张一肖 万海方 王振

[摘要] 目的 評估腹腔丛毁损术联合电针用于顽固性胰腺癌疼痛患者的镇痛效果。 方法2015年6月～2018年12月纳入本院37例胰腺癌患者，采用随机数字法分为两组：腹腔神经丛毁损联合电针组（Ⅰ组，n=19）和腹腔神经丛毁损组（Ⅱ组，n=18），Ⅰ组：取穴、配穴，应用2 Hz和100 Hz交替进行疏密（DD）波，隔日1次，治疗3周，Ⅱ组：单纯腹腔神经丛毁损治疗。两组患者术后均口服吗啡控释片。观察术后1、2、3周VAS评分及QOL、吗啡控释片用量及电针相关并发症等情况。 结果 在电针治疗后1、2、3周时VAS评分明显低于Ⅱ组，Ⅰ组生活质量QOL评分较Ⅱ组明显升高（P<0.05）。此外，Ⅰ组吗啡用量较Ⅱ组明显降低（P<0.05）。 结论 腹腔神经毁损联合电针射频治疗，可以辅助减轻胰腺癌疼痛，同时又能提高患者的生活质量。

[关键词] 胰腺癌疼痛;腹腔神经丛神经毁损术;电针治疗;生活质量

[中图分类号] R614          [文献标识码] B          [文章编号] 1673-9701（2020）15-0144-04

Observation on the efficacy of celiac plexus ablation combined with electroacupuncture in the treatment of pain induced by refractory pancreatic cancer

ZHANG Yixiao   WAN Haifang   WANG Zhen   HUANG Lixia   QU Pisheng  LIU Chenghao   TAO Fan

ZHENG Hanguang

Department of Anesthesiology and Pain， Zhejiang Hospital of Integrated Chinese and Western Medicine， Hangzhou  310003， China

[Abstract] Objective To evaluate the analgesic effect of celiac plexus ablation combined with electroacupuncture in the treatment for the patients with pain induced by refractory pancreatic cancer. Methods From June 2015 to December 2018， 37 patients with pancreatic cancer were included in our hospital. The patients were divided into two groups by random number method： celiac plexus ablation combined with electroacupuncture（group Ⅰ， n=19） and celiac plexus ablation group（group Ⅱ， n=18）. Group I： acupoints were collected and matched， and 2 Hz and 100 Hz were used for alternating dilatational waves（DD） once every other day for three weeks of treatment; Group Ⅱ： celiac plexus ablation was used alone. Both groups of patients were orally given morphine controlled release tablets after surgery. The VAS scores， QOL， dosage of morphine controlled-release tablets， and electroacupuncture-related complications at 1， 2， and 3 weeks after surgery were observed. Results VAS scores at 1， 2， and 3 weeks after electroacupuncture treatment were significantly lower than those in group Ⅱ. The QOL score of quality of life in group Ⅰ was significantly higher than that in group Ⅱ（P<0.05）. In addition， the dosage of morphine in group Ⅰ was significantly lower than that in group Ⅱ（P<0.05）. Conclusion Electroacupuncture and radiofrequency therapy combined with celiac plexus ablation can help reduce the pain of pancreatic cancer， while improve the quality of life of patients.

[Key words] Cancer pain induced by pancreatic cancer; Celiac plexus ablation; Electroacupuncture; Quality of life

癌痛为癌症患者最常见的症状，大约40%～85%的癌症患者遭受疼痛。癌痛可能在患病的不同阶段出现，新诊断患者中大概有25%，在抗肿瘤治疗过程中大概33%，而在晚期时大概75%[1-3]。50%～75%的胰腺癌患者经历着重度疼痛，治疗非常困难，且进行性加重，严重影响患者生存质量[4]，患者期望有效解决恶性肿瘤带来的晚期疼痛，成为临床工作中待解决的问题之一。胰腺癌在消化系统肿瘤中恶性程度较高，发病率和病死率逐年增加，极大威胁人类健康[5]。腹腔神经丛毁损术（neurolytic celiac plexus block，NCPB）常用于治疗顽固性胰腺癌并发疼痛，CT引导下的腹腔神经丛毁损术成为临床常用的胰腺癌镇痛方式[6]，近年来NCPB在CT引导下进行，安全性和准确性皆有显著优越性[7，8]。随着新的药物和外科技术用于治疗胰腺癌，部分患者可能生存的时间长于NCPB的镇痛作用时间，仍可能出现疼痛，本研究拟采用NCPB联合电针射频治疗，观察其对顽固性胰腺癌患者的镇痛治疗效果。……