Riedel H H, Semm K
Geburtshilfe Frauenheilkd. 1980 Jul;40(7):635-43. doi: 10.1055/s-2008-1037224.
Following laparoscopy 18.5% of 200 patients had sub-phrenic pain on the day of operation and 28% had shoulder pain. During the night following the operation or on the first post-operative day 30.5% of the 200 patients had sub-phrenic pain and 54.5% had shoulder pain. A total of 63% of the patients had shoulder pain and 37.5% of the patients had sub-phrenic pain. 31.5% of the patients had a combination of both types of pain. Most of the sub-diaphragmatic pain was on the right side. In 93% of all patients the post-operative radiological investigation of the chest showed subphrenic gas. The remaining gas was aspirated and measured by infrared spectroscopy. All the remaining gas was carbon dioxide. The previously suggested absorption rates for carbon dioxide are probably too high. The transition of anaesthetic gas (e.g. N2O) through the peritoneum into the abdominal cavity as suggested by Hodgson, McClelland, and Newton was not detected in these measurements. The most likely cause of the post-laparoscopic pain syndrome is the effect of the volume of the remaining gas of the phrenic nerve.
在200例患者中，腹腔镜检查后，18.5%的患者在手术当天出现膈下疼痛，28%的患者出现肩部疼痛。在手术后当晚或术后第一天，200例患者中有30.5%出现膈下疼痛，54.5%出现肩部疼痛。共有63%的患者出现肩部疼痛，37.5%的患者出现膈下疼痛。31.5%的患者同时出现两种类型的疼痛。大多数膈下疼痛位于右侧。在所有患者中，93%的胸部术后影像学检查显示膈下有气体。其余气体通过红外光谱法进行抽吸和测量。所有剩余气体均为二氧化碳。先前提出的二氧化碳吸收速率可能过高。在这些测量中未检测到霍奇森、麦克莱兰和牛顿所提出的麻醉气体（如N2O）通过腹膜进入腹腔的情况。腹腔镜术后疼痛综合征最可能的原因是剩余气体对膈神经的影响。
