Bisgaard T, Klarskov B, Trap R, Kehlet H, Rosenberg J
Department of Surgical Gastroenterology 435, University of Copenhagen, Hvidovre Hospital, DK-2650, Hvidovre, Denmark.
Surg Endosc. 2000 Apr;14(4):340-4. doi: 10.1007/s004640020014.
Laparoscopic cholecystectomy (LC) is traditionally performed with two 10-mm and two 5-mm trocars. The effect of smaller port incisions on pain has not been established in controlled studies.
In a double-blind controlled study, patients were randomized to LC or cholecystectomy with three 2-mm trocars and one 10-mm trocar (micro-LC). All patients received a multimodal analgesic regimen, including incisional local anesthetics at the beginning of surgery, NSAID, and paracetamol. Pain was registered preoperatively, for the first 3 h postoperatively, and daily for the 1st week.
The study was discontinued after inclusion of 26 patients because five of the 13 patients (38%) randomized to micro-LC were converted to LC. In the remaining 21 patients, overall pain and incisional pain intensity during the first 3 h postoperatively increased in the LC group (n = 13) compared with preoperative pain levels (p<0.01), whereas pain did not increase in the micro-LC group (n = 8).
Micro-LC in combination with a prophylactic multimodal analgesic regimen reduced postoperative pain for the first 3 h postoperatively. However, the micro-LC led to an unacceptable rate of conversion to LC (38%). The micro-LC instruments therefore need further technical development before this surgical technique can be used on a routine basis for laparoscopic cholecystectomy.
传统的腹腔镜胆囊切除术（LC）需使用两个10毫米和两个5毫米的套管针。在对照研究中，较小的切口对疼痛的影响尚未明确。
在一项双盲对照研究中，患者被随机分为接受LC手术组或使用三个2毫米套管针和一个10毫米套管针的胆囊切除术组（微型LC）。所有患者均接受多模式镇痛方案，包括手术开始时的切口局部麻醉、非甾体抗炎药和对乙酰氨基酚。术前、术后前3小时以及术后第1周每天记录疼痛情况。
纳入26例患者后该研究终止，因为随机分配至微型LC组的13例患者中有5例（38%）转为接受LC手术。在其余21例患者中，与术前疼痛水平相比，LC组（n = 13）术后前3小时的总体疼痛和切口疼痛强度增加（p<0.01），而微型LC组（n = 8）疼痛未增加。
微型LC联合预防性多模式镇痛方案可减轻术后前3小时的疼痛。然而，微型LC导致转为接受LC手术的比例高达38%，令人难以接受。因此，在该手术技术能够常规用于腹腔镜胆囊切除术之前，微型LC器械需要进一步的技术改进。
