腹腔镜与开放肝切除术后肩痛的前瞻性队列研究  

Shoulder pain after laparoscopic versus open hepatectomy:a prospective cohort study

作　　者：张芸魁 戴盛玲 张军 杨悦橙 ZHANG Yunkui;DAI Shengling;ZHANG Jun;YANG Yuecheng(Department of Anesthesiology,Shanghai Cancer Center,Fudan University,Shanghai 200032,China;不详)

机构地区：[1]复旦大学上海医学院肿瘤学系,复旦大学附属肿瘤医院麻醉科,上海200032 [2]复旦大学上海医学院肿瘤学系,复旦大学附属肿瘤医院肝外科,上海200032

出　　处：《上海医学》2024年第3期158-161,共4页Shanghai Medical Journal

基　　金：国家自然科学基金(82171261)。

摘　　要：目的探讨腹腔镜下肝切除术与开放肝切除术对术后肩痛发生和肩痛程度的影响。方法选择2022年6—9月在复旦大学附属肿瘤医院肝外科行腹腔镜下肝切除术的肝肿瘤患者79例(腹腔镜组),另选择同期行开放肝切除术的139例肝肿瘤患者作为对照(开放组)。采用倾向性评分匹配法(PSM)进行1∶1匹配,匹配成功后每组各60例。比较两组患者的一般资料(包括性别构成、年龄、BMI)和手术相关资料(包括硬膜外麻醉、肿瘤直径>5 cm的患者比例,以及舒芬太尼用量、切除肝段数量、手术时长),术后肩痛和中重度肩痛发生率。分别于手术当天、术后第1天、术后第2天采用疼痛数字评分法(NRS)评估并比较患者的肩痛程度。结果两组间患者的性别构成、年龄、BMI、舒芬太尼用量、切除肝段数量、手术时长,以及硬膜外麻醉、肿瘤直径>5 cm患者比例的差异均无统计学意义(P值均>0.05)。开放组术后肩痛发生率为33.3%(20/60),与腹腔镜组41.7%(25/60)的差异无统计学意义(P>0.05);开放组术后中重度肩痛发生率为16.7%(10/60),与腹腔镜组21.7%(13/60)的差异亦无统计学意义(P>0.05)。开放组手术当天、术后第1天、术后第2天肩痛NRS评分分别为2.0(1.0,5.0)、2.5(0,4.0)、0(0,1.0)分,腹腔镜组分别为3.0(0,6.0)、2.0(0,3.5)、0(0,3.0)分,两组间各时间点肩痛NRS评分的差异均无统计学意义(P值均>0.05)。结论与开放肝切除术相比,腹腔镜下肝切除术并不会增高术后肩痛的发生率,也不会加重术后肩痛的程度。Objective To compare postoperative shoulder pain between laparoscopy-assisted hepatectomy and open hepatectomy.Methods A total of 79 liver tumor patients who underwent laparoscopic liver resection at Fudan University Shanghai Cancer Center between June and September 2022 were selected(laparoscopy group).Concurrently,139 liver tumor patients who underwent open liver resection were chosen as controls(open group).Propensity score matching(PSM)was employed to achieve a 1∶1 match,resulting in 60 cases in each group after successful matching.The general characteristics(such as gender composition,age,BMI)and surgery-related data(the use of epidural anesthesia,the proportion of patients with tumor diameter>5 cm,sufentanil dosage,the number of liver segments resected,and operative duration),as well as the incidences of postoperative shoulder pain and moderate to severe shoulder pain,were compared between the two groups.The degree of shoulder pain was assessed by using the numeric rating scale(NRS)on the day of surgery,and day 1 and 2 after surgery.Results There were no statistically significant differences between the two groups in terms of gender composition,age,BMI,sufentanil dosage,the number of liver segments resected,operative duration,the use of epidural anesthesia,or the proportion of patients with tumor diameter>5 cm(all P>0.05).The incidence of postoperative shoulder pain was 33.3%(20/60)in the open group and 41.7%(25/60)in the laparoscopy group,with no significant difference(P>0.05).The incidences of moderate to severe postoperative shoulder pain were 16.7%(10/60)in the open group and 21.7%(13/60)in the laparoscopy group(P>0.05).The NRS scores for shoulder pain were 2.0(1.0,5.0),2.5(0,4.0),and 0(0,1.0)on the day of surgery,and day 1 and 2 after surgery,respectively,in the open group.The NRS scores for shoulder pain were 3.0(0,6.0),2.0(0,3.5),and 0(0,3.0)on the day of surgery,and day 1 and 2 after surgery,respectively,in the laparoscopy group.There were no significant differences in the NRS score at any time po

关 键 词：腹腔镜 肝切除术 肩痛 

分 类 号：R735.7[医药卫生—肿瘤]