腹腔镜术后肩痛的多中心研究

背景：肩痛是腹腔镜胆囊切除术后的常见并发症，原因不明。本研究的目的是寻找引起此类并发症的原因。 方法：本项前瞻性研究于2010年至2011年在广州的4家医院开展，共入组600例患者。所有患者均接受了腹腔镜手术，其中包括200例二氧化碳气腹下的腹腔镜胆囊切除术（组1）、200例非气腹下的腹腔镜胆囊切除术（组2）以及200例二氧化碳气腹下的腹腔镜胆囊切除术。于术后6、24、48及72小时用VAS评分来评估肩痛的严重程度。 结果：3组患者中位年龄分别是49、50及36岁。3组患者中女性患者的比例为58%、60%、49%。在所有的时间段，组1 与组2患者间的肩痛严重度差别无统计学意义。但组1或组2与组3比较，肩痛严重度差别有统计学意义。 结论：腹腔镜术后肩痛并不仅仅是因为腹腔膨胀及膈肌刺激。在某种程度上，腹腔镜胆囊切除术后肩痛与胆囊床的刺激有关。对于无气腹的腹腔镜胆囊切除术，膈肌刺激是由于腹壁的牵拉引起。

Shoulder pain after abdominal laparoscopic operation: a multicenter study

Shoulder pain is the most common complication of laparoscopic operations) The incidence and severity of shoulder pain has been well documented.2 This complication was commonly regarded as the result of CO2 pneumoperitoneum,which induced extension and stimulation to the diaphragmatic muscle.The incidence and severity of shoulder pain was correlated to the pressure and duration of CO2 pneumoperitoneum.3,4 However,we noticed that in non-pneumoperitoneum laparoscopic operations,patients experienced a higher incidence and more severe post-operative shoulder pain.This was a challenge to the theory that pneumoperitoneum induces shoulder pain.Therefore a more detailed study was required to provide more objective data to explain this phenomenon.