基于循证医学的临床常用癌痛微创介入技术

国际肿瘤学杂志››2016,Vol. 43››Issue (10): 775-778.doi:10.3760/cma.j.issn.1673-422X.2016.10.013

基于循证医学的临床常用癌痛微创介入技术

姬凯,邵月娟,王昆

300060 天津医科大学肿瘤医院疼痛治疗科国家肿瘤临床医学研究中心天津市肿瘤防治重点实验室

出版日期:2016-10-08发布日期:2016-09-07
通讯作者:Wang Kun E-mail:tjzlyycancerpain@126.com
基金资助:

天津医科大学肿瘤医院院级科研种子基金(1312)

Evidencebased interventional pain management techniques commonly used in clinical cancer pain

Ji Kai, Shao Yuejuan, Wang Kun

Department of Pain Management, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China

Online:2016-10-08Published:2016-09-07
Contact:王昆 E-mail:tjzlyycancerpain@126.com
Supported by:

Seed Fund for Scientific Research of Tianjin Medical University Cancer Institute and Hospital (1312)

摘要/Abstract

摘要：癌痛严重影响肿瘤患者的生命质量，临床上仍有一部分患者药物治疗后未能获得满意的疼痛缓解。微创介入在其中发挥了重要意义。根据循证医学证据，建议使用腹腔神经丛或内脏神经阻滞治疗上腹部癌痛、上腹下丛阻滞治疗骨盆肿瘤所致内脏痛、经皮椎体成形或椎体后凸成形术治疗肿瘤所致椎体疼痛。肋间神经阻滞治疗胸壁癌痛、奇神经节及鞍区阻滞治疗骨盆肿瘤所致会阴部癌痛只有在临床研究中或是无有效缓解手段时作为一种体恤性治疗使用。

关键词:肿瘤,疼痛,外科手术,微创性

Abstract:Cancer pain can seriously disturb patients′ quality of life. Intractable cancer pain not amenable to standard analgesics is a horrifying truth in parts of the patients. Interventional pain management techniques can be an effective alternative for those patients. Based on the evidence of evidencebased medicine, celiac plexus block or splanchnic nerve block are recommended for the management of upper abdominal cancer pain, pelvic cancer pain can be managed with superior hypogastric plexus block, and back pain due to vertebral compression fractures with tumor invasion can be managed with percutaneous vertebroplasty or kyphoplasty. Intercostal nerve block for chest wall cancer pain, ganglion impar block and saddle block for perineal pain due to pelvic tumors should be used only in the context of an experimental study or in cases of compassionate use with no other available forms of effective pain relief.

Key words:Neoplasms,Pain,Surgical procedures, minimally invasive

姬凯,邵月娟,王昆. 基于循证医学的临床常用癌痛微创介入技术[J]. 国际肿瘤学杂志, 2016, 43(10): 775-778.

Ji Kai, Shao Yuejuan, Wang Kun. Evidencebased interventional pain management techniques commonly used in clinical cancer pain[J]. Journal of International Oncology, 2016, 43(10): 775-778.

