Bali B, Deixonne B, Rzal K, Sawhi A, Squali J, Poirée G, Lapeyrie H
Département de Chirurgie digestive et de Cancérologie, CHU Carémeau, Nîmes.
Presse Med. 1995 Jun 3;24(20):928-32.
Surgical splanchnicectomy remains a useful means to relieve pain induced by malignant tumours of the pancreas and chronic pancreatitis. We report our experience in 37 patients.
Between 1983 and 1993, 37 patients underwent transhiatal bilateral splanchnicectomy; 32 had a non-resectable adenocarcinoma and 5 chronic pancreatitis. In all cases, morphine had been required for pain relief.
Symptomatic pain relief was immediately achieved, with complete sedation in 84.3% of the cases. Prolonged antalgic effect continued for the survival period in 84.3%. Mean post-operative follow-up was 12.7 weeks corresponding to mean survival in 32 patients with pancreatic tumour. Post-operative mortality was 21.6% with no direct relationship with neurectomy. Specific morbidity related to pleural drainage was 10.8%.
Compared with other surgical procedures, trans-hiatal bilateral splanchnicectomy is a simple technique which can be performed whatever the stage of the locoregional tumour extension. In patients without an indication for exploratory laparoscopy, percutaneous chemical neurolysis is still indicated, even if the long-term result is less effective. In case of failure or technical impossibilities, thoracoscopic splanchnicectomy should be performed.
手术性内脏神经切除术仍然是缓解胰腺癌和慢性胰腺炎所致疼痛的一种有效方法。我们报告37例患者的治疗经验。
1983年至1993年间，37例患者接受了经裂孔双侧内脏神经切除术；其中32例为不可切除的腺癌，5例为慢性胰腺炎。所有患者均需使用吗啡缓解疼痛。
症状性疼痛立即得到缓解，84.3%的患者完全镇静。84.3%的患者在生存期内持续有长期镇痛效果。32例胰腺肿瘤患者术后平均随访12.7周，相当于平均生存期。术后死亡率为21.6%，与神经切除术无直接关系。与胸腔引流相关的特定发病率为10.8%。
与其他手术方法相比，经裂孔双侧内脏神经切除术是一种简单的技术，无论局部肿瘤扩展处于何种阶段均可实施。对于无探索性腹腔镜检查指征的患者，即使长期效果较差，仍建议进行经皮化学性神经溶解术。若手术失败或技术上不可行，则应进行胸腔镜内脏神经切除术。
