PREDICTIVE FACTORS FOR PAIN RELIEF AFTER ENDOSCOPIC ULTRASOUND-GUIDED CELIAC PLEXUS NEUROLYSIS
PREDICTIVE FACTORS FOR PAIN RELIEF AFTER ENDOSCOPIC ULTRASOUND-GUIDED CELIAC PLEXUS NEUROLYSIS
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DOI：
10.1111/j.1443-1661.2010.01046.x
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发表时间：
2011-04-01
影响因子：
5.3
通讯作者：
Moriwaki, Hisataka
中科院分区：
文献类型：
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作者：
Iwata, Keisuke;Yasuda, Ichiro;Moriwaki, Hisataka
背景：腹丛神经松解术(CPN)是治疗上腹部癌痛的一种公认的方法。最近，超声内窥镜引导下的CPN(EUS-CPN)被引入，使得CPN能够在实时成像引导下进行，从而使这项技术变得更加安全和容易。然而，这一过程并不总是有效的，少数患者从中受益。不应推荐给怀疑预后不佳的患者。我们确定了影响EUS-CPN疗效的预测因素，以便合理选择治疗策略。患者和方法：连续47例在我们机构接受EUS-CPN的患者符合本研究的条件。在实时超声引导下，将含有造影剂的无水乙醇从腹主动脉注入腹主动脉干的正上方，并在手术后立即进行腹部计算机断层扫描，以评估注射的乙醇的分布。结果：32例(68.1%)疼痛得到缓解。多因素Logistic回归分析显示，直接侵犯腹膜丛和乙醇仅分布于左侧腹膜动脉是影响EUS-CPN疗效的显著因素(优势比分别为4.82和8.67，P=0.0387和0.0224)。结论：直接侵犯腹膜丛的患者EUS-CPN疗效较差。应在腹腔轴两侧注射乙醇，以获得更大的止痛效果。
Background:Celiac plexus neurolysis (CPN) is an established treatment for upper abdominal cancer pain. Recently, endoscopic ultrasound-guided CPN (EUS-CPN) was introduced and has enabled the performance of CPN under real-time imaging guidance, thereby making this technique much safer and easier. However, this procedure is not always efficacious, and a limited number of patients benefit from it. It should not be recommended for patients suspected of having unfavorable outcomes. We determined the predictive factors for response to EUS-CPN in order to enable rational selection of the therapeutic strategy.Patients and Methods:Forty-seven consecutive patients who underwent EUS-CPN at our institutions were eligible for this study. Absolute ethanol containing a contrast medium was injected just above the origin of the celiac trunk from the aorta under real-time EUS guidance, and abdominal computed tomography was performed immediately after the procedure to evaluate the distribution of the injected ethanol. The efficacy in pain relief was evaluated based on the pain score at day 7 after EUS-CPN.Results:Pain relief was obtained in 32 patients (68.1%). Multivariate analysis using a multiple logistic regression model revealed that direct invasion of the celiac plexus and distribution of ethanol only on the left side of the celiac artery were significant factors for a negative response to EUS-CPN (odds ratio = 4.82 and 8.67, P = 0.0387 and 0.0224, respectively).Conclusion:EUS-CPN seems to be less effective in patients with direct invasion of the celiac plexus. Ethanol should be injected on both sides of the celiac axis to obtain greater pain relief.