妇科腹腔镜手术腹膜超微结构损伤与术后肩痛的相关性  

Association between peritoneal ultrastructure damage and postoperative shoulder pain in gynecological laparoscopy

作　　者：陈海亭 孟庆香 刘雯[2] 齐峰[1] CHEN Hai-ting;MENG Qing-xiang;LIU Wen(Department of Anesthesiology,Qilu Hospital,Cheeloo College of Medicine,Shandong University,Jinan 250012,China;Center for Reproductive Medicine,Shandong University,National Research Center for Assisted Reproductive Technology and Reproductive Genetics,the Key Laboratory for Reproductive Endocrinology of Ministry of Education;Department of Anesthesiology,Shandong Rongjun General Hospital)

机构地区：[1]山东大学齐鲁医院麻醉科,山东济南250012 [2]山东大学生殖医学研究中心,生殖内分泌教育部重点实验室,山东省生殖医学重点实验室 [3]山东省荣军总医院麻醉科

出　　处：《腹腔镜外科杂志》2022年第2期139-142,共4页Journal of Laparoscopic Surgery

摘　　要：目的:探讨妇科腹腔镜手术气腹压力与腹膜超微结构损伤、术后肩痛的相关性。方法:选择2020年7月至2021年4月因输卵管性不孕需择期行妇科腹腔镜手术治疗的100例患者,18~40岁,BMI 18.1~29.3 kg/m^(2),ASAⅠ~Ⅱ级,手术时间2.5 h内,根据气腹压力分为低压力组(L组,n=50,气腹压力10 mmHg)与高压力组(H组,n=50,气腹压力14 mmHg),分别于术后3 h、6 h、12 h、24 h随访肩痛评分。每组内再随机选取20例分别于手术开始0 min(T_(0))、手术操作45 min(T_(1))及90 min(T_(2))于肝脏附近剪取0.5 mm^(2)的壁层腹膜组织,应用光学显微镜观察腹膜超微结构损伤(基底膜不连续、细胞水肿)变化并进行阳性结果统计。结果:两组患者术后肩痛评分差异无统计学意义(P>0.05)。两组光镜下腹膜超微结构损伤差异无统计学意义(P>0.05)。同组内腹膜超微结构损伤与手术时间有明显相关性(L组ρ=0.548,P<0.001;H组ρ=0.571,P<0.001)。术后6 h肩痛评分与腹膜超微结构损伤线性相关分析有统计学意义(ρ=0.571,P<0.001)。结论:手术时间2.5 h内的妇科腹腔镜手术后肩痛、腹膜超微结构损伤与气腹压力无明显相关性。腹膜超微结构损伤随手术时间延长而变重,并与术后肩痛有明显相关性。Objective:To investigate the association among pneumoperitoneum pressure in gynecological laparoscopic surgery,the peritoneal ultrastructure damages and the postoperative shoulder pain.Methods:One-hundred patients aged 18-40 years old with BMI 18.1-29.3 kg/m^(2),who were diagnosed with tubal infertility and underwent gynecological laparoscopic surgery between Jul.2020 and Apr.2021,were enrolled in this study.The ASA level of the participants wasⅠ-Ⅱand the operation time was within 2.5 h.The patients were divided into two groups according to the pneumoperitoneum pressure:the low-pressure group(L group,n=50,pneumoperitoneum pressure 10 mmHg)and the high-pressure group(H group,n=50,pneumoperitoneum pressure 14 mmHg).The postoperative shoulder pain scores were recorded at 3,6,12 and 24 h after operation.Additionally,20 cases were randomly selected in each group,in these patients,0.5 mm^(2) parietal peritoneal tissue near the liver was collected at 0 min(T_(0)),45 min(T_(1))and 90 min(T_(2))after the beginning of the surgery respectively to explore the ultrastructure damage(basement membrane discontinuity,cell edema)under optical microscope and to count the positive result.Results:The score of the postoperative shoulder pain was not significantly different between the two groups(P>0.05).There was no significant difference between the two groups in the damage of peritoneal ultrastructure under light microscope.In the same group,the peritoneal ultrastructure damage was associated with the operation time(L group:ρ=0.548,P<0.001;H group:ρ=0.571,P<0.001).The score of shoulder pain at 6 h after operation was significantly correlated with the peritoneal ultrastructure damage in linear correlation analysis(ρ=0.571,P<0.001).Conclusions:When the gynecologic operation time is no more than 2.5 h,the pneumoperitoneum pressure is not associated with either the peritoneal ultrastructure damage or the postoperative shoulder pain.The peritoneal ultrastructure damage increases with prolongation of operation time and is significa

关 键 词：妇科外科手术 腹腔镜检查 气腹 腹膜超微结构 肩痛 

分 类 号：R713[医药卫生—妇产科学]