Predictors of pain response in patients undergoing endoscopic ultrasound-guided neurolysis for abdominal pain caused by pancreatic cancer
Predictors of pain response in patients undergoing endoscopic ultrasound-guided neurolysis for abdominal pain caused by pancreatic cancer
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DOI：
10.1177/1756283x16644248
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发表时间：
2016-07-01
影响因子：
4.2
通讯作者：
Kudo, Masatoshi
中科院分区：
文献类型：
--
作者：
Minaga, Kosuke;Kitano, Masayuki;Kudo, Masatoshi
背景资料：开发了介入性内镜超声（EUS）引导的手术，如EUS引导的腹腔神经节神经松解术（EUS-CGN）和EUS引导的宽丛神经松解术（EUS-BPN），以治疗腹部癌症相关疼痛;然而，这些手术并不总是有效的。本研究的目的是探讨EUS引导下神经松解术胰腺癌相关pain.Methods的疼痛反应的预测因素：这是一个前瞻性的112例连续患者接受EUS-BPN在我们的机构收集的数据进行回顾性分析。在腹腔神经节可见的情况下增加EUS-CGN。将神经溶解扩散区域分为六个部分，并通过术后计算机断层扫描进行评价。使用视觉模拟量表（VAS）评估疼痛强度，神经松解术后VAS评分降低3分被认为是良好的疼痛反应。单变量和多变量Logistic回归分析，探讨预测疼痛反应在1和4 wk，和complications.Results：一个良好的疼痛反应，分别在77.7%和67.9%的患者在1和4 wk。在这些患者的多变量分析中，联合方法（EUS-BPN + CGN）是1周（比值比= 3.69，p = 0.017）和4周（比值比= 6.37，p = 0.043）时的显著阳性预测因素。联合方法和单一方法治疗的患者的神经溶解/造影剂扩散区域数（平均SD）分别为4.98 +/- 1.08和4.15 +/- 1.12（p < 0.001）。结论：EUS-BPN结合EUS-CGN是EUS引导下神经松解术治疗胰腺癌相关疼痛的良好疼痛反应的预测因子。神经溶解/造影剂扩散区域数量越多，接受联合治疗的患者的结局可能越好。
Background: Interventional endoscopic ultrasound (EUS)-guided procedures such as EUS-guided celiac ganglia neurolysis (EUS-CGN) and EUS-guided broad plexus neurolysis (EUS-BPN) were developed to treat abdominal cancer-associated pain; however, these procedures are not always effective. The aim of this study was to explore predictors of pain response in EUS-guided neurolysis for pancreatic cancer-associated pain.Methods: This was a retrospective analysis of prospectively collected data of 112 consecutive patients who underwent EUS-BPN in our institution. EUS-CGN was added in cases of visible celiac ganglia. The neurolytic-spread area was divided into six sections and evaluated by post-procedural computed tomography scanning. Pain intensity was assessed using a visual analog scale (VAS), and a decrease in VAS scores by 3 points after neurolysis was considered a good pain response. Univariable and multivariable logistic regression analyses were performed to explore predictors of pain response at 1 and 4 weeks, and complications.Results: A good pain response was obtained in 77.7% and 67.9% of patients at 1 and 4 weeks, respectively. In the multivariable analysis of these patients, the combination method (EUS-BPN plus CGN) was a significant positive predictive factor at 1 week (odds ratio = 3.69, p = 0.017) and 4 weeks (odds ratio = 6.37, p = 0.043). The numbers of neurolytic/contrast spread areas (mean SD) were 4.98 +/- 1.08 and 4.15 +/- 1.12 in patients treated with the combination method and single method, respectively (p < 0.001). There was no significant predictor of complications.Conclusions: EUS-BPN in combination with EUS-CGN was a predictor of a good pain response in EUS-guided neurolysis for pancreatic cancer-related pain. The larger number of neurolytic/contrast spread areas may lead to better outcomes in patients receiving combination treatment.