Treatment of pancreatic cancer celiac plexus block

By | April 2, 2012

Celiac plexus block in pancreatic cancer therapy is that the main factors affecting the choice of cases. Rykowski parts of the pancreatic cancer pain effect of CPN. 50 cases of pancreatic cancer in the X-measurement down CPN any surgery, 37 patients still have pain relief until death (74%), of which the first cancer was 33 cases faster (92%), 4 cases of carcinoma of the pancreas body and tail, and the remaining 13 patients the pain mitigation is not obvious, the 13 cases, including membrane of pancreatic head carcinoma in 3 cases and 10 cases of carcinoma of the body and tail. Are planning to use pain relief is not obvious after the chest CT guided down the foot CPN, CT examination revealed a large number of tumor tissue surrounding the celiac trunk, so even after repeated injection of CPN had no significant effect, the need to increase opiate treatment. Film head cancer pain effect seems to be better than the pancreatic body and tail cancer. After the efficacy of tumor invasion are not satisfied with celiac. It was pointed out that the report body and tail of the pancreas is even more advanced tumor stage. It has been reported soon after the onset of pancreatic cancer pain, the line CPN, there may be immediate and longer-term pain relief.
Celiac plexus block in pancreatic cancer treatment, these conclusions are also in clinical reasonable, pancreatic body and tail tumors symptoms in a late stage and make a diagnosis, then, may have been outside the nerve membrane of tumor invasion, tumor extension caused by celiac artery and anatomical changes in the solar plexus, and may direct the transfer combined with tumor pain. Gunaratnam so that adjuvant chemotherapy or radiation therapy with a celiac plexus block lower pain scores. It has recently been reported 98 cases of advanced pancreatic cancer palliative bypass surgery, plus radiation treatment after surgery, compared with surgery within the CPN survival time, survival time without pain medication than the latter. These results suggest that slow the spread of the tumor can increase the analgesic effect.
CPB used for analgesic effect of chronic pancreatitis is not clear. Most of the way with percutaneous CPN studies are not prospective, randomized double-blind, small sample size. Many studies have prompted after CPB may have short-term pain relief (weeks to months), were not more long-term pain relief, did not do repetitive research. Recent studies using corticosteroid injection in the treatment of chronic pancreatitis pain, not cause permanent nerve damage. Permanent nerve damage alcohol injections can cause a rare neurological complications, the use of hormones does not appear such complications. Percutaneous injection of hormones present path reported small sample size, sample design defects, limiting their widespread use.
Relatively closer to the stomach from the abdominal wall nerve to ensure that the needle accurately into the solar plexus, to avoid foot into the gap as well as accidental injury after chest nerves and lead to the possibility of pneumothorax, thus reducing the risk of complications and may increase the blocking effect. Although EUS is not unique advantages of the first path, but before the injection itself has a lower path of the risk of complications, almost does not occur, such as trauma, injection into or near the spinal artery or nerve, and injection across the cross-chest or pleural cavity caused by chest injury. Wiersema and Wiersema in 24 cases of pancreatic cancer pain, such as EUS-CPN treatment, patients were followed up for 12 weeks. Pain relief rate of 88%, the average effect for 10 weeks. Studies have reported 58 cases of pancreatic EUS-CPN result, after 2 weeks, 78% of the cases significantly lower pain scores, CP <O.0001), which lasted for 24 weeks, with the use of morphine and other support unrelated to treatment.
EUS-CPN seems to mitigate the pain of pancreatic cancer the same way as with other CPN safe and effective, the other with tumor grade and biopsy simultaneously. EUS-CPN has also been shown effective in controlling pain in chronic pancreatitis. Gress and other prospective studies of the EUS-CPN and CPN CT guided treatment of chronic pancreatitis pain. In 22 patients, 50% EUS-CPN and CT-CPN were pain scores decreased pain medication use decreased. No complications occurred, 30% EUS-CPN were pain relief for up to 24 weeks.
Wiersema initially reported EUS-CPN can significantly reduce the pain of pancreatic cancer, efficacy for up to 12 weeks. The same research group subsequently results not only include malignancy, use of drugs is also an income of chronic pancreatitis pain. The beginning of the two groups no significant difference in pain scores at 16 weeks, no significant pain relief of chronic pancreatitis, malignant disease of pain scores remained below the baseline, estimated time of malignant pain control for 20 weeks, chronic pancreatitis 2 weeks, pain medications (or maintain the amount of reduction) using two sets of the same. Ischia so soon after the discovery confirmed the line lesions (PN, rather than long intervals is better. Speculate on the extension with the disease, lesions of this anti-body to other organs and nerves, causing pain down effect. Gress so on 90fill] CPB membership of chronic pancreatitis pain injections Long Qu Anzai, and define a large reduction in pain scores.
Celiac plexus block in pancreatic cancer treatment, on the other hand, has also been reported percutaneous or EUS-CPB is not ideal. 1996 was reported EUS-CPB bupivacaine treatment of chronic pancreatitis, the operation was successful, the patient 24 hours once again the pain. Subsequent studies have pointed out, 90 cases of chronic pancreatitis 11,156% of cases were relieved of pain 8 weeks, 26% of remission for 12 weeks, 10% remission for 24 weeks. The negative predictive factor for treatment include: age of 45 years of age, surgical history with pancreatic diseases. The study, 12 patients with the CT and EUS-guided, only 12 patients radio EUS-CPB, but the cost of EUS are relatively cheap. Conducted a study of 18 patients with chronic pancreatitis CT or EUS guided CPB treatment, EUS-CPB group of more significant pain relief (50%: 25%), lasting pain relief (30% 24 weeks: 12% 12 weeks).
2003 review of the English literature regarding CPN / CPB, after the full article, Michael, etc. Summary: no matter what the technology used, CPN / CPB similar efficacy (EUS or PQ). EUS-CPN pain rate of pain and percutaneous approach was similar, although the comparison studies have not been widely carried out, but some people think those effects EUS seems to be high. EUS-CPN/CPB percutaneous neurological complications were similar or slightly lower, but EUS-CPN / ePB no reports of serious complications, however, EUS for the former path of the needle, needle does not enter the post-breast ultrasound foot compartment, neurological deficits and reduce the risk of pulmonary complications. PQ with a different path, EUS guided only through the thin stomach wall, will also reduce puncture injuries of abdominal organs. Transient diarrhea, hypotension, and complications such as local pain no difference between the two. EUS-CPN/CPB way through the stomach can not be disinfected, may increase the chance of infection.

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