低气腹压力有助于腹腔镜胃肠手术术后疼痛缓解及胃肠功能恢复：一项系统评价与Meta分析
Low pneumoperitoneum pressure facilitates postoperative pain relief and gastrointestinal function recovery in laparoscopic gastrointestinal surgery: a systematic review and meta-analysis.
作者信息
Lu Kai, Peng Xuefeng, Lan Ke, Zhang Faqiang, Cheng Yong, Yang Hua
机构信息
Department of General Surgery, Zigong Fourth People's Hospital, Zigong, Sichuan, China.
Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
出版信息
Front Oncol. 2025 Aug 21;15:1665112. doi: 10.3389/fonc.2025.1665112. eCollection 2025.
OBJECTIVE
The potential benefits of low pneumoperitoneum pressure (LPP) in laparoscopic gastrointestinal surgery, particularly gastric procedures, remain insufficiently investigated. This meta-analysis aims to systematically evaluate the advantages of LPP in laparoscopic gastrointestinal surgery compared to standard pneumoperitoneum pressure (SPP).
METHODS
A comprehensive literature search was conducted in Embase, Web of Science, PubMed, and Cochrane Library databases from inception to April 10, 2025. Studies comparing LPP with SPP in laparoscopic gastrointestinal surgery, including both randomized controlled trials (RCTs) and observational studies, were systematically reviewed. Data were analyzed using RevMan 5.3 software, with primary outcomes including postoperative pain at rest, pain in post-anesthesia care unit (PACU), and activity-related pain.
RESULTS
Twelve studies were included in the meta-analysis. Compared with SPP, LPP significantly reduced postoperative pain at rest (SMD = -0.40, 95% CI: -0.68 to -0.12, P = 0.005) and pain in PACU (SMD = -1.06, 95% CI: -1.65 to -0.47, P = 0.0004). Additionally, LPP was associated with faster recovery of gastrointestinal function (SMD = -0.27, 95% CI: -0.50 to -0.05, P = 0.02). However, no significant differences were observed between the two groups in terms of activity-related pain, operative time, intraoperative blood loss, surgical field visibility, length of hospital stay, anastomotic leakage, or postoperative complications. Notably, LPP was more frequently associated with intraoperative adjustments to pneumoperitoneum pressure (OR = 4.01, 95% CI: 2.48 to 6.50, P < 0.00001).
CONCLUSIONS
In laparoscopic gastrointestinal surgery, LPP provides clinically relevant benefits by reducing postoperative pain at rest and in PACU, as well as accelerating gastrointestinal recovery. However, surgeons should be aware of the potential need for more frequent intraoperative adjustments to pneumoperitoneum pressure when using LPP.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO/search, identifier CRD420251037390.
目的
低气腹压力（LPP）在腹腔镜胃肠手术，尤其是胃部手术中的潜在益处仍未得到充分研究。本荟萃分析旨在系统评估LPP在腹腔镜胃肠手术中相对于标准气腹压力（SPP）的优势。
方法
从数据库建立至2025年4月10日，在Embase、Web of Science、PubMed和Cochrane图书馆数据库中进行了全面的文献检索。对比较LPP与SPP在腹腔镜胃肠手术中的研究进行了系统回顾，包括随机对照试验（RCT）和观察性研究。使用RevMan 5.3软件进行数据分析，主要结局包括静息时术后疼痛、麻醉后恢复室（PACU）疼痛和活动相关疼痛。
结果
荟萃分析纳入了12项研究。与SPP相比，LPP显著降低了静息时术后疼痛（标准化均数差[SMD]= -0.40，95%可信区间[CI]：-0.68至-0.12，P = 0.005）和PACU疼痛（SMD = -1.06，95% CI：-1.65至-0.47，P = 0.0004）。此外，LPP与胃肠功能更快恢复相关（SMD = -0.27，95% CI：-0.50至-0.05，P = 0.02）。然而，两组在活动相关疼痛、手术时间、术中失血、手术视野清晰度、住院时间、吻合口漏或术后并发症方面未观察到显著差异。值得注意的是，LPP更常与术中调整气腹压力相关（比值比[OR]= 4.01，95% CI：2.48至6.50，P < 0.00001）。
结论
在腹腔镜胃肠手术中，LPP通过减轻静息时和PACU中的术后疼痛以及加速胃肠恢复提供了临床相关益处。然而，外科医生在使用LPP时应意识到可能需要更频繁地在术中调整气腹压力。
系统评价注册
https://www.crd.york.ac.uk/PROSPERO/search，标识符CRD420251037390。
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