腹腔镜手术后肩痛的原因及防治

腔镜术后患者发生肩痛的机制尚不完全明确，推测其发生的可能机制包括：碳酸对膈神经的直接刺激；气腹所导致的膈肌损伤和后续的炎症反应。发生肩痛的危险因素主要与手术时患者的体位、充气速度、手术时间、手术的类型、有无盆腔粘连、有无腹腔积血积液及个体因素相关。主要防治措施有充分排出腹腔内残余的CO2，膈神经区域阻滞，减少膈肌的损伤及非甾体抗炎药物（NSAID）的全面应用等。以上各种防治方法都存在不足，并有导致并发症发生的可能。腔镜术后发生肩痛尚有待进一步研究以明确其机制并获得简单可靠的治疗。

Cause and therapy of shoulder pain after laparoscopic surgery

Shoulder pain is a common complaint following laparoscopic surgery.Though the specific mechanism is still not clear,two causes have been suggested:(1) direct irritation to the phrenic nerve due to the residual CO2 pneumoperitoneum;(2) excessive traction of the triangular ligament and over stretching of the diaphragmatic fibers resulting in inflammation.The major risk factors of shoulder pain may be related to the operative position,pneumoperitoneum inflatable speed,operation time,surgical and personal facto...