Wildgaard Kim, Ravn Jesper, Kehlet Henrik
Section for Surgical Pathophysiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark.
Eur J Cardiothorac Surg. 2009 Jul;36(1):170-80. doi: 10.1016/j.ejcts.2009.02.005.
Chronic pain complaints after thoracic surgery represent a significant clinical problem in 25-60% of patients. Results from thoracic and other surgical procedures suggest multiple pathogenic mechanisms that include pre-, intra-, and postoperative factors. This review attempts to analyse the methodology and systematics of the studies on the post-thoracotomy pain syndrome (PTPS) after lung cancer surgery in adults, in order to clarify the relative role of possible pathogenic factors and to define future strategies for prevention. Literature published from 2000 to 2008 together with studies included in previous systematic reviews was searched recursively using PubMed and OVID by combining three categories of search terms. The available data have major inconsistencies in collection of pre-, intra- and postoperative data that may influence PTPS, thereby hindering precise conclusions as well as preventive and treatment strategies. However, intercostal nerve injury seems to be the most important pathogenic factor. Since there is a general agreement on the clinical relevance of PTPS, a proposal for design of future trials is presented.
胸外科手术后的慢性疼痛主诉在25%至60%的患者中是一个重大的临床问题。胸外科手术及其他外科手术的结果表明存在多种致病机制，包括术前、术中和术后因素。本综述试图分析成人肺癌手术后开胸术后疼痛综合征（PTPS）研究的方法和系统性，以阐明可能的致病因素的相对作用，并确定未来的预防策略。通过结合三类搜索词，使用PubMed和OVID对2000年至2008年发表的文献以及先前系统评价中纳入的研究进行递归搜索。现有数据在可能影响PTPS的术前、术中和术后数据收集方面存在重大不一致，从而阻碍了精确的结论以及预防和治疗策略。然而，肋间神经损伤似乎是最重要的致病因素。由于对PTPS的临床相关性已达成普遍共识，因此提出了未来试验设计的建议。
