妇科腹腔镜手术后疼痛的影响因素分析

Prospective Factors of Posto perative Pain Following Gynaecologic Lapa roscopic Surgery

目的 :分析妇科腹腔镜手术后疼痛的影响因素及处理措施。方法 :选择 2 0 0 2年 10月至 2 0 0 3年 1月在我院妇科接受腹腔镜手术治疗的妇科良性疾病患者共 14 4例 ,行腹腔镜辅助的阴式子宫切除、子宫肌瘤剔除术、附件切除术、卵巢囊肿剔除术和盆腔粘连分离术。采用疼痛视觉模拟量表法评价患者术后手术切口、两侧肩部和两侧季肋部疼痛情况。结果 :术后有 79 2 %的患者发生切口疼痛 ,4 5 7%的患者发生肩部疼痛 ,18 1%的患者发生季肋部疼痛。年龄、体重、受教育程度、生育史、手术方式、手术时间、形成气腹的速度、盆腔粘连情况以及是否放置引流管均与手术后疼痛的发生和程度有关。结论 :腹腔镜手术后的疼痛与多种因素有关 ,通过处理措施的改进能够减轻腹腔镜术后的疼痛。

Objective:To as sess the e ffects of several preoperative and surgi cal factors on po stoperative pain following gynaecologic laparoscopic surgery.Methods:One hundred forty-fo ur women under went laparoscopy for various gynecologic indi cations between January 2003 and October 2002. Surgical managements include LAVH ,myomectomy,appendectomy, cystectomy, an d adhesion division. Postopera tive pain in trocar sites, shoulder tips,a nd upper abdomen were evaluated by visual analogue scale (VAS). Results:After the operations , 79.2% of the patie nts suffered from trocar site pain, 45.7% with shoulder tip pain, and 18.1% with u pper abdominal pain. The following fact ors, in varying degrees, have been impli cated in postlaparoscopy pain: age, body weight, education, times of gestation / parturition, operative type, duration of the operation, spe ed of the insufflated gas, pelvic adhesi on and presence of drains.Conclusions:There are many f actors associate d with pain following operative laparosc opy and ther e are effective managements that can all eviate the pain.