超声引导下不同神经阻滞在腹腔镜胆囊切除术中的应用

Application of different nerve blocks under ultrasound guidance in laparoscopic cholecystectomy

腹腔镜胆囊切除术因其创伤小、术后恢复快等优点被认为是治疗胆囊结石症的金标准,但术中应激反应、术后疼痛仍会对患者造成影响,甚至多数患者术后因疼痛而不愿意早期下床,不利于恢复进程。目前,超声引导区域神经阻滞技术逐渐成熟并应用于胆囊切除术,如胸椎旁神经阻滞(TPVB)及近年来广泛应用于临床的竖脊肌平面阻滞(ESPB)均可与全身麻醉相结合应用在腹腔镜胆囊切除手术中,降低胆囊切除术所引起的各种疼痛。近年来新提出的肋横突阻滞(CTB)虽然相关报道较少,但本团队通过解剖学观察发现其应用于胆囊切除术可能具有更大的优势。本文就近年来有关TPVB、ESPB、CTB研究进展进行分析,探讨超声引导下3种不同神经阻滞技术在腹腔镜胆囊切除术中的优缺点。

Laparoscopic cholecystectomy is considered to be the gold standard for the treatment of cholecystolithiasis because of its advantages of less trauma and faster postoperative recovery,but intraoperative stress and postoperative pain still affect patients.Most patients are reluctant to get out of bed early after surgery due to pain,which is not conducive to patients'recovery.At present,ultrasound-guided regional nerve block techniques are gradually mature and applied to laparoscopic cholecystectomy,such as thoracic paravertebral nerve block(TPVB)and erector spinae plane block(ESPB)which have been widely used in clinic in recent years,can be combined with general anesthesia in laparoscopic cholecystectomy to reduce the pain caused by cholecystectomy.Although there are few reports on costotransverse block(CTB),which has been newly proposed in recent years,our team found that it may have greater advantages in cholecystectomy through anatomical observation.This article analyzes the research progress on TPVB,ESPB,and CTB in recent years,and explores the advantages and disadvantages of three different nerve block techniques under ultrasound guidance in laparoscopic cholecystectomy.