摘要
目的术后疼痛是胸部手术后的常见并发症,通过研究微创与开放Ivor Lewis食管切除手术后急性疼痛(acutepostsurgical pain, APSP)与慢性疼痛(chronic postsurgical pain,CPSP)的发生情况,进而探讨急慢性疼痛的转归规律及慢性疼痛的影响因素。方法回顾性分析2017-02-01-2018-01-31安徽医科大学附属省立医院收治的接受微创和开放Ivor Lewis食管癌切除手术的111例食管癌患者临床资料,其中53例接受开放Ivor Lewis食管切除术(Open Ivor Lewisesophagectomy,OILE)设为开放组,58例接受微创 Ivor Lewis 食管切除术(minimally invasire Ivor Lewis esophagectomy,MIILE)设为微创组。比较分析两组患者的围手术期资料,于术后第1、2、3、7天以数字等级评定量表(numerical ratingscale, NRS)进行疼痛程度评估,术后第3、6个月时通过电话随访疼痛程度及疼痛性质。结果两组患者在年龄、性别、体质量指数(body mass index,BMI)、肿瘤部位、TNM分期和手术时间方面差异无统计学意义(P>0.05),临床资料具有可比性。微创组胸腔引流时间为(8.74±2.45) d,低于开放组的(9.69±1.67) d,t=2.372, P=0.019;微创组术后住院天数为(12.66±2.56) d,低于开放组的(14.06±2.76) d, t=2.779, P=0.006;微创组术中失血量为(126.72±59.39) mL,低于开放组的(204.72±74.85) mL,t=6.107, P<0.001;微创组术后第1天NRS评分为(4.02±2.01),低于开放组的(4.85±2.37),t=1.997,P=0.048;微创组术后第2天NRS评分为(3.62±1.67),低于开放组的(4.43±2.08),t=2.278,P=0.025;微创组术后第3天NRS评分为(3.28±1.51),低于开放组的(4.09±1.91),t=2.513,P=0.013;微创组术后第7天NRS评分为(2.19±1.74),低于开放组的(3.02±1.77),t=2.486,P=0.014;术后3个月疼痛(NRS≥3)发生率为22.41%,低于开放组的52.83%,差异有统计学意义,χ^2= 10.999,P = 0.001;术后6个月疼痛(NRS≥3)发生率为15.52%,低于开放组的45.28%,差异有统计学意义,χ^2= 11.745,P=0.001。单因素分析显示,术后3个月CPSP的危�
OBJECTIVE Postoperative pain is a common complication after thoracic surgery. The purpose of this study was to explore the correlation of acute and chronic pain in patients after esophagectomy, and to describe predictors of chronic postsurgical pain between minimally invasive Ivor Lewis esophagectomy(MIILE) and open Ivor Lewis esophagectomy (OILE). METHODS The data of 120 patients who underwent minimally invasive Ivor Lewis esophagectomy (n=60) and open Ivor Lewis esophagectomy(n = 60) in Anhui Provincial Hospital Affiliated to Anhui Medical University from February 1?2017 to January 31,2018 was analyzed retrospectively. The clinical and operative data were assessed. Postoperative acute pain was measured with a numeric rating scale(NRS) on the 1st,2nd,3rd and 7th days during hospital stay,as well as during follow-ups by telephone at 3rd months and 6th months after surgery. RESULTS The two groups were similar in age,gender,BMI,tumor location,TNM staging and operative time (P>0. 05). The chest drainage time of the MILLE group [(8. 74±2. 45) d] was lower than that of the OILE group [(9. 69±1. 67) d],Z=2. 372,P=0. 019. The postoperative stay days of the MILLE group [(12. 66±2. 56) d] was lower than that of the OILE group [(14. 06± 2. 76) d],t = 2. 779,P = 0. 006. The surgical blood loss of the MILLE group [(126. 72 ± 59. 39) ml] was lower than that of the OILE group [(204. 72±74. 85) ml],t= 6. 107,P<0. 001. The pain NRS scores on the 1st,2nd,3rd and 7th days? 3rd months and 6th months after MULE group were lower than those in the OILE group. The incidence of CPSP was lower in the 3 months than in the OILE group (χ^2=10. 999, P = 0. 001),and the incidence of CPSP was lower in the 6 months after surgery than in the OILE group (χ^2= 11. 745, P = 0. 001). Univariate and Logistic regression analysis showed that the surgical approach and the 3rd, 7th pain in tensity were risk factors for postoperative chronic pain. CONCLUSIONS The MILLE has more advantages than the OILE in the incidence of acute and chronic pain. S
作者
林涛
解明然
马冬春
LIN Tao;XIE Ming-ran;MA Dong-chun(Department of Thoracic Surgery,Affiliated Provincial Hospital of Anhui Medical University,Hefei 230001,P.R.China)
出处
《中华肿瘤防治杂志》
CAS
北大核心
2019年第11期784-789,共6页
Chinese Journal of Cancer Prevention and Treatment
基金
安徽省自然科学基金(1708085MH179)
关键词
食管肿瘤
食管切除术
胸腔镜
腹腔镜
急性疼痛
慢性疼痛
esophageal neoplasms
esophagectomy
thoracoscopy
laparoscopy
acute pain
chronic pain