参考文献

［1］ Shao YJ, Ji K, Hao JL, et al. Nonpain symptom prevalence and intensity of inpatients with moderate to severe cancer pain in China［J］. Am J Hosp Palliat Care, 2016, 33(5): 448-455. DOI: 10.1177/1049909114565109. ［2］ Wong FC, Lee TW, Yuen KK, et al. Intercostal nerve blockade for cancer pain: effectiveness and selection of patients［J］. Hong Kong Med J, 2007, 13(4): 266-270. ［3］ Gulati A, Shah R, Puttanniah V, et al. A retrospective review and treatment paradigm of interventional therapies for patients suffering from intractable thoracic chest wall pain in the oncologic population［J］. Pain Med, 2015, 16(4): 802-810. DOI: 10.1111/pme.12558. ［4］ Wong GY, Schroeder DR, Carns PE, et al. Effect of neurolytic celiac plexus block on pain relief, quality of life, and survival in patients with unresectable pancreatic cancer: a randomized controlled trial［J］. JAMA, 2004, 291(9): 1092-1099. DOI: 10.1001/jama.291.9.1092. ［5］ Yan BM, Myers RP. Neurolytic celiac plexus block for pain control in unresectable pancreatic cancer［J］. Am J Gastroenterol, 2007, 102(2): 430-438. DOI: 10.1111/j.15720241.2006.00967.x. ［6］ Zhang CL, Zhang TJ, Guo YN, et al. Effect of neurolytic celiac plexus block guided by computerized tomography on pancreatic cancer pain［J］. Dig Dis Sci, 2008, 53(3): 856-860. DOI: 10.1007/s1062000799052. ［7］ Wyse JM, Carone M, Paquin SC, et al. Randomized, doubleblind, controlled trial of early endoscopic ultrasoundguided celiac plexus neurolysis to prevent pain progression in patients with newly diagnosed, painful, inoperable pancreatic cancer［J］. J Clin Oncol, 2011, 29(26): 3541-3546. DOI: 10.1200/JCO.2010.32.2750. ［8］ Zhong W, Yu Z, Zeng JX, et al. Celiac plexus block for treatment of pain associated with pancreatic cancer: a metaanalysis［J］. Pain Pract, 2014, 14(1): 43-51. DOI: 10.1111/papr.12083. ［9］ Mercadante S, Klepstad P, Kurita GP, et al. Sympathetic blocks for visceral cancer pain management: a systematic review and EAPC recommendations［J］. Crit Rev Oncol Hematol, 2015, 96(3): 577-583. DOI: 10.1016/j.critrevonc.2015.07.014. ［10］ Suleyman ON, Talu GK, Camlica H, et al. Efficacy of coeliac plexus and splanchnic nerve blockades in body and tail located pancreatic cancer pain［J］. Eur J Pain, 2004, 8(6): 539-545. DOI: 10.1016/j.ejpain.2004.01.001. ［11］ Pello S, Miller A, Ku T, et al. Hemorrhagic gastritis and duodenitis following celiac plexus neurolysis［J］. Pain Physician, 2009, 12(6): 1001-1003. ［12］ Staats PS, Hekmat H, Sauter P, et al. The effects of alcohol celiac plexus block, pain, and mood on longevity in patients with unresectable pancreatic cancer: a doubleblind, randomized, placebocontrolled study［J］. Pain Med, 2001, 2(1): 28-34. DOI: 10.1046/j.15264637.2001.002001028.x. ［13］ Amr YM, Makharita MY. Comparative study between 2 protocols for management of severe pain in patients with unresectable pancreatic cancer: oneyear followup［J］. Clin J Pain, 2013, 29(9): 807-813. DOI: 10.1097/AJP.0b013e3182757673. ［14］ Kroll CE, Schartz B, GonzalezFernandez M, et al. Factors associated with outcome after superior hypogastric plexus neurolysis in cancer patients［J］. Clin J Pain, 2014, 30(1): 55-62. DOI: 10.1097/AJP.0b013e3182869d68. ［15］ Mishra S, Bhatnagar S, Rana SP, et al. Efficacy of the anterior ultrasoundguided superior hypogastric plexus neurolysis in pelvic cancer pain in advanced gynecological cancer patients［J］. Pain Med, 2013, 14(6): 837-842. DOI: 10.1111/pme.12106. ［16］ Plancarte RS, MayerRivera FJ. Radiofrequency procedures for sacral and pelvic region pain［J］. Pain Pract, 2002, 2(3): 248-249. DOI: 10.1046/j.15332500.2002.02031.x. ［17］贾和平, 金瑞林, 李英杰, 等. 经骶尾椎间盘穿刺毁损奇神经节对会阴部晚期癌痛患者的疗效［J］. 中华麻醉学杂志, 2008, 28(4): 376-377. DOI: 10.3321/j.issn:02541416.2008.04.012. ［18］ Candido K, Stevens RA. Intrathecal neurolytic blocks for the relief of cancer pain［J］. Best Pract Res Clin Anaesthesiol, 2003, 17(3): 407-428. ［19］ Slatkin NE, Rhiner M. Phenol saddle blocks for intractable pain at end of life: report of four cases and literature review［J］. Am J Hosp Palliat Care, 2003, 20(1): 62-66. ［20］ Anselmetti GC, Manca A, Montemurro F, et al. Percutaneous vertebroplasty in multiple myeloma: prospective longterm followup in 106 consecutive patients［J］. Cardiovasc Intervent Radiol, 2012, 35(1): 139-145. DOI: 10.1007/s0027001101114. ［21］ Chew C, Ritchie M, O′Dwyer PJ, et al. A prospective study of percutaneous vertebroplasty in patients with myeloma and spinal metastases［J］. Clin Radiol, 2011, 66(12): 1193-1196. DOI: 10.1016/j.crad.2011.08.004. ［22］Berenson J, Pflugmacher R, Jarzem P, et al. Balloon kyphoplasty versus nonsurgical fracture management for treatment of painful vertebral body compression fractures in patients with cancer: a multicentre, randomised controlled trial［J］. Lancet Oncol, 2011, 12(3): 225-235. DOI: 10.1016/S14702045(11)700080. ［23］ Miller FG, Kallmes DF, Buchbinder R. Vertebroplasty and the placebo response［J］. Radiology, 2011, 259(3): 621-625. DOI: 10.1148/radiol.11102412. ［24］ Hulme PA, Krebs J, Ferguson SJ, et al. Vertebroplasty and kyphoplasty: a systematic review of 69 clinical studies［J］. Spine (Phila Pa 1976), 2006, 31(17): 1983-2001. DOI: 10.1097/01.brs.0000229254.89952.6b. ［25］ Mudano AS, Bian J, Cope JU, et al. Vertebroplasty and kyphoplasty are associated with an increased risk of secondary vertebral compression fractures: a populationbased cohort study［J］. Osteoporos Int, 2009, 20(5): 819-826. DOI: 10.1007/s0019800807455. ［26］ Papanastassiou ID, Aghayev K, Berenson JR, et al. Is vertebral augmentation the right choice for cancer patients with painful vertebral compression fractures?［J］. J Natl Compr Canc Netw, 2012, 10(6): 715-719.

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