Vranken J H, van der Vegt M H
Academisch Medisch Centrum/Universiteit van Amsterdam, Pijncentrum, afd. Anesthesiologie, Postbus 22.700, 1000 DE Amsterdam.
Ned Tijdschr Geneeskd. 2006 Apr 1;150(13):723-8.
Pancreatic cancer tends to be diagnosed at a relatively late stage of the disease when curative resection is precluded. In view of the poor prognosis and the severe pain, palliative care should be aimed at providing adequate pain relief and optimal quality of life. Pancreatic cancer pain is primarily treated by the combination of NSAIDs, adjuvant analgesic drugs, and oral or transdermal opioids. The neurolytic coeliac plexus block is recommended as adjuvant therapy for the palliative treatment of pancreatic cancer pain. In addition quality of life, especially functional and physical aspects, is significantly improved in patients following a coeliac plexus block. The most common approach to the coeliac plexus is the percutaneous posterior technique. Serious complications that may follow application of this technique include sensory disorders, muscle weakness and paraparesis. More recently, new techniques such as thoracoscopic splanchnicectomy and endoscopic ultrasound-guided coeliac plexus block have emerged as efficient alternatives in terms of pain relief and quality-of-life improvement. The neurolytic coeliac plexus block has become a well-developed method of pain relief in patients with pain resulting from malignancies of the pancreas. To define the role of these new techniques in the palliative treatment of pancreatic cancer pain, comparative studies regarding efficacy, side effects, and complications have to be performed.
胰腺癌往往在疾病的相对晚期才被诊断出来，此时无法进行根治性切除。鉴于预后较差且疼痛严重，姑息治疗应旨在提供充分的疼痛缓解和最佳生活质量。胰腺癌疼痛主要通过非甾体抗炎药、辅助镇痛药以及口服或经皮阿片类药物联合治疗。推荐将腹腔神经丛阻滞作为胰腺癌疼痛姑息治疗的辅助疗法。此外，接受腹腔神经丛阻滞后，患者的生活质量，尤其是功能和身体方面，会得到显著改善。腹腔神经丛最常用的穿刺方法是经皮后路技术。应用该技术可能出现的严重并发症包括感觉障碍、肌肉无力和轻瘫。最近，诸如胸腔镜内脏神经切除术和内镜超声引导下腹腔神经丛阻滞等新技术已成为在缓解疼痛和改善生活质量方面有效的替代方法。腹腔神经丛阻滞已成为缓解胰腺癌所致疼痛患者疼痛的一种成熟方法。为明确这些新技术在胰腺癌疼痛姑息治疗中的作用，必须开展关于疗效、副作用和并发症的比较研究。
