摘要:目的:探討通過腹腔內注射局部麻醉藥在腹腔鏡膽囊切除術中的鎮痛效果。方法:52例患者隨機分為4組,Ⅰ組術前腹腔內噴灑0.75％羅哌卡因20 mL;Ⅱ組術后腹腔內噴灑0.75％羅哌卡因20 mL;Ⅲ組為術后腹腔內噴灑0.5％布比卡因20 mL;Ⅳ組術后腹腔內噴灑生理鹽水20 mL。麻醉方法均為全憑靜脈麻醉。術后1、2、3、4 h 4個時間點記錄患者術后疼痛視覺模擬評分(VAS)。并觀察4組術后使用鎮痛藥物的例數和肩背痛、惡心嘔吐發生率。結果:術后1、2、3、4 h VAS評分Ⅱ組lt;Ⅲ組lt;Ⅰ組lt;Ⅳ組(Plt;0.05)。Ⅳ組使用鎮痛藥物的例數明顯高于Ⅰ組、Ⅱ組和Ⅲ組(Plt;0.05)。4組術后肩背痛、惡心嘔吐發生率差異無顯著性(Pgt;0.05)。結論:經腹腔給局麻藥鎮痛效果明顯,術畢給藥鎮痛效果優于術前給藥,羅哌卡因鎮痛效果優于布比卡因。Abstract: Objective: To investigate the effect of intraperitoneal local anesthetic on patients undergone laparoscopiccho1ecystectomy.Methods:Fiftytwo patients were randomly divided into four groups. Group Ⅰ received preoperational anesthetic spary with 20 mL of 0.75％ ropivacaine. Group Ⅱ was given the anesthetic ata same dosage after the operation. Group Ⅲ received preoperational anesthetic spary with 20 mL of 0.5％ bupivacaine. Group Ⅳ received preoperational anesthetic spary with 20 mL saline. The LC was completed under general anesthesia.After the operation,visual analog scale (VAS)was recorded at 1,2,3 and 4 hours to evaluate the degree of postoperative pain.Meanwhile,the number of the patients who received anesthetics after the surgery,as well as the incidence rates shoulder or back pain and nausea or vomiting were recorded. Results: Postoperative VAS of the group Ⅱ was significantly lower than that of the other three groups, while the VAS of group Ⅲ was significantly lower than that in group Ⅰ(both Plt;0.05).Compared to groups Ⅰ, Ⅱ and Ⅲ,more patients in the group Ⅳ needed anesthetics after the operation (Plt;0.05).No significant diference was noticed in the incidence rates of shoulder or back pain and nausea or vomiting among the four groups (Pgt;0.05).Conclusions: Intraperitoneal local anesthetic can significantly reduce postoperative pain after LC. It is more effective to give local anesthetic at the end of the procedure than using it before operation. The effect of ropivacaine is better than bupivacaine.
目的 探討完全腹膜化腹腔鏡腹腔內置片法（total peritoneum intraperitoneal onlay mesh,TPIPOM）治療腹股溝疝的有效性及優越性。方法 廣東省第二人民醫院2002年1月至2005年8月期間應用TPIPOM治療105例腹股溝疝（其中嵌頓疝22例，雙側疝44例，復發疝26例）后的恢復情況及隨訪結果，并與34例腹腔鏡經腹腔腹膜前網片修補術(trans-abdominal preperitoneal laparoscopic mesh repair,TAPP)治療腹股溝疝的結果相比較。結果 平均手術時間〔(30.8±10.3) min vs (68.4±22.4) min〕、平均住院時間〔(3.8±1.3) d vs (4.3±1.5) d〕、平均下床活動時間〔(1.2±0.5) d vs (1.8±0.7) d〕、平均術后疼痛持續時間〔(1.0±0.5) d vs (1.6±0.9) d〕及平均住院費用〔(5 000.8±800.5)元vs (8 000.5±950.6)元〕TPIPOM組均明顯少于TAPP組，差異有統計學意義（P＜0.01）； 兩組均無皮下血腫及陰囊水腫發生。兩組所有病例均得到隨訪,平均隨訪(18.6±8.9)個月，均無復發。結論 TPIPOM治療腹股溝疝是安全、可行的，且創傷小，恢復快，住院時間短，費用少，不易復發，無腸梗阻等并發癥，該方法是治療腹股溝疝的有效方法之一，值得進一步推廣。
