난치성 복통에 대한 흉강경적 내장신경절제술

• Published in: Annals of surgical treatment and research Vol. 69; no. 3; pp. 231 - 235
• Main Authors: 장한정(Han Jeong Chang), 이재길(Jae Gil Lee), 강창무(Chang Moo Kang), 양희준(Hee Joon Yang), 김경식(Kyung Sik Kim), 최진섭(Jin Sub Choi), 김병로(Byong Ro Kim), 이혜연(Hye Yeon Lee), 이우정(Woo Jung Lee)
• Format: Journal Article
• Language: Korean
• Published: 대한외과학회 01.09.2005
• Subjects: 일반외과학; 흉강경적 내장신경절제술; Thoracoscopic splanchnicectomy; Intractable abdominal pain; 난치성 복통
• ISSN: 2288-6575; 2288-6796

Purpose: In patient with intractable abdominal pain due to cancer, with respect to the quality of life, it is often insufficient to relieve pain with the use of analgesics. The development of laparoscopic surgery has made a thoracoscopic splanchnicectomy possible, but the results by using several different methods have varied between different authors. Herein, we introduce a modified method of thoracoscopic splanchnicectomy on the basis of anatomical background from cadaver dissection. Methods: Sixteen thoracoscopic splanchnicectomies were performed, with the Numerical rating scale (NRS) used for the assessment of pain. The procedure was performed, under general anesthesia, using a double lumen catheter to deflate the lung on the operation side with the patient in the lateral decubitus position. Openings were made in the 7th intercostal space at the postaxillary line for a 12 mm trocar and in the 4th and 5th intercostals spaces for 5 and 2 mm trocars, respectively. The terminal branch of the greater splanchnic nerve ends In 5th intercostal space. Six or seven branches of the splanchnic nerve were cut, dissected downward to just above the diaphragm and then cut. The sympathetic trunk was also cut in this level if the patient suffered from constipation. Results: A splanchicectomy appeared to result in significant reduction of abdominal pain in all cases. The average reduction in the pain score was 78%. There were no postoperative complications. Conclusion: A thoracoscopic splanchnicectomy is the treat- ment of choice for intractable intraabdominal cancer pain, helping with drug cessation or the reduction and recovery of daily activity in most patients. KCI Citation Count: 1