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

【导论】为了缓解无法切除的胰腺癌或慢性胰腺炎患者的难治性腹痛，我们在临床上对这类患者应用了大胰切除术。在此，我们根据自己的经验，讨论手术的临床意义。【患者与方法】1994 ~ 1999年，27例患者（23例胰腺癌，4例慢性pace炎，男15例，女12例，年龄36 ~ 76岁）行左侧（17例）或双侧（10例）大胰切除术；选择经胸（16次胸腔镜检查）或经口（11次剖腹手术）入路。术后以3个等级评估手术的有效性，分别为完全消失、部分减轻和先前存在的疼痛无变化。[结果]所有患者均完成了经胸和经口手术，无重大并发症。除神经切开术后平均动脉压短暂下降外，无其他不良影响（> 45 mmHg）。总的来说，我们可以评估腹痛程度的24例患者中，有20例（83%）的上腹痛在内脏切除术后立即完全消失。然而，在4例单独行左内脏切除术的患者中，右上腹部疼痛并未消失。在19例胰管切除术后立即没有腹痛的胰腺癌患者中，6例患者在胰管切除术后1周-3个月及之后出现下腹部和/或背部疼痛，但没有任何患者复发左上腹部疼痛。慢性胰腺炎患者无疼痛复发。【讨论与结论】本研究结果提示大胰切除术是一种安全有效的治疗胰腺疾病相关难治性腹痛的方法。经胸廓入路似乎适用于开腹行胆道分流和/或胃肠道吻合的患者，而经胸廓胰切除术可能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