Clinical Study of Painless Laparoscopic Cholecystectomy Based on Concept of Fast Track Surgery_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 MAJian-wei ¹ ,  YANGXiao-jun ² , ZHANGFu-li ¹ , LIXiang-jun ¹

1. Department of General Surgery, The 2nd Hospital of Baiyin City, Baiyin 730900, Gansu Province, China;
2. The 2nd Department of General Surgery, Gansu Provincial Hospital, Lanzhou 730000, Gansu Province, China;

Corresponding?author：

YANGXiao-jun, Email: yangxjmd@aliyun.com

Keywords：

Fast track surgery; Painless; Laparoscopic cholecystectomy

DOI：

10.7507/1007-9424.20160156

Video：

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Objective To study clinical value of perioperative multimodal analgesia for laparoscopic cholecystectomy based on concept of fast track surgery (FTS). Methods The clinical data of 268 patients were analyzed retrospectively, who underwent laparoscopic cholecystectomy in the Department of General Surgery, the 2nd Hospital of Baiyin City from July 2013 to July 2015. All these patients were divided into FTS group and traditional group according to the chronological order, 133 patients in the traditional group were performed traditional perioperative analgesia before August 31, 2014, and 135 patients in the FTS group were performed perioperative multimodal analgesia method based on the concept of FTS after September 1, 2014. The data of both groups were collected and analyzed, including point of numerical rating scale, intestinal function recovery time, intake food time, ambulation time, drainage tube duration, postoperative hospital stay, postoperative sleep time at 72 h, and complications. Results ①The points of numerical rating scale at 1 h, 4 h, 8 h, 12 h, 24 h, 48 h, and 72 h in the FTS group were significantly lower than those in the traditional group (P < 0.01).②Compared with the traditional group, the intestinal function recovery time, intake food time, ambulation time, drainage tube duration, and postoperative hospital stay were obviously shorter, the postoperative sleep time at 72 h was obviously longer in the FTS group.③The incidence of nausea and vomiting in the FTS group was significantly lower than that in the traditional group (P < 0.01), the incidences of the other complications such as acid reflux, urinary retention, and breathing difficulty had no significant differences between these two groups (P > 0.05). The satisfaction rate of postoperative analgesic effect in the FTS group was significantly higher than that in the traditional group (P < 0.01). Conclusions Perioperative multimodal analgesia for laparoscopic cholecystectomy based on concept of FTS is safe and effective. It could achieve painless effect of laparoscopic cholecystectomy.

Citation： MAJian-wei, YANGXiao-jun, ZHANGFu-li, LIXiang-jun. Clinical Study of Painless Laparoscopic Cholecystectomy Based on Concept of Fast Track Surgery. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(5): 581-585. doi: 10.7507/1007-9424.20160156 Copy

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2.	Wilmore DW, Kehlet H. Management of patients in fast track surgery. BMJ, 2001, 322(7284): 473-476.
3.	江志偉, 李寧, 黎介壽.加速康復外科的概念及臨床意義.中國實用外科雜志, 2007, 27(2): 131-133.
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10.	王美青, 潘寅兵, 錢燕寧.腹腔鏡膽囊切除術后疼痛的原因及對策.臨床麻醉學雜志, 2013, 29(11): 1126-1129.
11.	張東, 閔蘇.腹腔鏡膽囊切除術后急性疼痛的相關研究進展.腹腔鏡外科雜志, 2015, 20(5): 395-398.
12.	藍菊容.自控鎮痛泵用于普外科術后鎮痛的臨床觀察及護理.臨床醫學工程, 2010, 17(6): 97-98.
13.	孫繼雄, 郭建華, 石學銀.疼痛對上腹部術后呼吸肌功能不全的影響.臨床麻醉學雜志, 2003, 19(5): 268-269.
14.	張振宇, 安友仲, 馮藝. ICU腹部外科術后患者疼痛與睡眠關系的研究.中國疼痛醫學雜志, 2012, 18(2): 95-98.
15.	畢旭東.腹腔鏡膽囊切除術術后出現上腹部持續性疼痛伴腹脹的原因及處理.中國內鏡雜志, 2013, 19(4): 429-430.
16.	何苗, 吳曉英, 馮藝, 等.術后疼痛管理新進展.中國護理管理, 2014, 14(11): 1135-1137.
17.	郭紹紅, 董集生.腹腔鏡膽囊切除術后疼痛的原因與防治.中國微創外科雜志, 2001, 7(5): 308-311.
18.	保紅平, 方登華, 高瑞崗, 等.腹腔鏡膽囊切除術后疼痛的原因及處理.肝膽外科雜志, 2003, 11(5): 367-369.
19.	馬建勛, 王曉鵬, 高鵬, 等.腹腔鏡膽囊切除術后再疼痛的原因分析及預防.中國微創外科雜志, 2009, 15(7): 595-598.
20.	劉延超, 侯彥深, 蔣暉.婦科腹腔鏡術后羅哌卡因切口和盆腔浸潤的鎮痛作用.臨床麻醉學雜志, 2011, 27(7): 709-711.
21.	馬永豐, 李濤, 陳雪紅, 等.術后疼痛與前列腺素E2的改變.臨床麻醉學雜志, 2001, 17(5): 285.
22.	陳鶯, 朱晨.地佐辛對神經病理性疼痛大鼠行為學及脊髓腫瘤壞死因子-α和前列腺素E2水平的影響.新鄉醫學院學報, 2013, 30(9): 688-691.
23.	王英偉.平衡鎮痛與多模式鎮痛在術后疼痛治療中的價值.國外醫學麻醉學與復蘇分冊, 1995, 16(1): 43-46.
24.	劉慧麗, 張小青, 李躍新, 等.不同多模式鎮痛策略對腹腔鏡手術后疼痛的影響.臨床麻醉學雜志, 2014, 30(3): 235-238.
25.	劉爭, 李玉, 劉治榮.術前疼痛教育對腹部手術患者術后疼痛控制的影響.華西醫學, 2005, 20(3): 568-569.
26.	王宏, 孫紅, 賈梅燕, 等.肝膽外科術前患者疼痛認知及術后鎮痛滿意度現狀調查.寧夏醫學雜志, 2015, 37(12): 1174-1175.

