膈下引流管对腹腔镜胆囊切除术后72h内肩痛的影响

Effect of Diaphragm Drainage on Shoulder Pain Within 72 Hours After Laparoscopic Cholecystectomy

目的：探讨腹腔镜胆囊切除术（ laparoscopic cholecystectomy ，LC）后膈下引流管对术后72 h内肩部疼痛的影响。方法我院2014年1月～2015年10月行LC并进行分组的患者共312例，术后72 h内有右肩部疼痛118例，其中76例术后放置右膈下引流管（引流管组），42例不放置引流管（对照组），采用倾向得分匹配法（propensity score matching，PSM）均衡组间混杂因素的影响，获得31对患者，比较匹配后2组患者术后肩部疼痛程度、手术时间、术后住院时间及术后切口感染情况。结果引流管组术后12、24、72 h肩部疼痛视觉模拟评分（visual analogue scale，VAS）显著低于对照组[（1．03±0．46）分 vs．（2．52±1．11）分，t＝-6．904，P＝0．000；（1．25±0．27）分 vs．（2．64±1．38）分，t＝-5．504，P＝0．000；（0．33±0．07）分 vs．（0．52±0．28）分，t＝-3．665，P＝0.000]，2组患者术后48 h右肩部疼痛VAS评分无统计学差异[（0．98±0．43）分 vs．（1．12±0．26）分，t＝-1．551，P＝0．126）]。2组均未发生切口感染。引流管组手术时间明显长于对照组[（53．5±13．5）min vs．（46．4±11．6）min，t＝2．221，P＝0．030）]；2组术后住院时间无统计学差异[（5．2±1．3）d vs．（5．0±2．1）d，t＝0．409，P＝0．684]。结论 LC术后放置右膈下引流管可明显减轻术后24 h内右肩部疼痛程度，且不会明显延长术后住院时间，不会明显增加术后切口感染发生率，安全有效。

Objective To analyze the influence of diaphragmatic drainage on postoperative shoulder pain within 72 hours after laparoscopic cholecystectomy . Methods Among 312 cases of laparoscopic cholecystectomy from January 2014 to October 2015 in this hospital , there were 118 cases with postoperative right shoulder pain , 76 of which received right diaphragmatic drainage （ drainage group） and 42 of which underwent no drainage （control group）.To adjust for baseline differences, the propensity-score matching （PSM） was used to generate 31 pairs of matched patients.The degree of pain, operation time, postoperative hospital stay and postoperative wound infection rate were compared . Results The drainage group had significantly lower visual analog scores （ VAS） than the control group at 12 h, 24 h and 72 h postoperatively, respectively [（1.03 ±0.46） points vs.（2.52 ±1.11） points, t＝-6.904, P=0.000;（1.25 ±0.27） points vs.（2.64 ±1.38） points, t ＝-5.504, P =0.000; （0.33 ±0.07） points vs. （0.52 ±0.28） points, t＝-3.665, P=0.000].There was no significant difference in right shoulder pain at 48 h postoperatively [（0.98 ±0.43） points vs.（1.12 ±0.26） points, t＝-1.551, P=0.126].No postoperative wound infection happened in both groups.The operation time was significantly longer in the drainage group than that in the control group [（53.5 ±13.5） min vs. （46.4 ±11.6） min, t=2.221, P=0.030].There was no significant difference in postoperative hospital stay between the two groups [（5.2 ±1.3） d vs.（5.0 ±2.1） d, t=0.409, P=0.684]. Conclusion After laparoscopic cholecystectomy , right diaphragm drainage can significantly reduce the right shoulder pain within 24 hours after operation and do not prolong the length of hospital stay obviously , as well as not increase the incidence of postoperative wound infection obviously .It is safe and effective .