超声内镜引导下腹腔神经丛阻滞术及其衍生技术进展

doi:10.16139/j.1007-9610.2025.05.02

摘要/Abstract

摘要：

本综述系统总结了超声内镜引导下腹腔神经丛阻滞术（EUS-CPN）及其衍生技术的临床应用与研究进展。内容涵盖适应证与禁忌证、操作难点与技术原则，并重点介绍了单侧与双侧注射、腹腔神经节神经松解术（EUS-CGN）、广泛神经丛阻滞法（EUS-BPN）以及射频消融、放射性粒子植入等多种路径。同时，对相关并发症及防治策略进行了总结，并对未来发展方向进行了展望，旨在为临床实践提供技术参考与决策依据。

关键词: 超声内镜, 腹腔神经丛阻滞术, 癌性疼痛, 神经节注射, 射频消融

Abstract:

This review systematically summarizes the clinical applications and recent advances of endoscopic ultrasound-guided celiac plexus neurolysis (EUS-CPN) and its derived techniques. It addressed the indications, contraindications, technical challenges, and procedural principles, with a detailed overview of unilateral and bilateral injection, EUS-guided celiac ganglia neurolysis (EUS-CGN), EUS-guided broad-plexus neurolysis (EUS-BPN), as well as radiofrequency ablation and radioactive seed implantation. In addition, complications and their preventive strategies were discussed, and future directions were highlighted, aiming to provide technical references and decision-making guidance for clinical practice.

Key words: Endoscopic ultrasound (EUS), Celiac plexus neurolysis (CPN), Cancer pain, Ganglion injection, Radiofrequency ablation (RFA)

中图分类号:

R573

敖心怡, 李丽, 李志, 王凯旋. 超声内镜引导下腹腔神经丛阻滞术及其衍生技术进展[J]. 外科理论与实践, 2025, 30(05): 378-384.

AO Xinyi, LI Li, LI Zhi, WANG Kaixuan. Advances in endoscopic ultrasound-guided celiac plexus neurolysis and its derivative techniques[J]. Journal of Surgery Concepts & Practice, 2025, 30(05): 378-384.

