Department of Surgery, Center for Perioperative Optimization, Herlev Hospital, University Hospital of Copenhagen, Herlev Ringvej 75, 2730 Herlev, Denmark.
Surg Endosc. 2013 Jul;27(7):2283-92. doi: 10.1007/s00464-012-2760-z. Epub 2013 Jan 26.
The laparoscopic technique has many advantages compared with open surgery for symptomatic cholecystolithiasis. Despite these advantages, many patients complain about shoulder pain (SP) after laparoscopic cholecystectomy. The purpose of this review was to evaluate intraperitoneal instillation (IPI) of saline and local anesthesia (LA) to minimize SP.
A search of the literature was conducted using PubMed and Excerpta Medica Database (EMBASE). Eligibility criteria were: randomized clinical trials (RCT) evaluating IPI of saline and/or LA to minimize incidence or severity of SP after laparoscopic cholecystectomy. Only papers published in English were included. Data extracted were year of publication, number of participants and allocation, timing of IPI, and nonsignificant or significant effect on incidence or severity of SP.
A total of 24 RCTs were included in the review. Four RCTs reported results on IPI saline as intervention versus nothing as control. Seven RCTs reported results on IPI LA as intervention versus nothing as control. Sixteen RCTs reported results on IPI LA as intervention versus saline as control. IPI saline resulted in a significant reduction in SP severity compared with nothing. IPI LA was associated with an overall significant reduction of SP severity compared with nothing. Results regarding the effect IPI LA versus saline showed contradictory results in regards to both SP incidence and severity.
Both IPI of saline and LA can be used to reduce SP severity after laparoscopic cholecystectomy. It is not possible to conclude whether the incidence of SP can be reduced with saline or LA, due to contradictive results.
与开放式手术相比，腹腔镜技术在治疗有症状的胆囊结石症方面具有许多优势。尽管有这些优势，但许多患者在接受腹腔镜胆囊切除术后会出现肩部疼痛（SP）。本次综述的目的是评估腹腔内灌洗（IPI）盐水和局部麻醉（LA）以尽量减少 SP。
使用 PubMed 和 Excerpta Medica Database（EMBASE）对文献进行了检索。纳入标准为：评估腹腔镜胆囊切除术后使用盐水和/或 LA 进行腹腔内灌洗以减少 SP 发生率或严重程度的随机临床试验（RCT）。仅纳入发表英文文献的研究。提取的数据包括发表年份、参与者数量和分配、IPI 时机以及对 SP 发生率或严重程度的无显著或显著影响。
共有 24 项 RCT 纳入本次综述。4 项 RCT 报告了盐水作为干预与无干预相比对 SP 严重程度的影响。7 项 RCT 报告了 LA 作为干预与无干预相比对 SP 严重程度的影响。16 项 RCT 报告了 LA 作为干预与盐水作为对照的影响。与无干预相比，盐水腹腔内灌洗可显著降低 SP 严重程度。LA 腹腔内灌洗与无干预相比，整体上显著降低 SP 严重程度。关于 LA 与盐水相比对 SP 发生率和严重程度的影响的结果存在矛盾。
腹腔内灌洗盐水和 LA 均可减轻腹腔镜胆囊切除术后 SP 严重程度。由于结果相互矛盾，无法确定盐水或 LA 是否可以降低 SP 的发生率。
