EUS visualization and direct celiac ganglia neurolysis predicts better pain relief in patients with pancreatic malignancy
EUS visualization and direct celiac ganglia neurolysis predicts better pain relief in patients with pancreatic malignancy
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DOI：
10.1016/j.gie.2010.10.029
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发表时间：
2011-02-01
影响因子：
7.7
通讯作者：
Levi, Joe
中科院分区：
文献类型：
--
作者：
Ascunce, Gil;Ribeiro, Afonso;Levi, Joe
背景：超声内镜引导下腹腔神经丛松解术（EUS-CPN）可改善胰腺癌患者的疼痛控制。EUS可以可视化腹腔神经节。目的：确定64名胰腺恶性肿瘤患者队列中EUS-CPN反应的预测因素。设计：前瞻性数据库的回顾性分析。设置：学术医疗中心。患者：2008年3月至2010年1月期间，64名胰腺癌患者转诊至EUS。干预措施：EUS-CPN直接注射到腹腔神经节，当通过线性PUS或腹腔血管干双侧注射可见时。主要结果测量：通过单变量和多变量分析预测第1周疼痛改善。结果：第1周时，32例患者（50%）出现症状缓解。在一个包含8个潜在预测因子的多变量模型中，神经节的可视化是反应的最佳预测因子;神经节可见的患者反应的可能性高15倍以上（比值比15.7; P <0.01）。肿瘤位于头部以外的胰腺和患者具有较高的基线疼痛水平与一个良好的respond.Limitations弱相关：回顾性设计和缺乏blinding.Conclusions：可视化腹腔神经节直接注射是最好的预测反应EUS-CPN胰腺恶性肿瘤患者。（Gastrointest Endosc 201173：267-74.）
Background: EUS-guided celiac plexus neurolysis (EUS-CPN) improves pain control in patients with pancreatic cancer. EUS allows visualization of the celiac ganglion.Objective: To determine predictors of response to EUS-CPN in a cohort of 64 patients with pancreatic malignancy.Design: Retrospective analysis of prospective database.Setting: Academic medical center.Patients: Sixty-four patients with pancreatic cancer referred for EUS between March 2008 and January 2010.Interventions: EUS-CPN injected directly into celiac ganglia when visible by linear PUS or bilateral injection at the celiac vascular trunk.Main Outcome Measurements: Predictors of pain improvement at week 1 by univariate and multivariate analysis.Results: At week 1, 32 patients (50%) had a symptomatic response. In a multivariate model with 8 potential predictors, visualization of the ganglia was the best predictor of response; patients with visible ganglia were >15 times more likely to respond (odds ratio 15.7; P < :001). Tumors located outside the head of the pancreas and patients with a higher baseline pain level were weakly associated with a good response.Limitations: Retrospective design and lack of blinding.Conclusions: Visualization of celiac ganglia with direct injection is the best predictor of response to EUS-CPN in patients with pancreatic malignancy. (Gastrointest Endosc 201173:267-74.)