晚期胰腺癌患者癌性疼痛的治疗
Treatment of Cancer Pain in Patients with Advanced Pancreatic Cancer
DOI: 10.12677/acm.2025.15123675, PDF,   
作者: 汤永洪, 金成兵*:重庆医科大学附属第二医院肿瘤中心,重庆
关键词: 晚期胰腺癌癌性疼痛疼痛治疗Advanced Pancreatic Cancer Cancer Pain Pain Management
摘要: 胰腺癌恶性程度高,生存率低,初诊时具有可手术切除的患者不足20%,大部分在诊断时处于晚期。疼痛是晚期胰腺癌的主要症状之一,严重影响患者的生活质量。疼痛治疗是晚期胰腺癌患者姑息治疗的核心,可以提高晚期胰腺癌患者的生活质量,并改善患者预后。本文阐述了晚期胰腺癌相关疼痛的主要病理生理机制与肿瘤损伤腹腔神经丛、神经周围浸润相关,对当前治疗晚期胰腺癌患者癌性疼痛的主要治疗方法包括药物治疗、放疗、高强度聚集超声、腹腔丛神经阻滞术和松解术、鞘内药物输注等进行系统论述。
Abstract: Pancreatic cancer is highly aggressive and associated with dismal survival rates. Fewer than 20% of patients are eligible for surgical resection upon initial diagnosis, with the majority presenting at advanced stages. Pain is one of the main symptoms of advanced pancreatic cancer, which seriously affects the patient’s quality of life. Effective pain management serves as the cornerstone of palliative care for advanced pancreatic cancer patients, not only improving quality of life but also potentially influencing disease prognosis. This article elucidates the pathophysiological mechanisms of advanced pancreatic cancer-related pain, primarily attributed to tumor invasion of the celiac plexus and perineural infiltration. We systematically review current therapeutic modalities for managing cancer pain in these patients, including pharmacological interventions, radiotherapy, high-intensity focused ultrasound, neurolytic celiac plexus block, and intrathecal drug delivery systems.
文章引用:汤永洪, 金成兵. 晚期胰腺癌患者癌性疼痛的治疗[J]. 临床医学进展, 2025, 15(12): 2437-2444. https://doi.org/10.12677/acm.2025.15123675

参考文献

[1] Granata, V., Fusco, R., Catalano, O., Setola, S.V., de Lutio di Castelguidone, E., Piccirillo, M., et al. (2016) Multidetector Computer Tomography in the Pancreatic Adenocarcinoma Assessment: An Update. Infectious Agents and Cancer, 11, Article No. 57. [Google Scholar] [CrossRef] [PubMed]
[2] Pergolizzi, R.G. and Brower, S.T. (2024) Molecular Targets for the Diagnosis and Treatment of Pancreatic Cancer. International Journal of Molecular Sciences, 25, Article No. 10843. [Google Scholar] [CrossRef] [PubMed]
[3] Zeng, H., Zheng, R., Sun, K., Zhou, M., Wang, S., Li, L., et al. (2024) Cancer Survival Statistics in China 2019-2021: A Multicenter, Population-Based Study. Journal of the National Cancer Center, 4, 203-213. [Google Scholar] [CrossRef] [PubMed]
[4] Spiliopoulos, S., Reppas, L., Filippiadis, D., Delvecchio, A., Conticchio, M., Memeo, R., et al. (2023) Irreversible Electroporation for the Management of Pancreatic Cancer: Current Data and Future Directions. World Journal of Gastroenterology, 29, 223-231. [Google Scholar] [CrossRef] [PubMed]
[5] Tiwari, P.K., Shanmugam, P., Karn, V., Gupta, S., Mishra, R., Rustagi, S., et al. (2024) Extracellular Vesicular miRNA in Pancreatic Cancer: From Lab to Therapy. Cancers, 16, Article No. 2179. [Google Scholar] [CrossRef] [PubMed]
[6] Yang, Y., Shi, X., Chen, G. and Qian, L. (2023) Risk Factors for Unresectable Pancreatic Cancer Following High‐Intensity Focused Ultrasound Treatment. Cancer Medicine, 12, 19537-19547. [Google Scholar] [CrossRef] [PubMed]
[7] Yan, B.M. and Myers, R.P. (2007) Neurolytic Celiac Plexus Block for Pain Control in Unresectable Pancreatic Cancer. The American Journal of Gastroenterology, 102, 430-438. [Google Scholar] [CrossRef] [PubMed]
[8] Hameed, M., Hameed, H. and Erdek, M. (2010) Pain Management in Pancreatic Cancer. Cancers, 3, 43-60. [Google Scholar] [CrossRef] [PubMed]
[9] Bapat, A.A., Hostetter, G., Von Hoff, D.D. and Han, H. (2011) Perineural Invasion and Associated Pain in Pancreatic Cancer. Nature Reviews Cancer, 11, 695-707. [Google Scholar] [CrossRef] [PubMed]
[10] di Mola, F.F. and di Sebastiano, P. (2008) Pain and Pain Generation in Pancreatic Cancer. Langenbecks Archives of Surgery, 393, 919-922. [Google Scholar] [CrossRef] [PubMed]
[11] D’Haese, J.G., Hartel, M., Demir, I.E., Hinz, U., Bergmann, F., Büchler, M.W., et al. (2014) Pain Sensation in Pancreatic Diseases Is Not Uniform: The Different Facets of Pancreatic Pain. World Journal of Gastroenterology, 20, 9154-9161.
