 英语晨读 · 山东省立医院疼痛科英语晨读已经坚持10余年的时间了，每天交班前15分钟都会精选一篇英文文献进行阅读和翻译。一是可以保持工作后的英语阅读习惯，二是可以学习前沿的疼痛相关知识。我们会将晨读内容与大家分享，助力疼痛学习。 本次文献选自Vig S, Bhan S, Bhatnagar S. Celiac Plexus Block - An Old Technique with New Developments. Pain Physician. 2021 Aug;24(5):379-398. 本次学习由陈阳主治医师主讲。 Abstract BACKGROUND: Celiac plexus block (CPB) is an interventional technique known to be effective in the management of abdominal pain caused by pancreatic cancer. OBJECTIVE: To review the journey of CPB as an interventional analgesic technique from its inception to its current status in the field of cancer pain management. STUDY DESIGN: Descriptive review.METHODS: PubMed database was searched for celiac plexus block, celiac plexus neurolysis, and pancreatic cancer pain relief. Randomized control trials and case series with more than 10 patients were included. A second search was done from the references of all the included articles to add studies fulfilling the inclusion criteria which were missed in the first broad search. RESULTS: A total of 44 studies were included in this literature review. Available evidence through the years was categorized based on the imaging technique used to guide needle insertion and studies were tabulated based on study design, the number of patients included, the technique of CPB, and the conclusions drawn. LIMITATIONS: Meta-analysis of the available studies was not done because of heterogeneous nature of studies. CONCLUSION: Over the years, the majority of clinical trials have focused on fluoroscopy-guided CPB. Computed tomography-guided blockade of celiac plexus is the next choice among pain physicians and percutaneous ultrasound-guided CPB is a relatively new technique. The data generated over the years does not point to a single technique being the gold standard for CPB and choice of technique may be guided by the individual’s preference, familiarity with the technique, and institutional practice.KEY WORDS: Pancreatic cancer, coeliac plexus block, coeliac plexus neurolysis 背景:腹腔神经丛阻滞(CPB)是一种介入治疗胰腺癌引起的腹痛的有效方法。 目的:回顾CPB作为一种介入镇痛技术从产生到目前在癌症疼痛治疗领域的发展历程。 研究设计:描述性回顾。 方法:在PubMed数据库中搜索腹腔神经丛阻滞、腹腔神经丛毁损和胰腺癌疼痛缓解。纳入10例以上患者的随机对照试验和病例系列。从所有纳入文章的参考文献中进行了第二次搜索，以添加在第一次广泛搜索中遗漏的符合纳入标准的研究。 结果:本次文献综述共纳入44篇文献。根据引导针入的影像学技术对多年来的可用证据进行分类，并根据研究设计、纳入的患者数量、CPB技术和得出的结论将研究结果制成表格。 局限性:由于研究的异质性，没有对现有研究进行meta分析。 结论:多年来，大多数临床试验都集中在影像引导下的CPB。CT引导的腹腔神经丛阻断是疼痛医生的下一个选择，而经皮超声引导的CPB是一种相对较新的技术。多年来的数据并没有指出某一种技术是CPB的黄金标准，技术的选择可能受到个人偏好、对技术的熟悉程度和制度实践的指导。 关键词:胰腺癌，腹腔丛神经阻滞，腹腔丛神经毁损 Pain is a major cause of distress among cancer patients. Despite advances in analgesic modalities, the prevalence of cancer-related pain was estimated to be around 39% after curative treatment, 55% during anticancer therapy, and 66% in metastatic or terminal disease. 疼痛是癌症病人的一大主诉。尽管镇痛药在发展，癌症相关疼痛的发生率在治疗后约为39%，在抗癌治疗期间为55%，在转移性或晚期疾病中为66%
Abdominal malignancies constitute a major chunk of the global malignancy burden. Based on the GLOBOCAN 2018 estimates, pancreatic cancer is the 11th commonest cancer globally and the 7th leading cause of cancer-related mortality in industrialized countries. Pancreatic cancer, in early stages, may be asymptomatic and around 80-90% are diagnosed in the advanced unresectable stage. Thus, advanced pancreatic cancer is a major cause of uncontrolled abdominal pain. 腹部恶性肿瘤构成全球恶性肿瘤负担的一大块。根据GLOBO-CAN 2018的估计，胰腺癌在工业化国家发病率全球排第11位，肿瘤相关死亡率排第7位。胰腺癌在早期可能没有症状，有80-90%的患者是在晚期不能切除的阶段被诊断出来的。因此，晚期胰腺癌是导致无法控制的腹痛的主要原因。 |
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