Bisgaard T, Klarskov B, Trap R, Kehlet H, Rosenberg J
Department of Surgical Gastroenterology 435, University of Copenhagen, Hvidovre Hospital, 2650 Hvidovre, Denmark.
Surg Endosc. 2002 Mar;16(3):458-64. doi: 10.1007/s00464-001-9026-5. Epub 2001 Nov 16.
Downsizing the port incisions may reduce pain after laparoscopic cholecystectomy.
In a double-blind controlled study, 60 patients were randomized to undergo either microlaparoscopic cholecystectomy using one 10-mm and three 3.5-mm trocars (3.5-mm LC) or traditional laparoscopic cholecystectomy using two 10-mm and two 5-mm trocars (LC). Incisional pain at each port incision and overall pain were recorded for 1 week after the operation. Fatigue, nausea and vomiting, pulmonary function, and cosmetic results were also measured.
Data from 52 patients were analyzed; eight patients were excluded from the study for various reasons. One patient was converted from 3.5-mm LC to LC due to technical problems with the 3.5-mm optic. In the 3.5-mm LC group (n = 25), incisional pain was significantly decreased in the 1st postoperative week as compared with the LC group (n = 27) (p <0.01). In both groups, pain scores at the supraumbilical 10-mm port were significantly higher compared with other port sites (p <0.05). The cosmetic results were significantly better in the 3.5-mm LC group (p <0.01). There were no significant differences in any of the other variables.
The use of 3.5-mm trocars is feasible in LC, and it both reduces incisional pain and improves the cosmetic result.
缩小切口可能会减轻腹腔镜胆囊切除术后的疼痛。
在一项双盲对照研究中，60例患者被随机分为两组，分别接受使用一个10毫米和三个3.5毫米套管针的微腹腔镜胆囊切除术（3.5毫米LC组）或使用两个10毫米和两个5毫米套管针的传统腹腔镜胆囊切除术（LC组）。术后记录每个切口处的疼痛以及整体疼痛情况，持续1周。同时还测量了疲劳、恶心呕吐、肺功能和美容效果。
分析了52例患者的数据；8例患者因各种原因被排除在研究之外。1例患者因3.5毫米腹腔镜的技术问题从3.5毫米LC组转为LC组。在3.5毫米LC组（n = 25）中，术后第1周的切口疼痛与LC组（n = 27）相比显著降低（p <0.01）。在两组中，脐上10毫米切口处的疼痛评分均显著高于其他切口部位（p <0.05）。3.5毫米LC组的美容效果显著更好（p <0.01）。其他变量在两组之间均无显著差异。
在腹腔镜胆囊切除术中使用3.5毫米套管针是可行的，它既能减轻切口疼痛，又能改善美容效果。