[12] Chen, C.K. and Erdek, M.A. (2025) Celiac Plexus Block and Neurolysis Procedure: Treatment of Chronic Pain in Pancreatic Cancer. Pain Management, 15, 779-781. [Google Scholar] [CrossRef
[13] Sachdev, A.H. and Gress, F.G. (2018) Celiac Plexus Block and Neurolysis: A Review. Gastrointestinal Endoscopy Clinics of North America, 28, 579-586. [Google Scholar] [CrossRef] [PubMed]
[14] Furness, J.B., Callaghan, B.P., Rivera, L.R. and Cho, H. (2014) The Enteric Nervous System and Gastrointestinal Innervation: Integrated Local and Central Control. In: Lyte, M. and Cryan, J.F., Eds., Microbial Endocrinology: The Microbiota-Gut-Brain Axis in Health and Disease, Springer, 39-71. [Google Scholar] [CrossRef] [PubMed]
[15] Barreto, S.G. and Saccone, G.T.P. (2012) Pancreatic Nociception—Revisiting the Physiology and Pathophysiology. Pancreatology, 12, 104-112. [Google Scholar] [CrossRef] [PubMed]
[16] Ceyhan, G.O., Bergmann, F., Kadihasanoglu, M., Altintas, B., Demir, I.E., Hinz, U., et al. (2009) Pancreatic Neuropathy and Neuropathic Pain—A Comprehensive Pathomorphological Study of 546 Cases. Gastroenterology, 136, 177-186.e1. [Google Scholar] [CrossRef] [PubMed]
[17] Lohse, I. and Brothers, S.P. (2020) Pathogenesis and Treatment of Pancreatic Cancer Related Pain. Anticancer Research, 40, 1789-1796. [Google Scholar] [CrossRef] [PubMed]
[18] Lahoud, M.J., Kourie, H.R., Antoun, J., Osta, L.E. and Ghosn, M. (2016) Road Map for Pain Management in Pancreatic Cancer: A Review. World Journal of Gastrointestinal Oncology, 8, 599-606. [Google Scholar] [CrossRef] [PubMed]
[19] Warshaw, A.L., Banks, P.A. and Fernàndez-del Castillo, C. (1998) AGA Technical Review: Treatment of Pain in Chronic Pancreatitis. Gastroenterology, 115, 765-776. [Google Scholar] [CrossRef] [PubMed]
[20] Aprile, G., Rihawi, K., De Carlo, E. and Sonis, S.T. (2015) Treatment-Related Gastrointestinal Toxicities and Advanced Colorectal or Pancreatic Cancer: A Critical Update. World Journal of Gastroenterology, 21, 11793-11803. [Google Scholar] [CrossRef] [PubMed]
[21] Coveler, A.L., Mizrahi, J., Eastman, B., Apisarnthanarax, S., Dalal, S., McNearney, T., et al. (2021) Pancreas Cancer-Associated Pain Management. The Oncologist, 26, e971-e982. [Google Scholar] [CrossRef] [PubMed]
[22] Bunchorntavakul, C. and Reddy, K.R. (2013) Acetaminophen-Related Hepatotoxicity. Clinics in Liver Disease, 17, 587-607. [Google Scholar] [CrossRef] [PubMed]
[23] Corder, G., Castro, D.C., Bruchas, M.R. and Scherrer, G. (2018) Endogenous and Exogenous Opioids in Pain. Annual Review of Neuroscience, 41, 453-473. [Google Scholar] [CrossRef] [PubMed]
[24] Nersesyan, H. and Slavin, K.V. (2007) Current Approach to Cancer Pain Management: Availability and Implications of Different Treatment Options. Therapeutics and Clinical Risk Management, 3, 381-400.
