AIM To prospectively evaluate the effect of local wound infiltration with ropivacaine on postoperative pain relief and stress response reduction after open hepatectomy.METHODS A total of 56 patients undergoing open he...AIM To prospectively evaluate the effect of local wound infiltration with ropivacaine on postoperative pain relief and stress response reduction after open hepatectomy.METHODS A total of 56 patients undergoing open hepatectomy were randomly divided into two groups:a ropivacaine group(wound infiltration with ropivacaine solution)and a control group(infiltration with isotonic saline solution).A visual analog scale(VAS)at rest and on movement was used to measure postoperative pain for the first 48 h after surgery.Mean arterial pressure(MAP),heart rate(HR),time to bowel recovery,length of hospitalization after surgery,cumulative sufentanil consumption,and incidence of nausea and vomiting were compared between the two groups.Surgical stress hormones(epinephrine,norepinephrine,and cortisol)were detected using enzyme-linked immunosorbent assay,and the results were compared. RESULTS VAS scores both at rest and on movement at 24 h and48 h were similar between the two groups.Significantly lower VAS scores were detected at 0,6,and 12 h in the ropivacaine group compared with the control group(P<0.05 for all).MAP was significantly lower at 6,12,and 24 h(P<0.05 for all);HR was significantly lower at 0,6,12,and 24 h(P<0.05 for all);time to bowel recovery and length of hospitalization after surgery(P<0.05 for both)were significantly shortened;and cumulative sufentanil consumption was significantly lower at 6,12,24,and 36 h(P<0.05 for all)in the ropivacaine group than in the control group,although the incidence of nausea and vomiting showed no significant difference between the two groups.The levels of epinephrine,norepinephrine,and cortisol were significantly lower in the ropivacaine group than in the control group at 24 and 48 h(P<0.01 for all). CONCLUSION Local wound infiltration with ropivacaine after open hepatectomy can improve postoperative pain relief,reduce surgical stress response,and accelerate postoperative recovery.展开更多
目的:系统评价国内腹腔镜与开腹手术切除治疗肝癌的近期及远期疗效。方法:计算机检索ISI Web of Knowledge、MEDLINE、EMbase、PubMed,万方数据库、中国知网、维普资讯,收集国内研究机构完成的腹腔镜切除与开腹切除比较治疗肝癌的对照...目的:系统评价国内腹腔镜与开腹手术切除治疗肝癌的近期及远期疗效。方法:计算机检索ISI Web of Knowledge、MEDLINE、EMbase、PubMed,万方数据库、中国知网、维普资讯,收集国内研究机构完成的腹腔镜切除与开腹切除比较治疗肝癌的对照试验。数据提取和文献质量评价由2名评价员独立进行。采用RevMan 5.2对数据进行统计分析。结果:未获得随机对照试验,共纳入10个国内临床同期对照试验,累计病例552例。Meta分析结果显示:1)腹腔镜肝癌切除安全性更佳。可有效减少出血量[WMD=-83.3,95%CI(-124.3,-42.3),P<0.000 1],减少肝门阻断的使用[OR=0.17,95%CI(0.06,0.52),P=0.002],减少术后并发症的发生[OR=0.3,95%CI(0.16,0.59),P=0.000 4],明显缩短住院时间[WMD=-4.85,95%CI(-6.31,-3.38),P<0.000 01]。2)腹腔镜肝癌切除远期疗效无不良影响。腹腔镜与开腹手术组间的肿瘤复发率[OR=1.05,95%CI(0.6,1.85),P=0.87]及1、3、5年总体生存率[OR=1.40,95%CI(0.76,2.56),P=0.28;OR=1.15,95%CI(0.74,1.81),P=0.53;OR=0.91,95%CI(0.57,1.45),P=0.68]和1、3年无瘤生存率[OR=1.89,95%CI(0.96,3.7),P=0.16;OR=1.57,95%CI(0.94,2.61),P=0.18]差异无统计学意义(P>0.05)。结论:对于病变位于CouinaudⅡ、Ⅲ、Ⅳ、Ⅴ及Ⅵ段,肿瘤直径<10 cm,肝功能在Child B级以上的肝细胞癌患者,腹腔镜肝切除术对长期疗效无不良影响,且近期疗效更佳。展开更多
