单孔与多孔腹腔镜治疗妇科良性疾病术后肩膀疼痛情况及围手术期结局的比较研究

Comparison of shoulder pain and perioperative outcomes between single-port and conventional laparoscopy in the treatment of gynecological benign diseases

关键词:  单孔腹腔镜  多孔腹腔镜  肩膀疼痛  围手术期结局

Key words:  single-port laparoscopy  conventional laparoscopy  shoulder pain  perioperative outcomes

摘要:

目的对比研究经脐单孔腹腔镜与多孔腹腔镜治疗妇科良性疾病术后肩膀疼痛情况及围手术期结局；通过比较术后肩膀疼痛组与非疼痛组的病例特征，分析腹腔镜术后肩膀疼痛的高危因素。方法采用回顾性队列研究，选取2022年4月—2023年3月因妇科良性疾病行腹腔镜手术的患者216例，根据入路不同分为单孔腹腔镜手术组(单孔组，108例)及多孔腹腔镜手术组(多孔组，108例)。采用视觉模拟评分(visual analogue scale, VAS)对两组术后24h肩膀疼痛情况进行描述。比较两组术后肩膀疼痛情况及两组手术时间、术中出血量、术中腹腔CO2进气量、术后住院时间、术后血红蛋白(hemoglobin, Hb)下降幅度、术后是否放置腹腔引流及术后是否放置镇痛泵等围手术期结局。采用Logistic回归分析比较术后肩膀疼痛组与非疼痛组的病例特征，分析造成腹腔镜术后肩膀疼痛的高危因素。结果单孔组术后肩膀疼痛评分明显高于多孔组(2.2 vs 0.7,P<0.001)。两组手术时间(96.5min vs 95.1min,P=0.08)、术中出血量(67.5mL vs 50.1mL,P=0.11)、术后住院时间(2.8d vs 2.7d,P=0.22)差异无统计学意义。单孔组术中CO2进气量明显高于多孔组(181.9L vs 123.2L, P=0.002);单孔组术后放置腹腔引流的比例明显低于多孔组(62% vs 92.6%, P<0.001)；单孔组术后Hb下降幅度高于多孔组(13.5g/L vs 11.1g/L, P=0.02)。通过比较腹腔镜术后肩膀疼痛组与非疼痛组的病例特征发现，低BMI(22.4kg/m2 vs 23.4kg/m2, P=0.04)及未放置腹腔引流(34.2% vs 16.8%,P<0.001)是造成腹腔镜术后肩膀疼痛的高危因素。结论在治疗妇科良性疾病方面，与传统腹腔镜相比，单孔腹腔镜同样安全有效，但是增加了患者术后肩膀疼痛的发生。BMI低的患者更容易发生腹腔镜术后肩膀疼痛，腹腔镜术后放置腹腔引流可以减少术后肩膀疼痛的发生。

Abstract:

ObjectiveTo compare the postoperative shoulder pain and perioperative outcomes of single-port laparoscopy and conventional laparoscopy in the treatment of gynecological benign diseases. MethodsClinical data of 216 patients who underwent laparoscopic surgery for benign gynecological diseases in our hospital from April 2022 to March 2023 were retrospectively analyzed, including 108 cases receiving single-port laparoscopic surgery and 108 cases receiving conventional laparoscopic surgery. The shoulder pain 24h after surgery was assessed with VAS scores and compared between two groups. The perioperative outcomes including surgical time, intraoperative blood loss, intraoperative abdominal cavity CO2 use, postoperative hospital stay, postoperative Hb decrease, postoperative placement of abdominal drainage and postoperative placement of analgesic pump were compared between two groups. In addition, the risk factors of postoperative shoulder pain were analyzed with Logistic regression analysis. ResultsThe postoperative shoulder pain score in the single-port group was significantly higher than that in the conventional group(2.2 vs 0.7, P<0.001). There was no significant difference in surgical time(96.5min vs 95.1min, P=0.08), intraoperative bleeding volume(67.5mL vs 50.1mL, P=0.11) and postoperative hospital stay(2.8d vs 2.7d, P=0.22) between the two groups. The intraoperative CO2 use in the single-port group was significantly higher than that in the conventional group(181.9L vs 123.2L, P=0.002); the proportion of placing abdominal drainage after surgery in the single-port group was significantly lower than that in the conventional group(0.23(0.10-0.55)); the postoperative decrease in Hb in the single-port group was higher than that in the conventional group(13.5g/L vs 11.1g/L, P=0.02). In addition, Logistic regression analysis showed that low BMI(22.4kg/m2 vs 23.4kg/m2, P=0.04) and no placement of abdominal drainage(34.2% vs 16.8%， P＜0.001) were influencing factors related to shoulder pain after laparoscopic surgery. ConclusionCompared with conventional laparoscopy, single-port laparoscopy is safe and effective in treating benign gynecological diseases, but it increases the incidence of postoperative shoulder pain. Our study shows that patients with lower BMI are more likely to have shoulder pain after laparoscopic surgery, and placing abdominal drainage after laparoscopic surgery can reduce the occurrence of shoulder pain.