诊断性腹腔镜和粘连松解术:是否有助于外科手术中复杂盆腹腔疼痛综合征患者的治疗?

继发于粘连的腹痛是常见的主诉,但是除非患者存在肠梗阻症状,多数外科医生不会因此主诉而行手术治疗。本研究的目的是评价肠粘连松解术是否对治疗腹痛有效。我们回顾性分析了仅经历腹腔镜粘连松解术,而非器官切除的盆腹腔疼痛综合征(CAPPS)的患者在手术后疼痛改善情况。分别在手术后3,6,9和12个月随访了31例经腹腔镜粘连松解手术的患者,随访中第6,9和12个月后患者的疼痛评分显著降低,因此得出腹腔镜粘连松解手术对于粘连相关性疼痛有效的结论。粘连引起的疼痛可能有更复杂的疼痛传导通路,相比简单的切除瘢痕组织的手术,如截肢后的"幻肢痛",腹腔镜粘连松解手术患者术后的疼痛减轻需要较长时间。

Diagnostic Laparoscopy and Adhesiolysis： Does It Help with Complex Abdominal and Pelvic Pain Syndrome（CAPPS） in General Surgery？

Abdominal pains secondary to adhesions are a common complaint,but most surgeons do not perform surgery for this complaint unless the patient suffers from a bowel obstruction.The purpose of this evaluation was to determine if lysis of bowel adhesions has a role in the surgical management of adhesions for helping treat abdominal pain.The database of our patients with complex abdominal and pelvic pain syndrome(CAPPS) was reviewed to identify patients who underwent a laparoscopic lysis of adhesion without any organ removal and observe if they had a decrease in the amount of abdominal pain after this procedure.Thirty-one patients completed follow-up at 3,6,9,and 12 months.At 6,9,and 12 months postoperation,there were statistically significant decreases in patients’ analog pain scores.We concluded that laparoscopic lysis of adhesions can help decrease adhesion-related pain.The pain from adhesions may involve a more complex pathway toward pain resolution than a simple cutting of scar tissue,such as "phantom pain" following amputation,which takes time to resolve after this type of surgery.