基金Supported by National Natural Science foundation of China,No.81571367 and No.81502050Scientific and Technological Project of Shandong Province,No.2016GSf201082
文摘AIM To prospectively evaluate the effect of local wound infiltration with ropivacaine on postoperative pain relief and stress response reduction after open hepatectomy.METHODS A total of 56 patients undergoing open hepatectomy were randomly divided into two groups:a ropivacaine group(wound infiltration with ropivacaine solution)and a control group(infiltration with isotonic saline solution).A visual analog scale(VAS)at rest and on movement was used to measure postoperative pain for the first 48 h after surgery.Mean arterial pressure(MAP),heart rate(HR),time to bowel recovery,length of hospitalization after surgery,cumulative sufentanil consumption,and incidence of nausea and vomiting were compared between the two groups.Surgical stress hormones(epinephrine,norepinephrine,and cortisol)were detected using enzyme-linked immunosorbent assay,and the results were compared. RESULTS VAS scores both at rest and on movement at 24 h and48 h were similar between the two groups.Significantly lower VAS scores were detected at 0,6,and 12 h in the ropivacaine group compared with the control group(P<0.05 for all).MAP was significantly lower at 6,12,and 24 h(P<0.05 for all);HR was significantly lower at 0,6,12,and 24 h(P<0.05 for all);time to bowel recovery and length of hospitalization after surgery(P<0.05 for both)were significantly shortened;and cumulative sufentanil consumption was significantly lower at 6,12,24,and 36 h(P<0.05 for all)in the ropivacaine group than in the control group,although the incidence of nausea and vomiting showed no significant difference between the two groups.The levels of epinephrine,norepinephrine,and cortisol were significantly lower in the ropivacaine group than in the control group at 24 and 48 h(P<0.01 for all). CONCLUSION Local wound infiltration with ropivacaine after open hepatectomy can improve postoperative pain relief,reduce surgical stress response,and accelerate postoperative recovery.
文摘目的:系统评价国内腹腔镜与开腹手术切除治疗肝癌的近期及远期疗效。方法:计算机检索ISI Web of Knowledge、MEDLINE、EMbase、PubMed,万方数据库、中国知网、维普资讯,收集国内研究机构完成的腹腔镜切除与开腹切除比较治疗肝癌的对照试验。数据提取和文献质量评价由2名评价员独立进行。采用RevMan 5.2对数据进行统计分析。结果:未获得随机对照试验,共纳入10个国内临床同期对照试验,累计病例552例。Meta分析结果显示:1)腹腔镜肝癌切除安全性更佳。可有效减少出血量[WMD=-83.3,95%CI(-124.3,-42.3),P<0.000 1],减少肝门阻断的使用[OR=0.17,95%CI(0.06,0.52),P=0.002],减少术后并发症的发生[OR=0.3,95%CI(0.16,0.59),P=0.000 4],明显缩短住院时间[WMD=-4.85,95%CI(-6.31,-3.38),P<0.000 01]。2)腹腔镜肝癌切除远期疗效无不良影响。腹腔镜与开腹手术组间的肿瘤复发率[OR=1.05,95%CI(0.6,1.85),P=0.87]及1、3、5年总体生存率[OR=1.40,95%CI(0.76,2.56),P=0.28;OR=1.15,95%CI(0.74,1.81),P=0.53;OR=0.91,95%CI(0.57,1.45),P=0.68]和1、3年无瘤生存率[OR=1.89,95%CI(0.96,3.7),P=0.16;OR=1.57,95%CI(0.94,2.61),P=0.18]差异无统计学意义(P>0.05)。结论:对于病变位于CouinaudⅡ、Ⅲ、Ⅳ、Ⅴ及Ⅵ段,肿瘤直径<10 cm,肝功能在Child B级以上的肝细胞癌患者,腹腔镜肝切除术对长期疗效无不良影响,且近期疗效更佳。
