Mekaroonkamol Parit, Willingham Field F, Chawla Saurabh
Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine. Atlanta, GA, USA.
JOP. 2015 Jan 31;16(1):33-40. doi: 10.6092/1590-8577/2890.
Pancreatic cancer is the fourth leading cause of cancer-related death in the United States and one of the leading causes of cancer mortality in the United States. Due to its aggressive behavior and lack of effective therapies, palliation plays a critical role in the management of the disease. Most patients with pancreatic cancer suffer from severe pain, which adversely predicts prognosis and significantly impacts the quality of life. Therefore pain management plays a central role in palliation. Non-steroidal anti-inflammatory drugs and opioid agents are often first line medications in pain management, but they do not target the underlying pathophysiology of pain and their use is limited by adverse effects and dependence. The proposed mechanisms of pain development in pancreatic cancer include neurogenic inflammation and ductal hypertension which may be targeted by endoscopic therapies. Endoscopic ultrasound-guided celiac plexus neurolysis (EUS-CPN) and pancreatic duct stent placement are the two primary endoscopic modalities for palliative management in pancreatic cancer patients with refractory pain. Other endoscopic treatments such as biliary stent placement and enteral stent placement for biliary and duodenal obstruction may also help palliate pain in addition to their role in decompression. This article reviews the existing evidence for these endoscopic interventions for pain management in pancreatic cancer.
胰腺癌是美国癌症相关死亡的第四大主要原因，也是美国癌症死亡率的主要原因之一。由于其侵袭性以及缺乏有效的治疗方法，姑息治疗在该疾病的管理中起着关键作用。大多数胰腺癌患者遭受严重疼痛，这对预后有不利预测作用，并显著影响生活质量。因此，疼痛管理在姑息治疗中起着核心作用。非甾体抗炎药和阿片类药物通常是疼痛管理的一线药物，但它们并未针对疼痛的潜在病理生理学，其使用受到不良反应和依赖性的限制。胰腺癌疼痛发生的推测机制包括神经源性炎症和导管高压，内镜治疗可能针对这些机制。内镜超声引导下腹腔神经丛毁损术（EUS-CPN）和胰管支架置入是治疗难治性疼痛的胰腺癌患者姑息治疗的两种主要内镜方式。其他内镜治疗，如用于胆道和十二指肠梗阻的胆道支架置入和肠内支架置入，除了具有减压作用外，也可能有助于缓解疼痛。本文综述了这些内镜干预措施用于胰腺癌疼痛管理的现有证据。
