Paajanen Paavo, Fagerström Anne, Paajanen Hannu
School of Medicine, Faculty of Health Sciences, University of Eastern Finland.
Department of Gastrointestinal Surgery, Kuopio University Hospital, Kuopio.
J Clin Gastroenterol. 2018 Apr;52(4):e32-e36. doi: 10.1097/MCG.0000000000000787.
BACKGROUND/GOAL: Intra-abdominal adhesions are probably underdiagnosed cause for chronic abdominal pain. Our aim was to evaluate late (>10 y) effect of laparoscopic adhesiolysis on chronic abdominal pain.
This was a nonrandomized follow-up study of 68 patients (9 males, 59 females) who suffered chronic abdominal pain. The index operation (laparoscopy and adhesiolysis; n=72 patients) was performed during 1997 to 2001. A quality-of-life questionnaire was asked after the mean follow-up time of 15 years. The hospital records of patients, reoperations for chronic abdominal pain, and full medical history were also reviewed.
Patients reported that adhesion-related pain was abolished or diminished in 90% during 15-year follow-up, but still 28 (41%) complained about some abdominal symptom. One third of the patients used pain-relieving medication or proton-pump inhibitors to relieve their symptoms. Furthermore, 46 (68%) patients had contacted medical service for reexamination of abdominal discomfort and 16 (24%) were reoperated because of some abdominal disease. When the patients with dense adhesions versus no or minimal adhesions were compared in the long term, no difference in the response of pain was noticed after 15 years of adhesiolysis.
In carefully selected patients suffering from chronic abdominal pain, the positive effect of laparoscopic adhesiolysis stands beyond 15 years after the surgery. Although the patients reported relief of pain they still had various abdominal symptoms.
背景/目的：腹腔内粘连可能是慢性腹痛未被充分诊断的原因。我们的目的是评估腹腔镜粘连松解术对慢性腹痛的远期（>10年）疗效。
这是一项对68例慢性腹痛患者（9例男性，59例女性）的非随机随访研究。索引手术（腹腔镜检查和粘连松解术；72例患者）于1997年至2001年期间进行。在平均随访15年后进行了生活质量问卷调查。还查阅了患者的医院记录、因慢性腹痛进行的再次手术以及完整的病史。
患者报告在15年随访期间，90%与粘连相关的疼痛消失或减轻，但仍有28例（41%）抱怨有一些腹部症状。三分之一的患者使用止痛药物或质子泵抑制剂来缓解症状。此外，46例（68%）患者因腹部不适联系医疗服务进行复查，16例（24%）因某些腹部疾病接受了再次手术。长期比较有致密粘连与无粘连或轻度粘连的患者，粘连松解术后15年疼痛反应无差异。
在精心挑选的慢性腹痛患者中，腹腔镜粘连松解术的积极效果在手术后15年以上仍然存在。尽管患者报告疼痛缓解，但他们仍有各种腹部症状。