图/表 1

参考文献 52

[1]	STEELE G L, DUDEK A Z, GILMORE G E, et al. Impact of pain, opioids, and the mu-opioid receptor on progression and survival in patients with newly diagnosed stage Ⅳ pancreatic cancer[J]. Am J Clin Oncol, 2020, 43(8):591-597. doi: 10.1097/COC.0000000000000714 URL
[2]	WIERSEMA M J, WIERSEMA L M. Endosonography-guided celiac plexus neurolysis[J]. Gastrointest Endosc, 1996, 44(6):656-662. doi: 10.1016/s0016-5107(96)70047-0 pmid: 8979053
[3]	ON W, AHMED W, EVERETT S, et al. Utility of interventional endoscopic ultrasound in pancreatic cancer[J]. Front Oncol, 2023,13:1252824.
[4]	WYSE J M, BATTAT R, SUN S, et al. Practice guidelines for endoscopic ultrasound-guided celiac plexus neurolysis[J]. Endosc Ultrasound, 2017, 6(6):369-375. doi: 10.4103/eus.eus_97_17 pmid: 29251270
[5]	TEOH A Y B, DHIR V, KIDA M, et al. Consensus guidelines on the optimal management in interventional EUS procedures: results from the Asian EUS group RAND/UCLA expert panel[J]. Gut, 2018, 67(7):1209-1228. doi: 10.1136/gutjnl-2017-314341 pmid: 29463614
[6]	WYSE J M, SAHAI A V. Eus-guided celiac plexus neurolysis for pain in pancreatic cancer: when and how?[M]//Domínguez-Muñoz J E. Clinical Pancreatology for Practising Gastroenterologists and Surgeons. John Wiley & Sons,2021:514-519.
[7]	MINAGA K, KITANO M, SAKAMOTO H, et al. Predictors of pain response in patients undergoing endoscopic ultrasound-guided neurolysis for abdominal pain caused by pancreatic cancer[J]. Therap Adv Gastroenterol, 2016, 9(4):483-494. doi: 10.1177/1756283X16644248 pmid: 27366217
[8]	CHAN L K M, RAO T, MASANGCAY P, et al. A systema-tic review and meta-analysis of the efficacy of endoscopic ultrasound guided celiac plexus blocks for chronic pancreatitis pain[J]. J Pain Palliat Care Pharmacother, 2025, 39(2):254-265. doi: 10.1080/15360288.2025.2479481 URL
[9]	STRAND D S, LAW R J, YANG D, et al. AGA clinical practice update on the endoscopic approach to recurrent acute and chronic pancreatitis: expert review[J]. Gastroenterology, 2022, 163(4):1107-1114. doi: 10.1053/j.gastro.2022.07.079 URL
[10]	WILCOX C M, BANG J Y, BUXBAUM J, et al. Effect of endoscopic ultrasound guided celiac plexus block on the palliation of pain in chronic pancreatitis (EPOCH Trial): study protocol for a randomized multicenter sham-controlled trial {1}[J]. Trials, 2024, 25(1):676. doi: 10.1186/s13063-024-08478-y pmid: 39396987
[11]	LEVY M J, GLEESON F C, TOPAZIAN M D, et al. Combined celiac ganglia and plexus neurolysis shortens survival, without benefit, vs. plexus neurolysis alone[J]. Clin Gastroenterol Hepatol, 2019, 17(4):728-738.e9. doi: 10.1016/j.cgh.2018.08.040 URL
[12]	AGSE Standards of Practice Committee, ACOSTA R D, ABRAHAM N S, et al. The management of antithrombotic agents for patients undergoing GI endoscopy[J]. Gastrointest Endosc, 2016, 83(1):3-16. doi: 10.1016/j.gie.2015.09.035 pmid: 26621548
[13]	SACHDEV A H, GRESS F G. Celiac plexus block and neurolysis: a review[J]. Gastrointest Endosc Clin N Am, 2018, 28(4):579-586. doi: S1052-5157(18)30736-0 pmid: 30241645
[14]	ROSENTHAL M H, LEE A, JAJOO K. Imaging and endoscopic approaches to pancreatic cancer[J]. Hematol Oncol Clin North Am, 2015, 29(4):675-699. doi: 10.1016/j.hoc.2015.04.008 URL
