Sato Tetsumi, Sato Tetsu, Kamo Yoshiko, Tanaka Rei
Division of Palliative Medicine, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.
Palliative Care Team, Shizuoka Cancer Center, Nagaizumi-cho, Sunto-gun, Shizuoka, Japan.
Support Care Cancer. 2025 Feb 26;33(3):227. doi: 10.1007/s00520-025-09291-2.
Noxious stimuli caused by enlarged metastatic para-abdominal aortic lymph nodes (PAN) enter the spinal cord via the sympathetic nervous system, and the pain is sometimes resistant to conventional pharmacotherapy. The aim of this retrospective clinical investigation was to verify the efficacy and safety of splanchnic nerve neurolysis (SNN) for intractable abdominal and/or back pain caused by enlarged PAN.
Among cancer pain patients referred to the Palliative Care Team in our hospital between April 2016 and November 2023, those who received SNN for pain relief, with abdominal and/or back pain due to PAN swelling which seemed to be a determining factor for opioid dosage, were all included. SNN was performed under X-ray fluoroscopy guidance in all the cases using a transdiscal approach through Th12/L1 or L1/2 intervertebral space.
Sixteen (6 male and 10 female) patients aged 55.1 ± 12.5 years were included. The major primary sites of malignancy were the esophagus, colon, rectum, and uterine cervix. The opioid doses (oral morphine equivalent) including rescue doses during the 24 h before, 1 week after, and 4 weeks after SNN were 427 ± 514.7, 267.1 ± 296.8 (p = 0.006), and 229.2 ± 230.9 (p = 0.035) mg/day, respectively. The numbers of rescue doses were 4.9 ± 3.0, 1.7 ± 2.6 (p = 0.003), and 2.3 ± 2.5 (p = 0.035) times/day, respectively. Both these parameters significantly decreased by SNN. Mild diarrhea for 2 to 3 days after SNN was observed in two patients.
These results suggest that SNN is an effective and safe interventional treatment for intractable abdominal and/or back pain caused by enlarged PAN.
增大的转移性腹主动脉旁淋巴结（PAN）引起的伤害性刺激通过交感神经系统进入脊髓，且这种疼痛有时对传统药物治疗有抵抗性。这项回顾性临床研究的目的是验证内脏神经溶解术（SNN）对由增大的PAN引起的顽固性腹部和/或背部疼痛的疗效和安全性。
在2016年4月至2023年11月期间转诊至我院姑息治疗团队的癌症疼痛患者中，纳入所有因PAN肿大导致腹部和/或背部疼痛而接受SNN以缓解疼痛的患者，PAN肿大似乎是阿片类药物剂量的决定因素。所有病例均在X线透视引导下，采用经椎间盘途径通过胸12/腰1或腰1/2椎间隙进行SNN。
纳入16例患者（6例男性和10例女性），年龄55.1±12.5岁。主要原发恶性肿瘤部位为食管、结肠、直肠和子宫颈。SNN术前24小时、术后1周和术后4周包括解救剂量在内的阿片类药物剂量（口服吗啡当量）分别为427±514.7、267.1±296.8（p = 0.006）和229.2±230.9（p = 0.035）mg/天。解救剂量次数分别为4.9±3.0、1.7±2.6（p = 0.003）和2.3±2.5（p = 0.035）次/天。这两个参数均因SNN而显著降低。两名患者在SNN术后出现2至3天的轻度腹泻。
这些结果表明，SNN是治疗由增大的PAN引起的顽固性腹部和/或背部疼痛的一种有效且安全的介入治疗方法。
