术中腹腔神经丛阻滞术对不能切除的胰腺癌疼痛减轻及生活质量的影响

目的对不能切除的胰腺癌行姑息手术的同时行无水酒精腹腔神经丛阻滞术,观察其镇痛效果、并发症及对生活质量的影响。方法选取122例肿块不能切除、伴消化道梗阻、腹部和/或腰背部癌性疼痛的胰腺癌患者,其中姑息手术加腹腔神经丛阻滞术80例患者归为A组,仅行姑息手术42例患者归为B组,比较两组术后疼痛缓解情况、临床受益反应及术后不良反应。结果A与B组术后2周疼痛完全缓解率分别为52.5%和11.9%,总有效率分别为96%和47.6%;半年疼痛完全缓解率分别为20.7%和0%,总有效率分别为68.9%和11.1%;两者在术后各时间点(2周、1个月、3个月、6个月)之间差异有统计学意义(P<0.05)。A组治疗前后KPS评分比较差异有统计学意义(t=6.864,P<0.05),两组治疗前后KPS评分差值比较亦有统计学意义(t=5.326,P<0.05)。术后两组无严重并发症和手术死亡。结论经腹行腹腔神经丛阻滞术具有直视下定位准确、疼痛缓解满意、安全程度高等优点,能有效改善患者的生活质量。

Effects of intra-abdominal neurolytic celiac plexus block during palliative operation on the quality of life,pain-relief and complication in patients with unresectable pancreatic cancer

Objective To investigate the effects of intra-abdominal neurolytic celiac plexus block (NCPB) with anhydrous alcohol during palliative operation (PA) on the quality of life (QOL),pain-relief and complication in patients with unresectable pancreatic cancer (UPC).Methods 112 patients suffering from pain due to inoperable pancreatic cancer,randomly divided into group A (n=80) and group B (n=42),were treated with palliative operation, while patients in group A were treated with NCPB at the same time.Intensity of pain (VAS-pain),KPS and complication were compared among groups per-and 2 weeks,6 months post-operation.Results The effective rates and complete pain-relief rates in groups A and B were 96%,47.6% and 52.5%,11.9%,respectively,2 weeks after operation, while 68.9%,11.1% and 20.7%,0%,respectively,6 months post-operation(P<0.05).In groups A and B,KPS scores were significantly different between per-and post-operation (P< 0.01), and no severe complications and death.Conclusion QOL of UPC patients might be improved effectively by using NCPB with precise orientation,satisfying effects of pain-relief and safety.