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

胸腔镜下内脏大切除术缓解顽固性腹痛的临床应用研究

基本信息

批准号：
09671248
负责人：
TAKAHASHI Tsuyoshi
金额：
$ 2.5万
依托单位：
Kitasado University
依托单位国家：
日本
项目类别：
Grant-in-Aid for Scientific Research (C)
财政年份：
1997
资助国家：
日本
起止时间：
1997 至 1999
项目状态：
已结题

来源：
https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-09671248/
关键词：
greater splanchnic nerve resection of the nerve pancreas cancer relief of pain upper abdominal pain thoracoscopic approach transhiatal approach quality of life 癌性疼痛腹痛大内蔵神経経食道裂孔性大内蔵神経切離腹部頑痛神経切離術慢性膵炎

项目摘要

[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

[简介]减轻无法切除的胰腺癌或慢性胰腺炎患者的腹部疼痛，我们在临床上对此类患者采用了更大的方案。在这里，我们根据我们的经验讨论了该手术的临床意义。[患者和方法]在1994年，尽管1999年，有27例患者（23例胰腺癌和4例慢性蛋白炎； 15名男性和12名男性和12名女性；仅在剩下的（n = 17）或更大的（10）较大的（10）nicectomy nicectomy nicectomy nicectomy（n = 17）下；用于该手术的经胸膜（16个胸腔镜检查）或thranthiatal（11腹腔切开术）方法。随后以3年级的量表评估了该程序的有效性，因为所有患者在没有重大麻烦的所有患者中都完成了脑脑和经疗法的完全消失，部分降低和无变化。神经切开术后平均动脉压的瞬时下降（…更<45 mmHg），没有其他有害作用。总体而言，在示意图切除术后，有24例我们可以评估腹痛程度的患者中有20例（83％），截止性上腹部疼痛立即完全消失。然而，右上腹部的疼痛仅在4例接受左静态切除术的患者中没有消失。在静脉复制切除术后立即没有腹痛的19例胰腺癌患者中，有6例患者在分裂后1周和/或后腹部疼痛出现下腹部和/或背部疼痛，尽管左上腹痛从未在任何患者中复发。慢性胰腺炎患者没有疼痛。[讨论与结论]本研究的结果表明，分数示意图是缓解与胰腺疾病相关的可怕腹痛的安全有效程序。跨性别方法似乎适用于接受腹腔切开术的患者进行胆道转移和/或胃肠道吻合术，而经胸动型固定型切除术可以应用于不需要此类程序的患者。较少的