Objective: 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). Methods: 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 (n=48) , treated with CT-guided celiac plexus destruction; Group B (n=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. Results: 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 (P<0.05 or P<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 (P<0.05 or P<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 (P<0.05 or P<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 (P<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 (P<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 (P<0.05 or P<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 (P<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 (P<0.05 or P<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 (P<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. Conclusions: 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.
目的： 分析胰腺癌伴腹膜后淋巴结转移患者在CT引导下行腹腔神经丛毁损或腹腔神经丛毁损联合腹膜后肿大淋巴结无水乙醇注射治疗（简称联合治疗）胰腺癌相关疼痛的止痛效果。 方法： 回顾性分析2014年1月至2018年12月郑州大学附属肿瘤医院187例因上腹痛控制不佳入院的胰腺癌伴腹膜后淋巴结转移患者临床资料。根据治疗方式分为两组：A组（n=48），在CT引导下行腹腔神经丛毁损治疗；B组（n=139），在CT引导下行联合治疗。分别比较手术前、手术后1周、1个月及3个月时的止痛效果、吗啡应用剂量以及不良反应发生情况。 结果： A组患者术前以及术后1 d、1周、1个月、3个月口服吗啡剂量分别为（107±34）、（65±23）、（35±12）、（48±18）、（81±25）mg，B组患者分别为（112±37）、（53±17）、（27±14）、（42±16）、（63±20）mg；与术前相比，两组患者术后1 d、1周、1个月以及3个月口服吗啡剂量均明显减少，差异均有统计学意义（P<0.05或P<0.01）。术后1周A组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%；术后1个月A组分别为71.7%和45.6%，B组分别为89.0%和67.6%；术后3个月A组分别为48.6%和25.7%，B组分别为72.6%和47.0%；与A组相比，B组疼痛治疗有效率和优良率均增高，差异均有统计学意义（P<0.05或P<0.01）。两组患者术前及术后1 d恶心呕吐发生率差异均无统计学意义，但B组术后1周、1个月和3个月的恶心呕吐发生率明显降低，差异均有统计学意义（P<0.05或P<0.01）。与术前相比，A组术后1周和术后1个月的恶心呕吐发生率明显降低，差异均有统计学意义（P<0.01）；B组术后1 d、1周、1个月以及3个月的恶心呕吐发生率均明显降低，差异均有统计学意义（P<0.01）。与术后1 d相比，A组术后1周和术后1个月的恶心呕吐发生率明显降低（P<0.05或P<0.01），B组术后1周、1个月以及3个月的恶心呕吐发生率均明显降低，差异均有统计学意义（P<0.01）。与术后1周相比，两组患者在术后3个月恶心呕吐发生率有所增高，差异均有统计学意义（P<0.05或P<0.01）。与术后1个月相比，A组患者在术后3个月恶心呕吐发生率有所增高，差异有统计学意义（P<0.05）。两组患者术后一过性低血压发生率差异无统计学意义；术后腹泻发生率差异无统计学意义，在术后1 d内发生率最高，一般在术后7 d内基本恢复。 结论： 两种方案均可有效缓解胰腺癌伴腹膜后淋巴结转移患者的疼痛，降低吗啡用量。联合治疗的有效率和优良率更高，术后应用吗啡剂量更低，恶心呕吐等不良反应发生率更低。.
Keywords: Celiac plexus; Lymph nodes; Pain; Pancreatic neoplasms.