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

[导言]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，我们临床上对这类患者进行了大内脏切除术。[患者与方法]1994~1999年间，27例患者(其中胰腺癌23例，慢性胰腺炎4例；男15例，女12例；年龄36~76岁)行单侧(n=17)或双侧(10例)内脏大切除术，分别采用经胸(16例)或经腹(11例)入路。术后按原有疼痛完全消失、部分减轻、无变化3级评定疗效。[结果]所有患者均顺利完成经胸和经颅手术，无严重并发症发生。除一过性平均动脉压(…)下降外，没有其他不良影响神经切断术后较术前多观察到45毫米汞柱。总体而言，在我们可以评估腹痛程度的24例患者中，有20例(83%)的先前存在的上腹部疼痛在内脏切除后立即完全消失。然而，仅接受左内脏切除术的4名患者的右上腹部疼痛并未消失。19例内脏切除后即刻无腹痛的胰腺癌患者中，有6例在内脏切除后1周~3个月出现下腹部和/或背部疼痛，但无1例左上腹痛复发。慢性胰腺炎患者无疼痛复发。[讨论与结论]本研究结果提示，大鼠内脏切除是一种安全有效的方法，可有效缓解胰腺疾病所致的顽固性腹痛。对于行开腹胆道分流和/或胃肠吻合术的患者，经孔入路似乎是合适的，而对于那些不需要此类手术的患者，则可采用经胸内脏切除术。较少

[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