Schwenk W, Böhm B, Müller J M
Universitätsklinik und Poliklinik für Chirurgie, Medizinische Fakultät der Humboldt-Universität zu Berlin, Charité, Schumannstrasse 20/21, 10117 Berlin, Germany.
Surg Endosc. 1998 Sep;12(9):1131-6. doi: 10.1007/s004649900799.
Conventional colorectal resections are associated with severe postoperative pain and prolonged fatigue. The laparoscopic approach to colorectal tumors may result in less pain as well as less fatigue, and may improve postoperative recovery after colorectal resections.
Sixty patients were included into a prospective randomized trial to determine the influence of laparoscopic (n = 30) or conventional (n = 30) resection of colorectal tumors on postoperative pain and fatigue. Major endpoints of the study were dose of morphine sulfate during patient-controlled analgesia (PCA), visual analog scale for pain while coughing (VASC), and visual analogue scale for fatigue (VASF). Efficacy of pain medication was assessed by visual analogue score at rest (VASR).
Preoperative age, sex, stage, and localization of tumors were comparable in both groups. The PCA dose of morphine given immediately after surgery until postoperative day 4 was higher in the conventional group (median, 1.37 mg/kg; 5-95 percentile 0.71-2. 46 mg/kg) than the laparoscopic group (0.78 mg/kg; 0.24-2.38 mg/kg, p < 0.01). Postoperative VASR was comparable between both groups, but VASC was higher from the first to the seventh postoperative day (p < 0.01). Postoperative fatigue was higher after conventional than after laparoscopic surgery from the second to the seventh day (p < 0. 05).
This study confirms that analgetic requirements are lower and pain is less intense after laparoscopic than after conventional colorectal resection. Patients also experience less fatigue after minimal invasive surgery. Because of these differences, the duration of recovery is shortened, and the postoperative quality of life is improved after laparoscopic colorectal resections.
传统的结直肠切除术会导致严重的术后疼痛和长期疲劳。腹腔镜下结直肠肿瘤切除术可能会减轻疼痛和疲劳，并改善结直肠切除术后的恢复情况。
60例患者被纳入一项前瞻性随机试验，以确定腹腔镜（n = 30）或传统（n = 30）结直肠肿瘤切除术对术后疼痛和疲劳的影响。该研究的主要终点是患者自控镇痛（PCA）期间硫酸吗啡的剂量、咳嗽时疼痛的视觉模拟评分（VASC）和疲劳的视觉模拟评分（VASF）。通过静息时的视觉模拟评分（VASR）评估止痛药物的疗效。
两组患者术前的年龄、性别、分期和肿瘤位置具有可比性。传统组术后第1天至第4天立即给予的PCA吗啡剂量（中位数为1.37mg/kg；第5至95百分位数为0.71-2.46mg/kg）高于腹腔镜组（0.78mg/kg；0.24-2.38mg/kg，p<0.01）。两组术后VASR相当，但术后第1天至第7天VASC更高（p<0.01）。传统手术后第2天至第7天的术后疲劳程度高于腹腔镜手术后（p<0.05）。
本研究证实，腹腔镜结直肠切除术后的镇痛需求低于传统手术，疼痛程度也较轻。微创手术后患者的疲劳感也较轻。由于这些差异，腹腔镜结直肠切除术后的恢复时间缩短，术后生活质量得到改善。
