Study on clinical application of thoracoscopic greater splanchnicectomy for the relief of intractable abdominal pain

[引言]为了缓解不能切除的胰腺癌或慢性胰腺炎患者的顽固性腹痛，我们在临床上对这类患者进行了更大的内脏切除术。本文结合临床经验，对该手术的临床意义进行讨论。[病例与方法] 1994 ~ 1999年共收治胰腺癌23例，慢性胰腺炎4例，男15例，女12例，年龄36-76岁，行左侧内脏大神经切除术17例，双侧内脏大神经切除术10例，经胸（胸腔镜）16例，经裂孔（开腹）11例。术后根据3级量表评价手术的有效性，即既存疼痛完全消失、部分减轻和无变化。[结果]所有患者均顺利完成经胸、经裂孔手术，无严重并发症。除平均动脉压短暂下降外，无其他有害影响（ 关于我们 <45 mmHg）。总体而言，在我们可以评估腹痛程度的24例患者中，20例（83%）在内脏切除术后立即完全消失。然而，仅行左侧内脏神经切除术的4例患者右上腹疼痛并未消失。19例胰腺癌患者术后即刻无腹痛，6例患者术后1周~ 3个月出现下腹痛和（或）背痛，但左上腹痛无复发。慢性胰腺炎患者无疼痛复发。[讨论与结论]内脏大神经切除术是一种安全、有效的治疗胰腺疾病所致顽固性腹痛的方法。经裂孔入路适用于开腹胆道改道和（或）胃肠道吻合的患者，而经胸内脏大神经切除术适用于不需要此类手术的患者。少

[Introduction] To relieve intractable abdominal pain in the patients with unresectable pancreas cancer or chronic pancreatitis, we have clinically applied greater splanchnicectomy to such patients. Here, we discuss on the clinical significance of the procedure based on our experience.[Patients & Methods] During the period of 1994 though 1999, 27 patients (23 pancreas cancer and 4 chronic pacreatitis; 15 male and 12 female; age of 36-76 year-old) underwent either left only (n=17) or bilateral (10) greater splanchnicectomy; either transthoracic (16 thoracoscopy) or transhiatal (11 laparotomy) approach was chosen for the procedure. The effectiveness of the procedure was postoperatively evaluated on a 3-graded scale as complete disappearance, partial reduction, and no change, of the preexisting pain.[Results] Both transthoracic and transhiatal procedures were completed in all patients without major troubles. No detrimental effects other than a transient drop of the mean arterial pressure ( … More <45 mmHg) were observed after neurotomy. Overall, the preexisting upper abdominal pain completely disappeared immediately after splanchnicectomy in 20 (83%) out of 24 patients in whom we could assess the degree of abdominal pain. Pain in the right upper abdomen, however, did not disappear in 4 patients undergoing left splanchnicectomy alone. Among 19 pancreas cancer patients who had no abdominal pain immediately after splanchnicectomy, 6 patients developed lower abdominal and/or back pain at and after 1 week -3 months post-splanchnicectomy, though left upper abdominal pain never recurred in any patients. No pain recurred in the patients with chronic pancreatitis.[Discussion & Conclusion] Results of the present study suggest that rater splanchnicectomy is a safe and efficacious procedure for the relief of intractable abdominal pain associated with pancreas diseases. Transhiatal approach seems to be suitable for the patients who undergo laparotomy for biliary tract diversion and/or gastrointestinal anastomosis, while transthoracic splanchnicectomy may be applied to those requiring no such procedures. Less