1. Kehlet H, Wilmore DW. Multi-modal strategies to improve surgical outcome. Am J Surg, 2002, 183(6): 630-641.
2. Wilmore DW, Kehlet H. Management of patients in fast track surgery. BMJ, 2001, 322(7284): 473-476.
3. 江志偉, 李寧, 黎介壽.加速康復外科的概念及臨床意義.中國實用外科雜志, 2007, 27(2): 131-133.
4. 湯建燕, 鄔葉鋒, 程邦君, 等.加速康復外科在胃腸外科圍手術期應用進展.中國普外基礎與臨床雜志, 2013, 20(4): 498-501.
5. 江志偉, 黎介壽.加速康復外科的現狀與展望.中華外科雜志, 2016, 54(1): 6-8.
6. Osbome DA, Alexander G, Boe B, et al. Laparoscopic cholecystectomy past present and future. Surg Technol Int, 2006, 15(1): 81-85.
7. 王雨, 戴睿武, 閻勇, 等.老年急性膽囊炎開腹膽囊切除與腹腔鏡膽囊切除術的選擇策略(附149例報道).中國普外基礎與臨床雜志, 2009, 16(7): 563-565.
8. 李蓓, 李寧, 葉輝, 等.日間腹腔鏡膽囊切除術的優勢.中國普外基礎與臨床雜志, 2014, 21(10): 1207-1211.
9. 王明倉, 陳玲陽, 項海飛, 等.多模式鎮痛對腹腔鏡膽囊切除術患者術后疼痛及預后的影響.浙江創傷外科, 2011, 16(3): 372-373.
10. 王美青, 潘寅兵, 錢燕寧.腹腔鏡膽囊切除術后疼痛的原因及對策.臨床麻醉學雜志, 2013, 29(11): 1126-1129.
11. 張東, 閔蘇.腹腔鏡膽囊切除術后急性疼痛的相關研究進展.腹腔鏡外科雜志, 2015, 20(5): 395-398.
12. 藍菊容.自控鎮痛泵用于普外科術后鎮痛的臨床觀察及護理.臨床醫學工程, 2010, 17(6): 97-98.
13. 孫繼雄, 郭建華, 石學銀.疼痛對上腹部術后呼吸肌功能不全的影響.臨床麻醉學雜志, 2003, 19(5): 268-269.
14. 張振宇, 安友仲, 馮藝. ICU腹部外科術后患者疼痛與睡眠關系的研究.中國疼痛醫學雜志, 2012, 18(2): 95-98.
15. 畢旭東.腹腔鏡膽囊切除術術后出現上腹部持續性疼痛伴腹脹的原因及處理.中國內鏡雜志, 2013, 19(4): 429-430.
16. 何苗, 吳曉英, 馮藝, 等.術后疼痛管理新進展.中國護理管理, 2014, 14(11): 1135-1137.
17. 郭紹紅, 董集生.腹腔鏡膽囊切除術后疼痛的原因與防治.中國微創外科雜志, 2001, 7(5): 308-311.
18. 保紅平, 方登華, 高瑞崗, 等.腹腔鏡膽囊切除術后疼痛的原因及處理.肝膽外科雜志, 2003, 11(5): 367-369.
19. 馬建勛, 王曉鵬, 高鵬, 等.腹腔鏡膽囊切除術后再疼痛的原因分析及預防.中國微創外科雜志, 2009, 15(7): 595-598.
20. 劉延超, 侯彥深, 蔣暉.婦科腹腔鏡術后羅哌卡因切口和盆腔浸潤的鎮痛作用.臨床麻醉學雜志, 2011, 27(7): 709-711.
21. 馬永豐, 李濤, 陳雪紅, 等.術后疼痛與前列腺素E2的改變.臨床麻醉學雜志, 2001, 17(5): 285.
22. 陳鶯, 朱晨.地佐辛對神經病理性疼痛大鼠行為學及脊髓腫瘤壞死因子-α和前列腺素E2水平的影響.新鄉醫學院學報, 2013, 30(9): 688-691.
23. 王英偉.平衡鎮痛與多模式鎮痛在術后疼痛治療中的價值.國外醫學麻醉學與復蘇分冊, 1995, 16(1): 43-46.
24. 劉慧麗, 張小青, 李躍新, 等.不同多模式鎮痛策略對腹腔鏡手術后疼痛的影響.臨床麻醉學雜志, 2014, 30(3): 235-238.
25. 劉爭, 李玉, 劉治榮.術前疼痛教育對腹部手術患者術后疼痛控制的影響.華西醫學, 2005, 20(3): 568-569.
26. 王宏, 孫紅, 賈梅燕, 等.肝膽外科術前患者疼痛認知及術后鎮痛滿意度現狀調查.寧夏醫學雜志, 2015, 37(12): 1174-1175.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical Study of Painless Laparoscopic Cholecystectomy Based on Concept of Fast Track Surgery

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