CT引导下腹腔神经丛射频热凝术治疗晚期胰腺癌顽固性疼痛的临床分析

目的:探讨CT引导下腹腔神经丛射频热凝术治疗晚期胰腺癌顽固性疼痛的临床镇痛效果。方法:选取2016年6月至2018年6月70例晚期胰腺癌顽固性疼痛患者为研究对象，按随机数字表法分为对照组和观察组各35例。对照组:采用芬太尼透皮贴剂4.125 mg/贴×2/72 h 外用+加巴喷丁胶囊 200 mg po 3/d；观察组:采用CT引导下腹腔神经丛射频热凝术，射频治疗参数设置为:3 min，70 ℃。评价两组晚期胰腺癌顽固性疼痛患者镇痛效果。结果:治疗后3 d、6 d、21 d、60 d两组患者VAS评分均呈下降趋势（P<0.05)，且观察组治疗后各时间点VAS评分均低于对照组，疼痛缓解率均高于对照组，差异有统计学意义（P<0.05）。两组患者治疗前躯体功能评分、情绪功能评分、社会功能评分、总健康状况评分差异均无统计学意义（P>0.05）。治疗后3 d、6 d、21 d、60 d观察组较对照组躯体功能评分、情绪功能评分、社会功能评分呈下降趋势，总健康状况评分呈上升改变，两组差异有统计学意义（P<0.05)。治疗前1 d两组患者血清炎性因子TNF-α、IL-6、CRP含量比较差异无统计学意义（P>0.05）。治疗后1 d、3 d，观察组血清TNF-α、IL-6、CRP含量均明显低于对照组，两组差异有统计学意义（P<0.05)。结论:CT引导下腹腔神经丛射频热凝术治疗晚期胰腺癌顽固性疼痛镇痛效果确切，具有操作简单、创伤小、见效快、安全有效等优势。

Clinical analysis of CT-guided radiofrequency thermocoagulation of celiac plexus in the treatment of advanced pancreatic cancer with intractable pain

Objective:To explore the clinical analgesic effect of CT-guided radiofrequency ablation of abdominal plexus in the treatment of advanced pancreatic cancer with intractable pain.Methods:70 patients with advanced pancreatic cancer with intractable pain from June 2016 to June 2018 were enrolled in the study.They were divided into control group and observation group by 35 patients according to the random number table method.Control group received fentanyl transdermal patch 4.125 mg/paste×2/72 h topical+gabapentin capsule 200 mg po 3/d.Observation group received CT-guided abdominal plexus radiofrequency thermocoagulation.Radiofrequency treatment parameters were 3 min，70 ℃.Analgesic efficacy in patients with advanced pancreatic cancer with intractable pain was evalulated.Results:The VAS scores of the two groups were decreased at 3 d，6 d，21 d and 60 d after treatment (P<0.05)，and the VAS scores of the observation group were lower than those of the control group at each time point after treatment.The pain relief rate was higher than that of the control group.The difference was statistically significant (P<0.05).There were no significant differences in preoperative physical function scores，emotional function scores，social function scores，and total health status scores between the two groups (P>0.05).At 3 d，6 d，21 d and 60 d after treatment，the physical function score，emotional function score and social function score of the observation group showed a downward trend，and the total health status score showed an upward change.The difference between the two groups was statistically significant (P<0.05).There was no significant difference in serum TNF-α，IL-6 and CRP between the two groups before the treatment of serum inflammatory factors (P>0.05).The levels of serum TNF-α，IL-6 and CRP in the observation group were significantly lower than those in the control group at 1 and 3 days after treatment.The difference between the two groups was statistically significant (P<0.05).Conclusion:CT-guided radiofrequency thermocoagulation of the celiac plexus is effective in the treatment of advanced pancreatic cancer with intractable pain and analgesia.It is simple in operation，less invasive，quick in effect，safe and effective.