Gress F, Schmitt C, Sherman S, Ikenberry S, Lehman G
Division of Gastroenterology and Hepatology, Indiana University Medical Center, Indianapolis, USA.
Am J Gastroenterol. 1999 Apr;94(4):900-5. doi: 10.1111/j.1572-0241.1999.01042.x.
Computed tomography (CT)-guided celiac plexus neurolysis has been used for controlling the chronic abdominal pain associated with intra-abdominal malignancy and chronic pancreatitis. Endoscopic ultrasound (EUS)-guided celiac plexus neurolysis has been reported to have some success in controlling pain from pancreatic cancer. The aim of this study is to assess the efficacy of EUS-guided celiac plexus block versus CT-guided celiac plexus block for controlling the chronic abdominal pain associated with chronic pancreatitis.
Patients enrolled were randomly assigned to EUS-guided or CT-guided celiac plexus block. Pain scores were determined pre- and postceliac block for both techniques. Follow-up was obtained by a nurse at 1 day post-block, then weekly thereafter for 24 wk. Patients also rated overall experience with these procedures. The EUS celiac block was performed with a 22-gauge sterile needle inserted into the celiac region with guidance of real-time linear array endosonography followed by injection of 10 ml of bupivacaine (0.75%) and 3 ml (40 mg) of triamcinolone on both sides of the celiac area.
Twenty-two consecutive patients (10 men, 12 women), were ultimately enrolled in this study between 7/1/95 and 12/30/95; four patients were excluded for protocol violations. We performed EUS-guided celiac block in 10 patients and CT-guided celiac block in eight. A significant improvement in pain scores with reduction in pain medication usage occurred in 50% (five of 10) of patients having the EUS block. The mean postprocedure follow-up was 15 weeks (range: 8-24 wk). Persistent benefit was experienced by 40% of patients at 8 wk and by 30% at 24 wk. In the patients with CT block, however, only 25% (two of eight) had relief. The mean follow-up was 4 wk (range: 2-6 wk). Only 12% (one of eight) had some relief at 12 wk of follow-up. There were no complications. EUS-guided celiac block was the preferred technique among patients who experienced both techniques. A cost comparison between both celiac block techniques shows EUS to be less costly than CT.
EUS-guided celiac block provided more persistent pain relief than CT-guided block and was the preferred technique among the subjects studied. EUS-guided celiac block appears to be a safe, effective, and less costly method for controlling the abdominal pain that can accompany chronic pancreatitis in some patients.
计算机断层扫描（CT）引导下的腹腔神经丛毁损术已被用于控制与腹内恶性肿瘤和慢性胰腺炎相关的慢性腹痛。据报道，内镜超声（EUS）引导下的腹腔神经丛毁损术在控制胰腺癌疼痛方面取得了一定成功。本研究的目的是评估EUS引导下腹腔神经丛阻滞与CT引导下腹腔神经丛阻滞在控制慢性胰腺炎相关慢性腹痛方面的疗效。
入选患者被随机分配接受EUS引导或CT引导下的腹腔神经丛阻滞。两种技术在腹腔神经丛阻滞前后均测定疼痛评分。由护士在阻滞术后1天进行随访，此后每周随访一次，共随访24周。患者还对这些操作的总体体验进行评分。EUS引导下的腹腔神经丛阻滞是在实时线性阵列超声内镜引导下，将一根22号无菌针插入腹腔区域，然后在腹腔区域两侧注射10毫升布比卡因（0.75%）和3毫升（40毫克）曲安奈德。
1995年7月1日至1995年12月30日期间，共有22例连续患者（10例男性，12例女性）最终纳入本研究；4例患者因违反方案被排除。我们对10例患者进行了EUS引导下的腹腔神经丛阻滞，对8例患者进行了CT引导下的腹腔神经丛阻滞。接受EUS阻滞的患者中有50%（10例中的5例）疼痛评分显著改善，止痛药物使用减少。术后平均随访15周（范围：8 - 24周）。40%的患者在8周时仍有持续受益，24周时为30%。然而，在接受CT阻滞的患者中，只有25%（8例中的2例）疼痛得到缓解。平均随访4周（范围：2 - 6周）。随访12周时，只有12%（8例中的1例）有一定程度的缓解。未发生并发症。在同时接受两种技术的患者中，EUS引导下的腹腔神经丛阻滞是首选技术。两种腹腔神经丛阻滞技术的成本比较显示，EUS的成本低于CT。
EUS引导下的腹腔神经丛阻滞比CT引导下的阻滞提供了更持久的疼痛缓解，并且是所研究对象中的首选技术。EUS引导下的腹腔神经丛阻滞似乎是一种安全、有效且成本较低的方法，可用于控制部分患者慢性胰腺炎可能伴随的腹痛。
