Xie G L, Guo D P, Liu C, Wu G H, Chen H, Li Z G
Department of Pain, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450000, China.
Zhonghua Yi Xue Za Zhi. 2020 Feb 11;100(5):357-362. doi: 10.3760/cma.j.issn.0376-2491.2020.05.008.
To analyze the analgesic effect of CT-guided celiac nerve plexus destruction or celiac plexus destruction combined with absolute ethanol injection on retroperitoneal enlarged lymph nodes in patients with pancreatic cancer with retroperitoneal lymph node metastasis (combined therapy). Retrospective analysis of clinical data of 187 patients with pancreatic cancer and retroperitoneal lymph node metastasis admitted to Zhengzhou University Cancer Hospital from January 2014 to December 2018 due to poor abdominal pain control. According to the treatment method, they were divided into 2 groups: Group A (48) , treated with CT-guided celiac plexus destruction; Group B (139) , treated with CT-guided combined therapy. The analgesic effect, morphine application dose, and adverse reactions were compared before surgery, 1 week, 1 month, and 3 months after surgery. The oral morphine doses of patients in Group A before surgery and 1 day, 1 week, 1 month, and 3 months after surgery were (107±34) , (65±23) , (35±12) , (48±18) , (81±25) mg. The oral morphine doses of patients in Group B before surgery and 1 day, 1 week, 1 month, and 3 months after surgery were (112±37) , (53±17) , (27±14) , (42±16) , (63±20) mg. Compared with that before surgery, the oral morphine doses were significantly reduced at 1 day, 1 week, 1 month, and 3 months after surgery in both groups (0.05 or 0.01) . The effective rate and excellent rate of pain treatment in Group A at 1 week after operation were 83.3% and 60.4%, in Group B were 95.7% and 75.5%, respectively. The effective rate and excellent rate of pain treatment in Group A at one month after operation were 71.7% and 45.6%, in Group B were 89.0% and 67.6%, respectively; The effective rate and excellent rate of pain treatment in Group A at three months after operation were 48.6% and 25.7%, respectively, in Group B were 72.6% and 47.0%; Compared with Group A, the effective rate and excellent rate of pain treatment in Group B were increased, and the differences were statistically significant (0.05 or 0.01). There was no significant difference in the incidence of nausea and vomiting between the two groups of patients before and 1 day after surgery, but the incidence of nausea and vomiting at 1 week, 1 month, and 3 months after surgery in Group B was significantly reduced, and the differences were statistically significant (0.05 or 0.01). Compared with that before surgery, the incidence of nausea and vomiting in Group A was significantly reduced at 1 week and 1 month after operation, and the difference was statistically significant (0.01); The incidence of nausea and vomiting in Group B was significantly reduced at 1 day, 1 week, 1 month, and 3 months after operation, and the differences were statistically significant (0.01). Compared with 1 day after surgery, the incidence of nausea and vomiting in Group A was significantly reduced at 1 week and 1 month after surgery (0.05 or 0.01). The incidence of nausea and vomiting in Group B was significantly reduced at 1 week, 1 month, and 3 months after operation, and the differences were statistically significant (0.01). Compared with 1 week after surgery, the incidence of nausea and vomiting in the two groups increased at 3 months after surgery, and the differences were statistically significant (0.05 or 0.01). Compared with 1 month after surgery, the incidence of nausea and vomiting in Group A increased at 3 months after surgery, and the difference was statistically significant (0.05). There was no significant difference in the incidence of transient hypotension after surgery in the two groups. The difference in the incidence of postoperative diarrhea was not statistically significant. The incidence was highest within 1 day after surgery and generally recovered within 7 days after surgery. The two schemes can effectively relieve pain in patients with pancreatic cancer with retroperitoneal lymph node metastasis, reduce morphine dose. The combination therapy has higher efficiency and excellent rate, lower morphine dosage after surgery, and lower incidence of nausea and vomiting.
分析CT引导下腹腔神经丛毁损术或腹腔神经丛毁损联合无水乙醇注射对腹膜后淋巴结转移的胰腺癌患者腹膜后肿大淋巴结的镇痛效果（联合治疗）。回顾性分析2014年1月至2018年12月因腹痛控制不佳入住郑州大学附属肿瘤医院的187例腹膜后淋巴结转移的胰腺癌患者的临床资料。根据治疗方法，将其分为2组：A组（48例），采用CT引导下腹腔神经丛毁损术治疗；B组（139例），采用CT引导下联合治疗。比较术前、术后1周、1个月和3个月的镇痛效果、吗啡应用剂量及不良反应。A组患者术前及术后1天、1周、1个月和3个月的口服吗啡剂量分别为（107±34）、（65±23）、（35±12）、（48±18）、（81±25）mg。B组患者术前及术后1天、1周、1个月和3个月的口服吗啡剂量分别为（112±37）、（53±17）、（27±14）、（42±16）、（63±20）mg。两组患者术后1天、1周、1个月和3个月的口服吗啡剂量均较术前显著降低（P<0.05或P<0.01）。A组术后1周疼痛治疗有效率和优良率分别为83.3%和60.4%，B组分别为95.7%和75.5%。A组术后1个月疼痛治疗有效率和优良率分别为71.7%和45.6%，B组分别为89.0%和67.6%；A组术后3个月疼痛治疗有效率和优良率分别为48.6%和25.7%，B组分别为72.6%和47.0%；与A组比较，B组疼痛治疗有效率和优良率升高，差异有统计学意义（P<0.05或P<0.01）。两组患者术前及术后1天恶心呕吐发生率比较差异无统计学意义，但B组术后1周、1个月和3个月恶心呕吐发生率显著降低，差异有统计学意义（P<0.05或P<0.01）。与术前比较，A组术后1周和1个月恶心呕吐发生率显著降低，差异有统计学意义（P<0.01）；B组术后1天、1周、1个月和3个月恶心呕吐发生率显著降低，差异有统计学意义（P<0.01）。与术后1天比较，A组术后1周和1个月恶心呕吐发生率显著降低（P<
0.05或P<0.01）。B组术后1周、1个月和3个月恶心呕吐发生率显著降低，差异有统计学意义（P<0.01）。与术后1周比较，两组术后3个月恶心呕吐发生率升高，差异有统计学意义（P<0.05或P<0.01）。与术后1个月比较，A组术后3个月恶心呕吐发生率升高，差异有统计学意义（P<0.05）。两组术后短暂性低血压发生率比较差异无统计学意义。术后腹泻发生率差异无统计学意义。发生率在术后1天内最高，术后7天内一般恢复。两种方案均可有效缓解腹膜后淋巴结转移的胰腺癌患者的疼痛，减少吗啡剂量。联合治疗有效率和优良率更高，术后吗啡用量更低，恶心呕吐发生率更低。
