诊断性腹腔镜和粘连松解术：是否有助于外科手术中复杂盆腹腔疼痛综合征患者的治疗？-《中国微创外科杂志》

文章信息/Info

Title:: Diagnostic Laparoscopy and Adhesiolysis: Does It Help with Complex Abdominal and Pelvic Pain Syndrome (CAPPS) in General Surgery?

Author(s):: Gregory D. McClainJay A. RedanSteven D. McCarus; et al; Department of General Surgery, Florida HospitalCelebration Health, Celebration, Florida, USA② Department of Gynecology, Center for Advanced Specialized Gynecology, Florida HospitalCelebration Health, Celebration, Florida, USA

摘要:: 继发于粘连的腹痛是常见的主诉，但是除非患者存在肠梗阻症状，多数外科医生不会因此主诉而行手术治疗。本研究的目的是评价肠粘连松解术是否对治疗腹痛有效。我们回顾性分析了仅经历腹腔镜粘连松解术，而非器官切除的盆腹腔疼痛综合征（CAPPS）的患者在手术后疼痛改善情况。分别在手术后3,6,9和12个月随访了31例经腹腔镜粘连松解手术的患者，随访中第6,9和12个月后患者的疼痛评分显著降低，因此得出腹腔镜粘连松解手术对于粘连相关性疼痛有效的结论。粘连引起的疼痛可能有更复杂的疼痛传导通路，相比简单的切除瘢痕组织的手术，如截肢后的“幻肢痛”，腹腔镜粘连松解手术患者术后的疼痛减轻需要较长时间。

Abstract:: Abdominal pains secondary to adhesions are a common complaint, but most surgeons do not perform surgery for this complaint unless the patient suffers from a bowel obstruction. The purpose of this evaluation was to determine if lysis of bowel adhesions has a role in the surgical management of adhesions for helping treat abdominal pain. The database of our patients with complex abdominal and pelvic pain syndrome (CAPPS) was reviewed to identify patients who underwent a laparoscopic lysis of adhesion without any organ removal and observe if they had a decrease in the amount of abdominal pain after this procedure. Thirtyone patients completed followup at 3, 6, 9, and 12 months. At 6, 9, and 12 months postoperation, there were statistically significant decreases in patients’ analog pain scores. We concluded that laparoscopic lysis of adhesions can help decrease adhesionrelated pain. The pain from adhesions may involve a more complex pathway toward pain resolution than a simple cutting of scar tissue, such as “phantom pain” following amputation, which takes time to resolve after this type of surgery.