中国实用外科杂志

中国实用外科杂志

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腹腔镜辅助腹横肌平面阻滞技术用于结直肠癌手术安全性和有效性研究

杨    鋆a，李东明a，曾    娜b，田名伟a，李    俊a，吴国聪a，金    岚 a，杨盈赤 a，张忠涛a   

  1. 首都医科大学附属北京友谊医院  a.普外科 结直肠肿瘤临床诊疗与研究中心 国家消化系统疾病临床医学研究中心普外分中心  b.临床流行病学与循证医学室 国家消化系统疾病临床医学研究中心方法学平台，北京 100050
  • 出版日期:2021-04-01 发布日期:2021-04-20

  • Online:2021-04-01 Published:2021-04-20

摘要： 目的    探讨腹腔镜辅助腹横肌平面（Lap-TAP）阻滞技术对于结直肠外科术后镇痛的安全性和有效性。方法    采用前瞻性随机对照研究方法，选择2020年4—9月首都医科大学附属北京友谊医院普外科收治的行腹腔镜手术治疗的65例结直肠癌病人，根据病人术中是否行Lap-TAP阻滞，采用随机数字表法将病人随机分为试验组（32例）和对照组（33例），对比分析两组病人术后指标。结果    试验组Lap-TAP 阻滞操作时间为（4.8±0.6）min，均未发生腹横肌平面（TAP）阻滞相关并发症，而且与对照组相比，试验组Lap-TAP阻滞并未增加病人的手术时间［（207.2±21.7）h vs.（201.7±22.1）h，P＞0.05］。试验组病人在术后2 h内以及6、12、24 h的疼痛评分明显低于对照组。试验组病人的术后首次下床时间、首次饮水时间、首次排气时间明显较对照组缩短［（7.3±0.7）h vs. （19.1±1.2）h，（12.6±1.4）h vs. （17.5±1.3）h，（33.1±1.8）h vs. （39.2±1.7）h；P均＜0.001］。两组病人术后使用非甾体抗炎药剂量、术后首次进流食时间、术后住院时间等指标差异无统计学意义（P＞0.05）。结论    Lap-TAP阻滞是一种安全有效的镇痛方式，可在术后早期产生良好的镇痛效果，促进病人术后早期下床、加快病人胃肠道功能恢复，具有良好的临床应用价值。

关键词: 腹腔镜辅助腹横肌平面阻滞, 结直肠外科, 围手术期, 镇痛, 胃肠功能

Abstract: Safety and efficacy of laparoscopic-assisted transversus abdominis plane（LAP-TAP） block for colorectal cancer surgery        YANG Yun*，LI Dong-ming，ZENG Na，et al. *Department of General Surgery，Beijing Friendship Hospital，Capital Medical University；National Clinical Research Center for Digestive Disease；Clinical Center for Colorectal Cancer，Capital Medical University，Beijing 100050，China
Corresponding author：YANG Ying-chi，E-mail：yangyingchi@ccmu.edu.cn
YANG Yun and LI Dong-ming are the first authors who contributed equally to the article.
Abstract Objective To study the safety and efficacy of laparoscopic-assisted transversus abdominis plane （Lap-TAP） block in postoperative analgesia during colorectal surgery. Methods    It was a prospective randomized controlled study，and 65 patients underwent laparoscopic colorectal surgery in Department of General Surgery of Beijing Friendship Hospital，Capital Medical University from April 2020 to September 2020 were included. According to whether Lap-TAP block was performed intraoperatively，those patients were randomly divided into experimental group （32 cases） and control group （33 cases） by using a random number table. Postoperative data of the two groups were compared and analyzed. Results    The operation time of LAP-TAP block in experimental group was （4.8±0.6）min，and no TAP block-related complications occurred in all 32 patients in the study. Compared with the control group，there wasn’t significant differences in the operation time of experimental group which received Lap-TAP block ［（207.2±21.7） h vs. （201.7±22.1） h，P > 0.05］. The postoperative pain scores in the experimental group were significantly lower than those in the control group at 2，6，12 and 24 h after surgery Time of first ambulation，first drinking water and first exhaust in experimental group were significantly earlier than those in control group ［（7.3±0.7） h vs. （19.1±1.2） h，（12.6±1.4） h vs. （17.5±1.3） h，（33.1±1.8） h vs. （39.2±1.7） h；all P＜0.001］. But there was no statistically significant difference in the usage of NSAIDs dose，time of first fluid intake，duration of hospital stay after the surgery and other indicators between two groups （P＞0.05）. Conclusion    Lap-TAP block is a safe and effective analgesic method，which can decrease the pain experienced in the early stage of post-operation，promote patients' early mobilization，and accelerate the recovery of gastrointestinal function. So Lap-TAP block has a great value of clinical application.

Key words: laparoscopic-assisted transversus abdominis plane block, colorectal surgery, perioperative, analgesia, gastrointestinal function