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[微创食管切除术中的硬膜外镇痛:证据与实践]

[Epidural Analgesia in Minimally Invasive Esophagectomy: Evidence and Practice].

作者信息

Xie Bihua, Li Tingting, Hu Yang, Xiong Liulin, Wang Tinghua, Liu Fei

机构信息

( 610041) Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, China.

( 644000) Department of Anesthesiology, The Third People's Hospital of Yibin, Yibin 644000, China.

出版信息

Sichuan Da Xue Xue Bao Yi Xue Ban. 2025 Mar 20;56(2):556-562. doi: 10.12182/20250360102.

Abstract

Esophagectomy is an effective treatment for esophageal cancer, and there has been growing attention on the importance of postoperative pain management in patients undergoing the surgery. Epidural analgesia is the preferred analgesic approach for open esophagectomy. With the development of surgical technology, minimally invasive esophagectomy (MIE) has become the mainstream surgical approach. However, no conclusion has been reached concerning whether epidural analgesia is still the preferred analgesic approach for MIE. Herein, we analyzed the relevant literature published in recent years and found that epidural analgesia continued to be an important analgesic approach for MIE, offering the best analgesic effect. Epidural analgesia can reduce postoperative pulmonary complications, improve the quality of life, and reduce the stress response. Adverse effects can be minimized through accurate selection of epidural puncture segments, individualized medication, and multimodal analgesia strategies. In the future, precision-based multimodal analgesia can be achieved using emerging technologies such as big data analytics and artificial intelligence.

摘要

食管切除术是治疗食管癌的有效方法,术后疼痛管理在接受该手术的患者中的重要性日益受到关注。硬膜外镇痛是开放性食管切除术的首选镇痛方法。随着手术技术的发展,微创食管切除术(MIE)已成为主流手术方式。然而,关于硬膜外镇痛是否仍是MIE的首选镇痛方法尚无定论。在此,我们分析了近年来发表的相关文献,发现硬膜外镇痛仍然是MIE的重要镇痛方法,具有最佳镇痛效果。硬膜外镇痛可减少术后肺部并发症,提高生活质量,并减轻应激反应。通过准确选择硬膜外穿刺节段、个体化用药和多模式镇痛策略,可将不良反应降至最低。未来,利用大数据分析和人工智能等新兴技术可实现精准多模式镇痛。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cc35/12207040/99613e8e20cf/scdxxbyxb-56-2-556-1.jpg

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