[25] Harris, D.G. (2014) Management of Pain in Advanced Disease. British Medical Bulletin, 110, 117-128. [Google Scholar] [CrossRef] [PubMed]
[26] Gendron, L., Cahill, C.M., von Zastrow, M., Schiller, P.W. and Pineyro, G. (2016) Molecular Pharmacology of δ-Opioid Receptors. Pharmacological Reviews, 68, 631-700. [Google Scholar] [CrossRef] [PubMed]
[27] Wolny-Rokicka, E., Sutkowski, K., Grządziel, A., Dorsz, Ż., Tukiendorf, A., Lipiński, J., et al. (2016) Tolerance and Efficacy of Palliative Radiotherapy for Advanced Pancreatic Cancer: A Retrospective Analysis of Single-Institutional Experiences. Molecular and Clinical Oncology, 4, 1088-1092. [Google Scholar] [CrossRef] [PubMed]
[28] Tello Valverde, C.P., Ebrahimi, G., Sprangers, M.A., Pateras, K., Bruynzeel, A.M.E., Jacobs, M., et al. (2024) Impact of Short-Course Palliative Radiation Therapy on Pancreatic Cancer-Related Pain: Prospective Phase 2 Nonrandomized PAINPANC Trial. International Journal of Radiation Oncology Biology Physics, 118, 352-361. [Google Scholar] [CrossRef] [PubMed]
[29] Wang, Y., Timotin, E., Zia, W., Farrell, T., Reiter, H., Chan, B., et al. (2018) Pain Palliation Using Hypofractionated Radiotherapy for Unresectable Pancreatic Cancer. Journal of Medical Imaging and Radiation Sciences, 49, 293-300. [Google Scholar] [CrossRef] [PubMed]
[30] Buwenge, M., Macchia, G., Arcelli, A., Frakulli, R., Fuccio, L., Guerri, S., et al. (2018) Stereotactic Radiotherapy of Pancreatic Cancer: A Systematic Review on Pain Relief. Journal of Pain Research, 11, 2169-2178. [Google Scholar] [CrossRef] [PubMed]
[31] Buwenge, M., Arcelli, A., Cellini, F., Deodato, F., Macchia, G., Cilla, S., et al. (2022) Pain Relief after Stereotactic Radiotherapy of Pancreatic Adenocarcinoma: An Updated Systematic Review. Current Oncology, 29, 2616-2629. [Google Scholar] [CrossRef] [PubMed]
[32] Lawrence, Y.R., Miszczyk, M., Dawson, L.A., Diaz Pardo, D.A., Aguiar, A., Limon, D., et al. (2024) Celiac Plexus Radiosurgery for Pain Management in Advanced Cancer: A Multicentre, Single-Arm, Phase 2 Trial. The Lancet Oncology, 25, 1070-1079. [Google Scholar] [CrossRef] [PubMed]
[33] Liu, Y., Chen, M., Liu, L., Shen, Z. and Wu, B. (2025) High-Intensity Focused Ultrasound (HIFU) in Pancreatic Cancer-Related Pain: Current Evidence and Future Directions. Ultrasound in Medicine & Biology, 51, 1639-1645. [Google Scholar] [CrossRef] [PubMed]
[34] Fergadi, M.P., Magouliotis, D.E., Rountas, C., Vlychou, M., Athanasiou, T., Symeonidis, D., et al. (2021) A Meta-Analysis Evaluating the Role of High-Intensity Focused Ultrasound (HIFU) as a Fourth Treatment Modality for Patients with Locally Advanced Pancreatic Cancer. Abdominal Radiology, 47, 254-264. [Google Scholar] [CrossRef] [PubMed]
[35] Yang, W., Zhu, B., Li, J., Diao, L., Ma, K. and Fan, Y. (2019) High-Intensity Focused Ultrasound Ablation for Advanced Pancreatic Cancer. Journal of Cancer Research and Therapeutics, 15, Article No. 831. [Google Scholar] [CrossRef] [PubMed]
[36] Ning, Z.Y., Cheng, C.S., Xie, J., Chen, Q.W., Xu, L.T., Zhuang, L.P., et al. (2016) A Retrospective Analysis of Survival Factors of High Intensity Focused Ultrasound (HIFU) Treatment for Unresectable Pancreatic Cancer. Discovery Medicine, 21, 435-445.
[37] Marinova, M., Feradova, H., Gonzalez-Carmona, M.A., Conrad, R., Tonguc, T., Thudium, M., et al. (2021) Improving Quality of Life in Pancreatic Cancer Patients Following High-Intensity Focused Ultrasound (HIFU) in Two European Centers. European Radiology, 31, 5818-5829. [Google Scholar] [CrossRef] [PubMed]
[38] Wiechowska-Kozłowska, A., Boer, K., Wójcicki, M. and Milkiewicz, P. (2012) The Efficacy and Safety of Endoscopic Ultrasound-Guided Celiac Plexus Neurolysis for Treatment of Pain in Patients with Pancreatic Cancer. Gastroenterology Research and Practice, 2012, Article ID: 503098. [Google Scholar] [CrossRef] [PubMed]
[39] Reenas, J., Dixon, B., Hendrix, J.M., et al. (2025) Celiac Plexus Block. StatPearls.
