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肝癌肝动脉化疗栓塞及肝动脉灌注化疗术后疼痛的治疗进展
Treatment progress of pains caused by transcatheter arterial chemoembolization and hepatic arterial infusion chemotherapy in hepatocellular carcinoma
- 局解手术学杂志 2024年33卷第2期 页码：170-174
- 作者机构：
重庆医科大学附属第二医院麻醉科，重庆 400010
- 作者简介：
但伶，E-mail：302069@hospital.cqmu.edu.cn
- 基金信息：重庆市2018年科卫联合医学科研项目(2018ZDXM033)
DOI：10.11659/jjssx.03E023034
中图分类号： R441.1纸质出版日期：2024-02-25，
收稿日期：2023-03-07，
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贾贵鎣,黄燕,黄河等.肝癌肝动脉化疗栓塞及肝动脉灌注化疗术后疼痛的治疗进展[J].局解手术学杂志,2024,33(02):170-174.
JIA Gui-ying,HUANG Yan,HUANG He,et al.Treatment progress of pains caused by transcatheter arterial chemoembolization and hepatic arterial infusion chemotherapy in hepatocellular carcinoma[J].JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY,2024,33(02):170-174.
贾贵鎣,黄燕,黄河等.肝癌肝动脉化疗栓塞及肝动脉灌注化疗术后疼痛的治疗进展[J].局解手术学杂志,2024,33(02):170-174. DOI： 10.11659/jjssx.03E023034.
JIA Gui-ying,HUANG Yan,HUANG He,et al.Treatment progress of pains caused by transcatheter arterial chemoembolization and hepatic arterial infusion chemotherapy in hepatocellular carcinoma[J].JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY,2024,33(02):170-174. DOI： 10.11659/jjssx.03E023034.
摘要
肝动脉化疗栓塞（TACE）及肝动脉灌注化疗（HAIC）等转化治疗是目前将不可切除晚期肝癌降期转化为可切除肝癌的主要治疗方法，不仅可以有效提高患者生存率，同时可为患者提供肝移植的机会。然而，疼痛为肝癌TACE和HAIC治疗的主要并发症，TACE术后腹痛的发生率为19.3％～71.2％，HAIC治疗过程中近64.6%的患者会出现不同程度的疼痛，严重影响患者的生活质量，缩短患者的生存期。目前，TACE和HAIC引起疼痛的发生机制尚不明确，可能与栓塞剂阻塞肿瘤供血动脉后局部肝组织肿胀、肝组织被膜压力增高或肿块包膜被牵拉、栓塞剂与抗肿瘤药物对肝动脉的化学刺激、邻近正常脏器的误栓及肠管缺血所致的内脏痛觉敏化有关。疼痛的干预措施主要有两种，一种是利多卡因、阿片类药物、非甾体抗炎药物及糖皮质激素等干预措施；另一种是腕踝针、中药汤剂等其他干预措施，但治疗效果参差不齐。本文就肝癌TACE及HAIC治疗所致疼痛情况及治疗现状进行综述，以期为其临床治疗提供参考。
Abstract
Conversion therapy such as transcatheter arterial chemoembolization （TACE） and hepatic arterial infusion chemotherapy （HAIC） is the main treatment method to transform unresectable advanced liver cancer into resectable liver cancer， which can not only effectively increase the survival rate of patients， but also provide patients with the opportunity of liver transplantation. However， pain is a major complication of TACE and HAIC in the treatment of liver cancer， and the incidence of abdominal pain after TACE is from 19.3% to 71.2%， and nearly 64.6% of patients have different degrees of pain during HAIC， which seriously affects the quality of life of patients and shortens their survival time. At present， the mechanism of pains caused by TACE and HAIC is not clear， and it may be related to local liver tissue swelling after embolic agents block the tumor blood supply artery， increased pressure in the liver tissue envelope or traction of the mass capsule， chemical stimulation of the hepatic artery by embolic agents and antineoplastic drugs， thrombosis adjacent to the normal organs， and visceral pain sensitization caused by intestinal ischemia. There are two main intervention measures for pain， one of which is lidocaine， opioids， non-steroidal anti-inflammatory drugs and glucocorticoids， and the other is wrist and ankle acupuncture and traditional Chinese medicine decoction， but their treatment effects are uneven. This article summarizes the status and treatment of pain caused by TACE and HAIC therapies for liver cancer， in order to provide reference for its clinical treatment.
关键词
肝动脉化疗栓塞肝动脉灌注化疗疼痛肝癌
Keywords
transcatheter arterial chemoembolizationhepatic arterial infusion chemotherapypainliver cancer
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