[15]	KITANO M, KAMATA K. Advances in EUS[M]//JONNALAGADDA S S. Gastrointestinal endoscopy: new technologies and changing paradigms. Springer,2015:147-178.
[16]	GLEESON F C, LEVY M J, PAPACHRISTOU G I, et al. Frequency of visualization of presumed celiac ganglia by endoscopic ultrasound[J]. Endoscopy, 2007, 39(7):620-624. pmid: 17549662
[17]	朱春辉, 王哲银, 凌地洋. CT-CPN和EUS-CPN在缓解胰腺癌所致癌性腹痛中的价值对比[J]. 现代诊断与治疗, 2019, 30(8):1303-1304.
	ZHU C H, WANG Z Y, LING D Y. Comparative value of CT‑guided versus EUS‑guided celiac plexus neurolysis for pancreatic cancer-related cancer pain[J]. Mod Diagn Treat, 2019, 30(8):1303‑1304.
[18]	OKITA M, OTANI K, GIBO N, et al. Systematic review and meta-analysis of celiac plexus neurolysis for abdominal pain associated with unresectable pancreatic cancer[J]. Pain Pract, 2022, 22(7):652-661. doi: 10.1111/papr.13143 pmid: 35748531
[19]	OKITA M, OTANI K, MATSUI S. Efficacy of endoscopic ultrasound-guided celiac plexus neurolysis for abdominal pain in patients with unresectable pancreatic cancer: network meta-analysis of randomized controlled trials[J]. J Clin Gastroenterol, 2023, 57(10):1054-1062. doi: 10.1097/MCG.0000000000001773 URL
[20]	KOULOURIS A I, ALEXANDRE L, HART A R, et al. Endoscopic ultrasound-guided celiac plexus neurolysis (EUS-CPN) technique and analgesic efficacy in patients with pancreatic cancer: a systematic review and meta-analysis[J]. Pancreatology, 2021, 21(2):434-442. doi: 10.1016/j.pan.2020.12.016 pmid: 33461931
[21]	BHATNAGAR S, JOSHI S, RANA S P, et al. Bedside ultrasound-guided celiac plexus neurolysis in upper abdominal cancer patients: a randomized, prospective study for comparison of percutaneous bilateral paramedian vs. unilateral paramedian needle-insertion technique[J]. Pain Pract, 2014, 14(2):E63-E68.
[22]	ASIF A A, WALAYAT S K, BECHTOLD M L, et al. EUS-guided celiac plexus neurolysis for pain in pancrea-tic cancer patients - a meta-analysis and systematic review[J]. J Community Hosp Intern Med Perspect, 2021, 11(4):536-542.
[23]	SAHAI A V, LEMELIN V, LAM E, et al. Central vs. bila-teral endoscopic ultrasound-guided celiac plexus block or neurolysis: a comparative study of short-term effectiveness[J]. Am J Gastroenterol, 2009, 104(2):326-329. doi: 10.1038/ajg.2008.64 URL
[24]	LEVY M J, TOPAZIAN M D, WIERSEMA M J, et al. Initial evaluation of the efficacy and safety of endoscopic ultrasound-guided direct Ganglia neurolysis and block[J]. Am J Gastroenterol, 2008, 103(1):98-103. pmid: 17970834
[25]	XUAN M, LI N, WU C. A meta-analysis on the efficacy of endoscopic ultrasonography for treatment of pancreatic cancer[J]. Clinics (Sao Paulo), 2024,79:100348.
[26]	DOI S, YASUDA I, KAWAKAMI H, et al. Endoscopic ultrasound-guided celiac ganglia neurolysis vs. celiac plexus neurolysis: a randomized multicenter trial[J]. Endoscopy, 2013, 45(5):362-369. doi: 10.1055/s-00000012 URL
[27]	ASCUNCE G, RIBEIRO A, REIS I, et al. EUS visualization and direct celiac ganglia neurolysis predicts better pain relief in patients with pancreatic malignancy (with video)[J]. Gastrointest Endosc, 2011, 73(2):267-274. doi: 10.1016/j.gie.2010.10.029 pmid: 21295640
