2025 年第 7 期 第 20 卷

快速康复外科实践中妇科腹腔镜术后腹壁Trocar穿刺孔疼痛的动态观察

Dynamic observation on pain of Trocar puncture hole in abdominal wall after gynecologic laparoscopic surgery in rapid rehabilitation surgery practice

作者：侯坤郭俊于飞

英文作者：Hou Kun Guo Jun Yu Fei

单位：首都医科大学附属北京同仁医院妇产科，北京100730

英文单位：Department of Obstetrics and Gynecology Beijing Tongren Hospital Capital Medical University Beijing 100730 China

关键词：快速康复外科；Trocar穿刺孔；疼痛；患者自控静脉镇痛

英文关键词：Rapidrehabilitationsurgery;Trocarpuncturehole;Pain;Patient-controlledintravenousanalgesia

• 摘要：

• 目的 观察快速康复外科实践中妇科腹腔镜术后腹壁Trocar穿刺孔疼痛的动态变化情况。方法 选取2019年10月至2020年3月首都医科大学附属北京同仁医院妇科收治实施快速康复外科方案术后采用患者自控静脉镇痛的腹腔镜手术患者40例。分别在术后2、4、8、12、24 h采用疼痛视觉模拟量表（VAS）评分针对不同的腹壁Trocar穿刺孔术后疼痛变化进行评价，并记录术后镇痛相关并发症发生率、挽救性镇痛药物使用情况。结果 40例患者年龄（35±9）岁。术后2、4、8、12、24 h脐下正中直径1.0 cm穿刺孔及脐左侧1.5 cm穿刺孔术后各时点VAS评分均高于脐左侧直径0.5 cm孔、脐右侧直径0.5 cm孔（均P<0.05）。脐下正中直径1.0 cm Trocar穿刺孔在术后2、4、8、12、24 h的VAS评分差异有统计学意义（P＜0.001），主要表现为自术后2 h逐渐上升直至8 h达高峰，而后下降；脐左侧直径1.5 cm Trocar穿刺孔在术后2、4、8、12、24 h的VAS评分差异有统计学意义（P＜0.001），主要表现为术后4 h明显升高，于8 h达高峰并持续至12 h，而后下降。术后焦虑自评量表评分明显低于术前［37.0（33.5,44.8）分比40.0（36.3,51.5）分］（Z=-4.103，P=0.002）。术后共18例（45.0%）患者出现恶心呕吐，35例（87.5%）患者出现嗜睡。9例（22.5%）患者使用挽救性镇痛。结论 快速康复外科实践中妇科腹腔镜术后腹壁疼痛主要集中在脐下正中直径1.0 cm及脐左侧直径1.5 cm Trocar穿刺孔，且穿刺孔引起的疼痛主要在术后4～12 h，于术后8 h达高峰。

• Objective  To observe the dynamic changes of abdominal Trocar puncture hole pain after gynecologic laparoscopic surgery in the practice of rapid rehabilitation surgery. Methods A total of 40 patients with laparoscopic surgery who received patient-controlled intravenous analgesia after fast track surgery in Beijing Tongren Hospital, Capital Medical University from October 2019 to March 2020 were selected. The visual analogue scale (VAS) score was used to evaluate the postoperative pain changes of different Trocar puncture holes in the abdominal wall at 2, 4, 8, 12 and 24 h after surgery, and the incidence of postoperative analgesia related complications and the use of rescue analgesic drugs were recorded. Results The age of 40 patients was (35±9) years. At 2, 4, 8, 12, 24 h after surgery, the VAS scores of the puncture hole with a median diameter of 1.0 cm under the umbilicus and the puncture hole with a diameter of 1.5 cm on the left side of the umbilicus were higher than those of the puncture hole with a diameter of 0.5 cm on the left side of the umbilicus and 0.5 cm on the right side of the umbilicus (all P<0.05). The VAS scores of Trocar puncture hole with a median diameter of 1.0 cm under the umbilicus were significantly different at 2, 4, 8, 12 and 24 h after operation (P<0.001), which mainly showed that the VAS score gradually increased from 2 h to 8 h after operation, and then decreased. The VAS scores of the Trocar puncture hole with a diameter of 1.5 cm on the left side of the umbilicus were significantly different at 2, 4, 8, 12, 24 h after operation (P<0.001), which mainly showed that the VAS score increased significantly at 4 h after operation, peaked at 8 h and continued to 12 h, and then decreased. The postoperative Self-Rating Anxiety Scale score was significantly lower than that before surgery ［37.0(33.5, 44.8)scores vs 40.0(36.3, 51.5)scores］(Z=-4.103, P=0.002). A total of 18 patients (45.0%) developed nausea and vomiting, and 35 patients (87.5%) developed lethargy. Rescue analgesia was used in 9 patients (22.5%). Conclusion In the practice of fast track surgery, the abdominal wall pain after gynecologic laparoscopic surgery is mainly concentrated in the Trocar puncture hole with a diameter of 1.0 cm below the middle of the umbilicus and 1.5 cm on the left of the umbilicus, and the pain caused by the puncture hole is mainly 4-12 h after surgery, reaching a peak at 8 h after surgery.