Wildgaard K, Ravn J, Nikolajsen L, Jakobsen E, Jensen T S, Kehlet H
Section for Surgical Pathophysiology, Departments of Cardiothoracic Anaesthesia, Copenhagen University, Copenhagen, Denmark.
Acta Anaesthesiol Scand. 2011 Jan;55(1):60-8. doi: 10.1111/j.1399-6576.2010.02357.x. Epub 2010 Nov 15.
post-thoracotomy pain syndrome (PTPS) and its social consequences have been inconsistently investigated as most studies were either small sized, focused on a limited number of risk factors or included heterogeneous surgical procedures. The current objectives were to obtain detailed information on the consequences of PTPS after thoracotomy and video-assisted thoracic surgery (VATS) from homogenous unselected nationwide data, and to suggest mechanisms for the development of PTPS.
data from 1327 patients were collected using a prospective national database and combined with a detailed questionnaire.
the response rate was 81.5%, resulting in 546 patients without prior thoracic surgery for the final analysis. Follow-up was 22 months (range 12-36). PTPS occurred in 33% thoracotomy patients and 25% VATS patients. Clinically relevant pain was present in 11-18% of the patients and severe pain in 4-12% depending on the level of physical activity. In PTPS patients, 64% also had pain from other locations on the body. Perceived sensory changes in the thoracic area were present in 63% of PTPS patients vs. 25% in pain-free patients (P<0.001). When comparing VATS with thoracotomy, no consistent differences in the prevalence, distribution of pain, sensory changes or effect of pain on daily activities were observed although clinically relevant and severe pain was reduced after VATS.
this nationwide study corroborates that PTPS is a clinically relevant problem influencing daily activities a long time after thoracotomy and VATS. Nerve injury and increased pain responsiveness may explain the majority of symptoms, the prevalence and distribution of pain including perceived sensory sensations.
开胸术后疼痛综合征（PTPS）及其社会影响尚未得到一致的研究，因为大多数研究规模较小，聚焦于有限数量的风险因素，或者纳入了异质性的手术操作。当前的目标是从全国范围内同质的、未经筛选的数据中获取关于开胸手术和电视辅助胸腔镜手术（VATS）后PTPS后果的详细信息，并提出PTPS发生发展的机制。
使用前瞻性全国数据库收集了1327例患者的数据，并结合一份详细问卷。
应答率为81.5%，最终分析纳入了546例既往无胸外科手术史的患者。随访时间为22个月（范围12 - 36个月）。33%的开胸手术患者和25%的VATS患者发生了PTPS。根据体力活动水平，11% - 18%的患者存在临床相关疼痛，4% - 12%的患者存在严重疼痛。在PTPS患者中，64%还伴有身体其他部位的疼痛。63%的PTPS患者存在胸部区域的感觉异常，而无痛患者中这一比例为25%（P<0.001）。比较VATS和开胸手术时，在患病率、疼痛分布、感觉变化或疼痛对日常活动的影响方面未观察到一致差异，尽管VATS后临床相关疼痛和严重疼痛有所减轻。
这项全国性研究证实，PTPS是一个影响开胸手术和VATS后很长一段时间日常活动的临床相关问题。神经损伤和疼痛反应性增加可能解释了大多数症状、疼痛的患病率和分布，包括感觉异常。
