Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark.
Eur J Cardiothorac Surg. 2013 Jan;43(1):95-103. doi: 10.1093/ejcts/ezs159. Epub 2012 Apr 20.
Most studies of persistent post-surgical pain following thoracic surgery have focused on classic posterolateral thoracotomy in mixed surgical populations without systematic assessment of disease recurrence and other potential sources of pain. The purpose of this study was to examine patterns in the prevalence of persistent post-surgical pain following lung cancer surgery and to quantitatively assess the characteristics of persistent post-surgical pain and associated sensory changes.
In May 2010, a sample of 702 patients undergoing lung cancer surgery from 1 January 2000 to 31 December 2009 was asked to complete a mail distributed questionnaire. The questionnaire included the Brief Pain Inventory and questions on pain-associated characteristics, symptoms and sensory changes. Patients were enrolled according to the following criteria: (1) no additional surgical procedures performed in the thoracic region 10 years prior to and up until the cross section; (2) no explorative surgery; (3) no resection of the thoracic wall and (4) no clinical or radiological signs of disease recurrence. Patients undergoing video-assisted thoracoscopic surgery were excluded.
The response rate was 89%. The final study population consisted of 414 patients with a median age of 69 years and a median follow-up time of 45 months. The overall prevalence of persistent post-surgical pain following anterior thoracotomy was estimated to 19% (95% CI: 15-23%). Clinically relevant pain defined as ≥4 on a 0-10 numerical rating scale was prevalent in 9% of the study participants (95% CI: 6-12%); pain with neuropathic characteristics was present in 36% (95% CI: 25-48%). A total of 62% of the participants with persistent post-surgical pain reported an increased or decreased sense of touch in the painful area.
Persistent post-surgical pain following anterior thoracotomy was prevalent in 19% (95% CI: 15-23%) of lung cancer patients for up to 10 years postoperatively. Future preventive strategies should focus on the role of intraoperative nerve damage, including the potentially protective role of anterior thoracotomy.
大多数关于胸外科手术后持续性术后疼痛的研究都集中在混合手术人群中的经典后外侧开胸术上，而没有对疾病复发和其他潜在疼痛源进行系统评估。本研究的目的是研究肺癌手术后持续性术后疼痛的流行模式，并定量评估持续性术后疼痛的特征和相关感觉变化。
2010 年 5 月，对 2000 年 1 月 1 日至 2009 年 12 月 31 日期间接受肺癌手术的 702 例患者进行了一项邮件问卷调查。问卷包括简要疼痛量表和与疼痛相关的特征、症状和感觉变化问题。患者符合以下标准入选：（1）10 年前和横截面前胸部没有进行额外的手术；（2）无探查性手术；（3）无胸壁切除术；（4）无临床或影像学疾病复发迹象。排除接受电视辅助胸腔镜手术的患者。
应答率为 89%。最终的研究人群由 414 例中位年龄为 69 岁且中位随访时间为 45 个月的患者组成。前开胸手术后持续性术后疼痛的总体患病率估计为 19%（95%CI：15-23%）。临床上定义为 0-10 数字评分量表≥4 的疼痛的患病率为 9%（95%CI：6-12%）；具有神经病理性特征的疼痛为 36%（95%CI：25-48%）。62%的持续性术后疼痛患者报告在疼痛区域有触觉增加或减少。
肺癌患者在前开胸手术后 10 年内持续性术后疼痛的患病率为 19%（95%CI：15-23%）。未来的预防策略应侧重于术中神经损伤的作用，包括前开胸术的潜在保护作用。
