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不同子宫切除术技术术后疼痛率的比较:一项回顾性研究。

Comparison of postoperative pain rates with different hysterectomy techniques: A retrospective study.

作者信息

Kurçaloğlu Mustafa, Önal Mesut, Yaşar Cemal, Yilmazlar Firdevs, Uslu Pinar Uzun, Yoleri Yasemin

机构信息

Anesthesiology and Reanimation Department, Ondokuz Mayis University Faculty of Medicine, Pain Clinic, Samsun, Turkey.

Department of Obstetrics and Gynecology, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey.

出版信息

Medicine (Baltimore). 2025 Sep 5;104(36):e44374. doi: 10.1097/MD.0000000000044374.

Abstract

This study aimed to compare different hysterectomy techniques regarding postsurgical pain. Women who underwent hysterectomy for nonmalignant etiologies between January 2019 and March 2023 were included in this retrospective study. The participants were divided into 4 groups based on the surgical techniques performed: abdominal hysterectomy (AH), laparoscopic hysterectomy, vaginal hysterectomy, and vaginal natural orifice transluminal endoscopic surgery (vNOTES). Pain scores and analgesic consumption were used for pain assessment. Parameters before the surgery and 24 hours, 1 week, 1, 3, and 6 months after the operation were retrospectively evaluated. Additionally, possible factors associated with pain, such as age, previous pelvic pain, previous abdominal surgery, indications for surgery duration of the surgery, volume of hysterectomy material, mean postoperative hospital stay, and blood transfusion were analyzed. A total of 264 patients were enrolled in this study. Thirty (11.3%) patients reported postsurgical chronic pain (PSCP). The mean number of days with postoperative pain was highest in the AH group and lowest in the vNOTES group. AH patients had the highest pain scores at the 24th hour and 1 week after surgery, and vNOTES cases had the lowest pain frequency in the 3rd- and 6th-month records. The preoperative presence of pain and higher pain intensity in the early postoperative period were other factors associated with PSCP. There was no significant difference in perioperative complications. The results of this study suggest that vNOTES is superior to other hysterectomy techniques in terms of postoperative chronic pain control without increased perioperative complication rates. Effective pain control during the early postoperative period may decrease the frequency of PSCP.

摘要

本研究旨在比较不同子宫切除术技术在术后疼痛方面的差异。2019年1月至2023年3月期间因非恶性病因接受子宫切除术的女性被纳入本回顾性研究。根据所采用的手术技术,参与者被分为4组:腹式子宫切除术(AH)、腹腔镜子宫切除术、阴道子宫切除术和阴道自然腔道内镜手术(vNOTES)。疼痛评分和镇痛药物消耗量用于疼痛评估。对手术前以及术后24小时、1周、1个月、3个月和6个月的参数进行回顾性评估。此外,还分析了与疼痛相关的可能因素,如年龄、既往盆腔疼痛、既往腹部手术史、手术指征、手术持续时间、子宫切除标本体积、术后平均住院时间和输血情况。本研究共纳入264例患者。30例(11.3%)患者报告有术后慢性疼痛(PSCP)。术后疼痛天数的平均值在AH组最高,在vNOTES组最低。AH组患者在术后第24小时和1周时疼痛评分最高,vNOTES组患者在术后第3个月和第6个月记录中的疼痛频率最低。术前存在疼痛以及术后早期较高的疼痛强度是与PSCP相关的其他因素。围手术期并发症方面无显著差异。本研究结果表明,在控制术后慢性疼痛方面,vNOTES优于其他子宫切除术技术,且围手术期并发症发生率未增加。术后早期有效的疼痛控制可能会降低PSCP的发生率。

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