[28]	HAO S J, XU W J, YANG D, et al. How to improve the efficacy of endoscopic ultrasound-guided celiac plexus neurolysis in pain management in patients with pancreatic cancer: analysis in a single center[J]. Surg Laparosc Endosc Percutan Tech, 2014, 24(1):31-35.
[29]	KAMATA K, KINOSHITA M, KINOSHITA I, et al. Efficacy of EUS-guided celiac plexus neurolysis in combination with EUS-guided celiac ganglia neurolysis for pancreatic cancer-associated pain: a multicenter prospective trial[J]. Int J Clin Oncol, 2022, 27(7):1196-1201. doi: 10.1007/s10147-022-02160-6 pmid: 35412211
[30]	ISHIWATARI H, HAYASHI T, YOSHIDA M, et al. Phenol-based endoscopic ultrasound-guided celiac plexus neurolysis for East Asian alcohol-intolerant upper gastrointestinal cancer patients: a pilot study[J]. World J Gastroenterol, 2014, 20(30):10512-10517. doi: 10.3748/wjg.v20.i30.10512 URL
[31]	SINGH S, FACCIORUSSO A, VINAYEK R, et al. Endoscopic ultrasound-guided treatments for pancreatic cancer: understanding how endoscopic ultrasound has revolutionized management of pancreatic cancer[J]. Cancers(Basel), 2024, 17(1):89.
[32]	SINGH G, KAUFMAN M S, ERBER J A, et al. M2032 efficacy of endoscopic ultrasound (EUS) guided celiac plexus neurolysis (CPN) for managing abdominal pain associated with pancreas cancer: a meta-analysis[J]. Gastroenterology, 2008, 134(4):A-454.
[33]	LU F, DONG J, TANG Y, et al. Bilateral vs. unilateral endoscopic ultrasound-guided celiac plexus neurolysis for abdominal pain management in patients with pancreatic malignancy: a systematic review and meta-analysis[J]. Support Care Cancer, 2018, 26(2):353-359.
[34]	MOUTINHO-RIBEIRO P, COSTA-MOREIRA P, CALDEIRA A, et al. Endoscopic ultrasound-guided celiac plexus interventions[J]. GE Port J Gastroenterol, 2020, 28(1):32-38. doi: 10.1159/000508293 URL
[35]	FUJII-LAU L L, BAMLET W R, ELDRIGE J S, et al. Impact of celiac neurolysis on survival in patients with pancreatic cancer[J]. Gastrointest Endosc, 2015, 82(1):46-56.e2. doi: 10.1016/j.gie.2014.12.036 URL
[36]	SAKAMOTO H, KITANO M, KAMATA K, et al. EUS-guided broad plexus neurolysis over the superior mesenteric artery using a 25-gauge needle[J]. Am J Gastroenterol, 2010, 105(12):2599-2606. doi: 10.1038/ajg.2010.339 pmid: 20823834
[37]	GAI B, ZHANG F. Chinese expert consensus on radioactive (125)I seeds interstitial implantation brachytherapy for pancreatic cancer[J]. J Cancer Res Ther, 2018, 14(7):1455-1462. doi: 10.4103/jcrt.JCRT_96_18 URL
[38]	BANG J Y, SUTTON B, HAWES R H, et al. EUS-guided celiac ganglion radiofrequency ablation versus celiac plexus neurolysis for palliation of pain in pancreatic cancer: a randomized controlled trial (with videos)[J]. Gastrointest Endosc, 2019, 89(1):58-66. doi: 10.1016/j.gie.2018.08.005 URL
[39]	SINGH S, SHEPHERD K, MAAN S, et al. EUS guided radiofrequency ablation (RFA) of celiac ganglion using a novel RFA needle for pain management in patients with pancreatic cancer: a pilot study[J]. Gastrointestinal Endoscopy, 2025, 101(5):S546-S547.
[40]	JIN Z, DU Y, LI Z, et al. Endoscopic ultrasonography-guided interstitial implantation of iodine 125-seeds combined with chemotherapy in the treatment of unresectable pancreatic carcinoma: a prospective pilot study[J]. Endoscopy, 2008, 40(4):314-320. doi: 10.1055/s-2007-995476 pmid: 18283622
