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腹腔镜胆囊切除术与小切口胆囊切除术后疼痛、代谢反应及健康感知的随机、前瞻性、盲法比较

A randomized, prospective, blinded comparison of postoperative pain, metabolic response, and perceived health after laparoscopic and small incision cholecystectomy.

作者信息

Squirrell D M, Majeed A W, Troy G, Peacock J E, Nicholl J P, Johnson A G

机构信息

Department of Surgical and Anaesthetic Sciences, University of Sheffield, U.K.

出版信息

Surgery. 1998 May;123(5):485-95. doi: 10.1067/msy.1998.87552.

Abstract

BACKGROUND

We have previously shown that in a randomized comparison of laparoscopic (LC) versus small incision (SC) cholecystectomy, postoperative hospital stay is comparable. This randomized prospective study compares the postoperative pain, analgesic and antiemetic consumption, perceived health, and metabolic and respiratory responses after these two procedures.

METHODS

Two hundred patients were recruited; postoperative stay, pain scores, analgesic and antiemetic consumption were recorded. Nottingham Health Profile questionnaires were completed by a subgroup of 100 patients, and the metabolic and respiratory responses were also compared in a further subgroup of 20 patients.

RESULTS

Pain scores in both groups were low. LC, however, was associated with lower postoperative pain scores and analgesic requirements compared with SC, but the antiemetic requirements were greater after LC. The duration of hospital stay and the perceived health after operation were the same in both groups, and both procedures were associated with a similar reduction of respiratory function. Twenty-four hours after operation the inflammatory (C-reactive protein, CRP) response to LC (22 +/- 20 mg/L) was significantly lower than after SC (68 +/- 30 mg/L), but the neuroendocrine (cortisol) response was similar (LC, 475 +/- 335 nmol/L, compared with SC, 710 +/- 410 nmol/L). Independent of the technique used, the duration of postoperative hospital stay correlated significantly with the magnitude of both the 24-hour postoperative cortisol and CRP responses (cortisol: rs = 0.678, p < 0.001; CRP: rs = 0.566, p = 0.011).

CONCLUSIONS

LC appears to be associated with less tissue destruction and pain than SC, but this did not confer any advantage in the degree of postoperative respiratory impairment, length of hospital stay, or postoperative perceived health. The neuroendocrine component of the metabolic response evoked by each procedure was similar and had a significant correlation to patient's postoperative hospital stay. This finding may explain the similar postoperative recovery after LC and SC.

摘要

背景

我们之前已经表明,在腹腔镜胆囊切除术(LC)与小切口胆囊切除术(SC)的随机对照研究中,术后住院时间相当。这项随机前瞻性研究比较了这两种手术术后的疼痛、镇痛和止吐药物的使用、健康感受以及代谢和呼吸反应。

方法

招募了200名患者;记录术后住院时间、疼痛评分、镇痛和止吐药物的使用情况。100名患者的亚组完成了诺丁汉健康状况调查问卷,另外20名患者的亚组也比较了代谢和呼吸反应。

结果

两组的疼痛评分都较低。然而,与SC相比,LC术后疼痛评分和镇痛需求较低,但LC术后止吐需求更大。两组的住院时间和术后健康感受相同,两种手术对呼吸功能的降低程度相似。术后24小时,LC后的炎症反应(C反应蛋白,CRP)(22±20mg/L)明显低于SC后(68±30mg/L),但神经内分泌反应(皮质醇)相似(LC为475±335nmol/L,SC为710±410nmol/L)。无论采用何种技术,术后住院时间与术后24小时皮质醇和CRP反应的幅度均显著相关(皮质醇:rs = 0.678,p < 0.001;CRP:rs = 0.566,p = 0.011)。

结论

与SC相比,LC似乎导致的组织损伤和疼痛更少,但在术后呼吸功能损害程度、住院时间或术后健康感受方面并无优势。每种手术引起的代谢反应的神经内分泌成分相似,且与患者术后住院时间显著相关。这一发现可能解释了LC和SC术后恢复相似的原因。

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