[40] Eisenberg, E., Carr, D.B. and Chalmers, T.C. (1995) Neurolytic Celiac Plexus Block for Treatment of Cancer Pain: A Meta-Analysis. Anesthesia & Analgesia, 80, 290-295. [Google Scholar] [CrossRef
[41] Levy, M.J., Topazian, M.D., Wiersema, M.J., Clain, J.E., Rajan, E., Wang, K.K., et al. (2008) Initial Evaluation of the Efficacy and Safety of Endoscopic Ultrasound-Guided Direct Ganglia Neurolysis and Block. The American Journal of Gastroenterology, 103, 98-103. [Google Scholar] [CrossRef] [PubMed]
[42] Eye, N., Metz, T., Arneson, F. and McKean, H.A. (2025) Impact of Intrathecal Targeted Drug Delivery (ITDD) on Oral Morphine Equivalents and Pain Scores in Advanced Pancreatic Cancer Pain. Journal of Clinical Oncology, 43, 686-686. [Google Scholar] [CrossRef
[43] Carvajal, G., Dupoiron, D., Seegers, V., Lebrec, N., Boré, F., Dubois, P., et al. (2018) Intrathecal Drug Delivery Systems for Refractory Pancreatic Cancer Pain: Observational Follow-Up Study over an 11-Year Period in a Comprehensive Cancer Center. Anesthesia & Analgesia, 126, 2038-2046. [Google Scholar] [CrossRef] [PubMed]
[44] Li, J., Sheng, S., Zhang, K. and Liu, T. (2016) Pain Analysis in Patients with Pancreatic Carcinoma: Irreversible Electroporation versus Cryoablation. BioMed Research International, 2016, Article ID: 2543026. [Google Scholar] [CrossRef] [PubMed]
[45] Marinova, M., Wilhelm-Buchstab, T. and Strunk, H. (2019) Advanced Pancreatic Cancer: High-Intensity Focused Ultrasound (HIFU) and Other Local Ablative Therapies. RöFo-Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren, 191, 216-227. [Google Scholar] [CrossRef] [PubMed]
[46] Whitcomb, D.C., Lehman, G.A., Vasileva, G., Malecka-Panas, E., Gubergrits, N., Shen, Y., et al. (2010) Pancrelipase Delayed-Release Capsules (CREON) for Exocrine Pancreatic Insufficiency Due to Chronic Pancreatitis or Pancreatic Surgery: A Double-Blind Randomized Trial. American Journal of Gastroenterology, 105, 2276-2286. [Google Scholar] [CrossRef] [PubMed]
[47] Jia, S., Wen, F., Gong, T., Li, X., Wang, H., Sun, Y., et al. (2020) A Review on the Efficacy and Safety of Iodine-125 Seed Implantation in Unresectable Pancreatic Cancers. International Journal of Radiation Biology, 96, 383-389. [Google Scholar] [CrossRef] [PubMed]
[48] Masuda, T., Kuramoto, M., Shimada, S., Ikeshima, S., Yamamoto, K., Nakamura, K., et al. (2014) Splanchnicectomy for Pancreatic Cancer Pain. BioMed Research International, 2014, Article ID: 941726. [Google Scholar] [CrossRef] [PubMed]
[49] Vance, C.G., Dailey, D.L., Rakel, B.A. and Sluka, K.A. (2014) Using TENS for Pain Control: The State of the Evidence. Pain Management, 4, 197-209. [Google Scholar] [CrossRef] [PubMed]
[50] Zhang, R., Lao, L., Ren, K. and Berman, B.M. (2014) Mechanisms of Acupuncture-Electroacupuncture on Persistent Pain. Anesthesiology, 120, 482-503. [Google Scholar] [CrossRef] [PubMed]
[51] Staats, P.S., Hekmat, H., Sauter, P. and Lillemoe, K. (2001) The Effects of Alcohol Celiac Plexus Block, Pain, and Mood on Longevity in Patients with Unresectable Pancreatic Cancer: A Double-Blind, Randomized, Placebo-Controlled Study. Pain Medicine, 2, 28-34. [Google Scholar] [CrossRef] [PubMed]
[52] Hendifar, A.E., Petzel, M.Q.B., Zimmers, T.A., Denlinger, C.S., Matrisian, L.M., Picozzi, V.J., et al. (2018) Pancreas Cancer-Associated Weight Loss. The Oncologist, 24, 691-701. [Google Scholar] [CrossRef] [PubMed]
[53] Samala, R.V., Lagman, R.L., Najafi, S. and Fielding, F. (2021) Frequently Asked Questions about Managing Cancer Pain: An Update. Cleveland Clinic Journal of Medicine, 88, 183-191. [Google Scholar] [CrossRef] [PubMed]