[41]	WANG K X, JIN Z D, DU Y Q, et al. EUS-guided celiac ganglion irradiation with iodine-125 seeds for pain control in pancreatic carcinoma: a prospective pilot study[J]. Gastrointest Endosc, 2012, 76(5):945-952. doi: 10.1016/j.gie.2012.05.032 URL
[42]	TIAN L, LI Z, WANG X. Tu1371 combined EUS-guided celiac plexus neurolysis and Iodine-125 versus EUS-guided celiac plexus neurolysis for palliation of pain in pancreatic cancer: a prospective, randomized study[J]. Gastrointestinal Endoscopy, 2019, 89(6):AB595.
[43]	ZHANG P P, SU X J, LI L, et al. Clinical efficacy of EUS-guided celiac plexus neurolysis versus EUS-guided celiac ganglion irradiation with iodine-125 seeds for pain relief in advanced pancreatic cancer: a long-term retrospective study[J]. Endosc Ultrasound, 2024, 13(2):100-106. doi: 10.1097/eus.0000000000000048 URL
[44]	ALVAREZ-SÁNCHEZ M V, JENSSEN C, FAISS S, et al. Interventional endoscopic ultrasonography: an overview of safety and complications[J]. Surg Endosc, 2014, 28(3):712-734. doi: 10.1007/s00464-013-3260-5 URL
[45]	LAKHTAKIA S. Complications of diagnostic and therapeutic endoscopic ultrasound[J]. Best Pract Res Clin Gastroenterol, 2016, 30(5):807-823. doi: S1521-6918(16)30087-7 pmid: 27931638
[46]	AHMED H M, FRIEDMAN S E, HENRIQUES H F, et al. End-organ ischemia as an unforeseen complication of endoscopic-ultrasound-guided celiac plexus neurolysis[J]. Endoscopy, 2009, 41(Suppl 2):E218-E219. doi: 10.1055/s-0029-1214941 URL
[47]	FUJII L, CLAIN J E, MORRIS J M, et al. Anterior spinal cord infarction with permanent paralysis following endoscopic ultrasound celiac plexus neurolysis[J]. Endoscopy, 2012, 44(Suppl 2 UCTN):E265-E266. doi: 10.1055/s-00000012 URL
[48]	GIMENO-GARCÍA A Z, ELWASSIEF A, PAQUIN S C, et al. Fatal complication after endoscopic ultrasound-guided celiac plexus neurolysis[J]. Endoscopy, 2012, 44 (Suppl 2 UCTN):E267. doi: 10.1055/s-00000012 URL
[49]	MINAGA K, KITANO M, IMAI H, et al. Acute spinal cord infarction after EUS-guided celiac plexus neurolysis[J]. Gastrointest Endosc, 2016, 83(5):1039-1040. doi: 10.1016/j.gie.2015.10.044 pmid: 26551729
[50]	MITTAL M K, RABINSTEIN A A, WIJDICKS E F. Pearls & oy-sters: acute spinal cord infarction following endoscopic ultrasound-guided celiac plexus neurolysis[J]. Neurology 2012, 78(9):e57-e59.
[51]	ZHAO Y, GUO X, WANG K, et al. A retrospective multicenter study comparing bupivacaine and ropivacaine in endoscopic ultrasound guided celiac plexus neurolysis[J]. Ann Palliat Med, 2021, 10(2):1755-1762. doi: 10.21037/apm-20-1158 pmid: 33302641
[52]	ESMAIL E, PAQUIN S C, SAHAI A V. Protocol for a randomized controlled trial of endoscopic ultrasound guided celiac plexus neurolysis (EUS-CPN) with vs. without bupivacaine[J]. Trials, 2023, 24(1):576. doi: 10.1186/s13063-023-07487-7

技术分类	例数	疼痛缓解率	疼痛评分	参考文献
单侧比双侧注射	646例	/	单侧/双侧 (P=0.20)	[18]
	662例	单侧/双侧： 70%/74% （P>0.05）	/	[19]
	727例	单侧/双侧： 67%/68% （P>0.05）	/	[20]
	60例	/	单侧/双侧： 12.3/13.0 （P=0.88）	[21]
	980例	单侧/双侧： 66%/57% （P>0.05）	/	[22]
	160例	单侧/双侧： 45.9%/70.4% （P=0.001 6）	/	[23]
EUS-CGN	17例	94%	/	[24]
EUS-CGN	382例	83%	/	[25]
EUS-CGN比EUS-CPN	68例	CGN/CPN： 73.5%/45.5% （P=0.026）	/	[26]
	64例	CGN/CPN： 65%/25% （P=0.002）	/	[27]
	41例	CGN/CPN： 65.4%/53.3% （P=0.041 4）	/	[28]
EUS-CGN+EUS-CPN 比EUS-CPN	51例	CPN/CPN+CGN： 0/34.1% （P=0.045）	/	[29]