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首页> 外文期刊>Surgical Endoscopy >Surgical techniques to minimize shoulder pain after laparoscopic cholecystectomy. A systematic review.
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Surgical techniques to minimize shoulder pain after laparoscopic cholecystectomy. A systematic review.

机译：腹腔镜胆囊切除术后减少肩痛的手术技术。系统的审查。

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摘要

Laparoscopic cholecystectomy (LC) is the treatment of choice for symptomatic cholecystolithiasis. Despite the many advantages over open surgery, many patients complain about referred pain to the shoulder during the postoperative course. The purpose of this review was to evaluate different intraoperative surgical methods to minimize shoulder pain (SP).A search of the literature was conducted using PubMed, Excerpta Medica Database (EMBASE), and Cochrane database of systematic reviews. Eligibility criteria were: randomized clinical trials or meta-analysis evaluating intraoperative surgical methods applied to minimize incidence or severity of SP after LC. Only papers published in English were included. Data extracted were year of publication, number of participants and allocation, nonsignificant or significant effect on incidence or severity of SP.A total of 31 papers where included in the review. Seven, 8, and 12 papers investigated the effect of drains, abdominal wall lift (AWL), and low-pressure pneumoperitoneum respectively. Four papers investigated drain suction, active gas aspiration, low insufflation flow or N2O insufflation respectively. The interventions that overall showed a significant reduction on either the incidence or severity of SP were low-pressure pneumoperitoneum, low insufflation rate, and active gas aspiration.Drainage and AWL are not recommended to reduce SP after LC. Low-pressure pneumoperitoneum with carbon dioxide is the best documented intraoperative surgical method to minimize both the incidence and severity of SP after LC.
机译：腹腔镜胆囊切除术（LC）是有症状胆囊结石症的首选治疗方法。尽管与开放式手术相比有许多优势，但许多患者抱怨术后过程中肩部疼痛。这篇综述的目的是评估不同的术中手术方法以最大程度地减少肩痛（SP）。使用PubMed，Excerpta Medica数据库（EMBASE）和Cochrane系统评价数据库进行文献检索。入选标准为：随机临床试验或荟萃分析评估术中手术方法，以尽量减少LC后SP的发生率或严重性。只包括英文发表的论文。所提取的数据为发表年份，参与者数量和分配，对SP发生率或严重性的无显着或重大影响。总共纳入31篇论文。七篇，八篇和十二篇论文分别研究了引流管，腹壁举升（AWL）和低压气腹的效果。四篇论文分别研究了排水吸引，活性气体吸入，低吹入流量或N2O吹入。总体而言，低压气腹，低吹气率和主动吸气可显着降低SP的发生率或严重程度，因此不建议采用引流和AWL降低LC后的SP。低压气腹加二氧化碳是记录最清楚的术中手术方法，可最大程度地减少LC后SP的发生率和严重程度。

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