| Project/Area Number |
09671248
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| Research Category |
Grant-in-Aid for Scientific Research (C)
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| Allocation Type | Single-year Grants |
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| Section | 一般 |
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| Research Field |
General surgery
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| Research Institution | Kitasado University |
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Principal Investigator |
TAKAHASHI Tsuyoshi Kitasato Univ. School of Medicine, Assistant Professor, 医学部, 講師 (70245405)
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| Co-Investigator(Kenkyū-buntansha) |
YOSHIDA Muneki Kitasato Univ. School of Medicine, Assistant Professor, 医学部, 講師 (50201017)
SHIMADA Ken Kitasato Univ. School of Medicine, Research Associate, 医学部, 助手 (60216059)
KAKITA Akira Kitasato Univ. School of Medicine, Professor, 医学部, 教授 (90109439)
ITO Yoshiya Kitasato Univ. School of Medicine, Research Associate, 医学部, 助手 (40203187)
KITAMURA Masaya Kitasato Univ. School of Medicine, Research Associate, 医学部, 助手 (60281325)
泉家 久直 北里大学, 医学部, 助手 (30193379)
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| Project Period (FY) |
1997 – 1999
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| Project Status |
Completed (Fiscal Year 1999)
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| Budget Amount *help |
¥3,900,000 (Direct Cost: ¥3,900,000)
Fiscal Year 1999: ¥600,000 (Direct Cost: ¥600,000)
Fiscal Year 1998: ¥300,000 (Direct Cost: ¥300,000)
Fiscal Year 1997: ¥3,000,000 (Direct Cost: ¥3,000,000)
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| Keywords | 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 |
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| Research Abstract |
[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
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