abdominal pain based on the anatomic observation of 26 embalmed Korean cadaveric specimens in Yonsei University Medical Center, Seoul, Korea. All patients were preoperatively asked to rate the extent of their current pain by using the numeric rating scale (NRS), where 0 indicated no pain and 10 indicated intractable pain. The effectiveness of this thoracoscopic procedure was assessed based on the NRS reevaluated after surgery. RESULTS: NRS score was significantly reduced after thoracoscopic surgery (1.71 +/- 1.10 versus 8.52 +/- 1.08, paired t test, P < .0001). Sixteen patients (76.2%) could tolerate pain without or with reduced dose of analgesics. No mortality and morbidity were found in this study. CONCLUSION: This bilateral thoracoscopic splanchnicectomy with sympathectomy is safe, easy, and effective method in managing cancer-derived visceral abdominal pain.     

The efficacy of single-dose postoperative intravenous dexamethasone for pain relief after endoscopic submucosal dissection for gastric neoplasm

Background

Endoscopic submucosal dissection (ESD) is the gold standard technique for en bloc resection of large superficial tumors in the upper and lower gastrointestinal tract. Little is known about the management of epigastric pain after ESD of gastric neoplasms. This study investigated the utility and safety of single-dose, perioperative, intravenous dexamethasone for epigastric pain relief following ESD.

Methods

The efficacy of intravenous dexamethasone 0.15 mg/kg (DEXA group) compared with saline-only placebo (placebo) for epigastric pain after ESD of early gastric neoplasms was assessed in a double-blinded, placebo-controlled trial. Patients completed a questionnaire about present pain intensity (PPI) and short-form McGill pain (SF-MP) categories for immediate and 6-, 12-, and 24-h postoperative periods. The primary outcome variable was PPI at 6 h following ESD. Secondary outcome variables included pain medication, SF-MP scores, complications, second-look endoscopic findings, and length of stay.

Results

A total of 36 patients participated in the study. The mean 6-h PPI value was lower (p < 0.001) in the DEXA group (1.61 ± 0.21) than in the placebo group (2.66 ± 0.19). The total 6-h SF-MP score, especially the sensory domain, was higher (p = 0.054) in the placebo group (11.56 ± 0.75) than in the DEXA group (8.89 ± 0.75). Tramadol for epigastric pain relief was more frequent (p = 0.026) in the placebo group (44.4 %) than in the DEXA group (11.1 %). No differences were noted between groups in length of stay or complications, including acute or delayed bleeding. The distribution of artificial ulcer patterns at 48-h post-ESD as determined by second-look endoscopy was similar in both groups.

Conclusion

Single-dose perioperative intravenous dexamethasone after ESD effectively relieved epigastric pain 6 h postoperatively.     

Prospective evaluation of pain control and quality of life in patients with chronic pancreatitis following bilateral thoracoscopic splanchnicectomy

Background

Abdominal pain in chronic pancreatitis (CP) is the most common symptom with a highly unfavorable impact on the quality of life. It has been shown that bilateral thoracoscopic splanchnicectomy (BTS) may produce marked pain relief for the majority of patients. The aim of this study was to evaluate the effectiveness of BTS in pain control and quality-of-life improvement in patients with a severe form of CP.

Methods

Between April 2000 and April 2009, a total of 30 patients qualified for BTS due to CP-related pain. Their age ranged from 28 to 60 years. A 12-month follow-up period was planned for all the patients enrolled. To evaluate effectiveness of BTS, an 11-point Numeric Rating Scale (NRS) and the Quality of Life Questionnaire C-30 (QLQ-C30) in its basic form, developed by European Organization for Research and Treatment of Cancer, were used. An NRS value between 0 and 3 was considered a positive postoperative pain control result.

Results

The bilateral splanchnicectomy procedure was performed successfully in 27 of 30 qualified patients. A positive effect based on decreased pain (p < 0.05) at 12 months was achieved in 24 patients (80 %). The initial change in quality of life was not significant but it gradually improved with time (preop vs. 12 months QLQ-C30 score, p < 0.001).

Conclusions

This study showed that BTS is safe and efficacious for pain alleviation in patients with severe CP. It may significantly increase the chances of a long-lasting, life-changing improvement in the quality of life.