Al-Jumah Rana, Urits Ivan, Viswanath Omar, Kaye Alan D, Hasoon Jamal
Department of Anesthesia, Baylor College of Medicine, Houston, USA.
Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center - Harvard Medical School, Boston, USA.
Cureus. 2020 Oct 1;12(10):e10758. doi: 10.7759/cureus.10758.
Abdominal pain related to gastrointestinal malignancy can be notoriously difficult to manage and can lead to significant morbidity and suffering. The blockade of the celiac plexus has traditionally been performed for alleviating abdominal pain related to malignancy. Visceral structures that are innervated by these nerves include the pancreas, liver, gallbladder, mesentery, omentum, and the gastrointestinal tract from the stomach to the transverse colon. Alternatively, this pain can be treated by disrupting visceral nociceptive signals at the splanchnic nerves. In this report, we describe our experience of treating a 50-year-old male patient suffering from severe abdominal pain related to pancreatic cancer with multiple liver metastases. The patient failed medication management and had an international normalized ratio of 1.6, which was a concern for performing a celiac plexus block given the proximity of major vascular structures. The patient instead underwent radiofrequency ablation (RFA) as well as alcohol neurolysis of the bilateral splanchnic nerves and obtained significant relief from the procedure.
与胃肠道恶性肿瘤相关的腹痛 notoriously 难以处理，且会导致严重的发病情况和痛苦。传统上，为缓解与恶性肿瘤相关的腹痛会进行腹腔神经丛阻滞。受这些神经支配的内脏结构包括胰腺、肝脏、胆囊、肠系膜、网膜以及从胃到横结肠的胃肠道。另外，这种疼痛可以通过破坏内脏神经中的内脏伤害性信号来治疗。在本报告中，我们描述了治疗一名50岁男性患者的经验，该患者患有与胰腺癌相关的严重腹痛并伴有多处肝转移。患者药物治疗无效，国际标准化比值为1.6，鉴于主要血管结构的临近，这对进行腹腔神经丛阻滞是一个担忧因素。该患者转而接受了射频消融（RFA）以及双侧内脏神经酒精神经溶解术，并从该手术中获得了显著缓解。
