朱晓婷,王东伟

术后慢性疼痛(Chronic Post-Surgical Pain,CPSP)是一种在手术后持续超过3个月的疼痛状态，CPSP可显著影响患者的生活质量，导致情绪障碍、睡眠问题等并发症。近年来，系统性免疫炎症指数(SII)作为一个新型的炎症标志物，在多种疾病中展现出优于传统指标的预测价值，为CPSP的早期预测和干预提供了新的研究方向。本文综述了CPSP的定义、发病机制、临床特征以及与免疫炎症反应的关系，重点探讨了腹腔镜结直肠手术后CPSP的特点及SII在疾病预测中的应用前景。

术后慢性疼痛；腹腔镜结直肠手术；系统性免疫炎症指数；神经-免疫-炎症反应；预测价值

[1] Crombie IK,Davies HT,Macrae WA.Cut and thrust:antecedent surgery and trauma among patients attending a chronic pain clinic[J].Pain, 1998,76(1-2):167-171. [2] Macrae WA.Chronic pain after surgery[J].Br J Anaesth,2001,87(1):88-98. [3] Werner MU,Kongsgaard UE.I.Defining persistent post-surgical pain:is an update required?[J].Br J Anaesth,2014,113(1):1-4. [4] Treede RD,Rief W,Barke A,Aziz Q,Bennett MI,Benoliel R,Cohen M,Evers S,Finnerup NB,First MB,Giamberardino MA,Kaasa S, Kosek E,Lavand'homme P,Nicholas M,Perrot S,Scholz J,Schug S,Smith BH,Svensson P,Vlaeyen JWS,Wang SJ.A classification of chronic pain for ICD-11[J].Pain,2015,156(6):1003-1007. [5] Simanski CJ,Althaus A,Hoederath S,Kreutz KW,Hoederath P,Lefering R,Pape-Kohler C,Neugebauer EA.Incidence of chronic postsurgical pain(CPSP)after general surgery[J].Pain Med,2014,15(7):1222-1229. [6] Miller R,Bartolo DC,Roe A,Cervero F,Mortensen NJ.Anal sensation and the continence mechanism[J].Dis Colon Rectum,1988,31(6):433-438. [7] Baranowski AP.Chronic pelvic pain[J].Best Pract Res Clin Gastroenterol,2009,23(4):593-610. [8] Walters A,Muhleman M,Osiro S,Bubb K,Snosek M,Shoja MM,Tubbs RS,Loukas M.One is the loneliest number:a review of the ganglion impar and its relation to pelvic pain syndromes[J].Clin Anat,2013,26(7):855-861. [9] Pucciani F.A review on functional results of sphincter-saving surgery for rectal cancer:the anterior resection syndrome[J].Updates Surg, 2013,65(4):257-263. [10] Wells CI,Vather R,Chu MJ,Robertson JP,Bissett IP.Anterior resection syndrome--a risk factor analysis[J].J Gastrointest Surg,2015,19(2):350-359. [11] Rao SS,Bharucha AE,Chiarioni G,Felt-Bersma R,Knowles C,Malcolm A,Wald A.Functional Anorectal Disorders[J].Gastroenterology,2016. [12] Deumens R,Steyaert A,Forget P,Schubert M,Lavand'homme P,Hermans E,De Kock M.Prevention of chronic postoperative pain:cellular,molecular,and clinical insights for mechanism-based treatment approaches[J].Prog Neurobiol,2013,104:1-37. [13] 田雪,陶元祥.术后持续性疼痛的研究进展[J].中华麻醉学杂志,2019,39(6):655-659. [14] Huang C,Liu H,Hu Y,Sun Y,Su X,Cao H,Hu J,Wang K,Suo J,Tao K,He X,Wei H,Ying M,Hu W,Du X,Yu J,Zheng C,Liu F,Li Z,Zhao G,Zhang J,Chen P,Li G,Chinese Laparoscopic Gastrointestinal Surgery Study G.Laparoscopic vs Open Distal Gastrectomy for Locally Advanced Gastric Cancer:Five-Year Outcomes From the CLASS-01 Randomized Clinical Trial[J].JAMA Surg,2022,157(1):9-17. [15] Liu F,Huang C,Xu Z,Su X,Zhao G,Ye J,Du X,Huang H,Hu J,Li G,Yu P,Li Y,Suo J,Zhao N,Zhang W,Li H,He H,Sun Y,Chinese Laparoscopic Gastrointestinal Surgery Study G.Morbidity and Mortality of Laparoscopic vs Open Total Gastrectomy for Clinical Stage I Gastric Cancer:The CLASS02 Multicenter Randomized Clinical Trial[J].JAMA Oncol,2020,6(10):1590-1597. [16] Niitsu H,Hinoi T,Kawaguchi Y,Ohdan H,Hasegawa H,Suzuka I,Fukunaga Y,Yamaguchi T,Endo S,Tagami S,Idani H,Ichihara T,Watanabe K,Watanabe M,Japan Society of Laparoscopic Colorectal S.Laparoscopic surgery for colorectal cancer is safe and has survival outcomes similar to those of open surgery in elderly patients with a poor performance status:subanalysis of a large multicenter case-control study in Japan[J].J Gastroenterol,2016,51(1):43-54. [17] Johnson AC,Greenwood-Van Meerveld B.The Pharmacology of Visceral Pain[J].Adv Pharmacol,2016,75:273-301. [18] Chou YJ,Ou YC,Lan KC,Jawan B,Chang SY,Kung FT.Preemptive analgesia installation during gynecologic laparoscopy:a randomized trial[J].J Minim Invasive Gynecol,2005,12(4):330-335. [19] Kaba A,Laurent SR,Detroz BJ,Sessler DI,Durieux ME,Lamy ML,Joris JL.Intravenous lidocaine infusion facilitates acute rehabilitation after laparoscopic colectomy[J].Anesthesiology,2007,106(1):11-18;discussion 15-16. [20] Gebhart GF,Bielefeldt K.Physiology of Visceral Pain[J].Compr Physiol,2016,6(4):1609-1633. [21] Blichfeldt-Eckhardt MR,Ording H,Andersen C,Licht PB,Toft P.Early visceral pain predicts chronic pain after laparoscopic cholecystectomy[J].Pain,2014,155(11):2400-2407. [22] Joris JL,Georges MJ,Medjahed K,Ledoux D,Damilot G,Ramquet CC,Coimbra CI,Kohnen LP,Brichant JF.Prevalence,characteristics and risk factors of chronic postsurgical pain after laparoscopic colorectal surgery:Retrospective analysis[J].Eur J Anaesthesiol,2015,32(10):712-717. [23] Feddern ML,Jensen TS,Laurberg S.Chronic pain in the pelvic area or lower extremities after rectal cancer treatment and its impact on quality of life:a population-based cross-sectional study[J].Pain,2015,156(9):1765-1771. [24] Lee JY,Kim HC,Huh JW,Sim WS,Lim HY,Lee EK,Park HG,Bang YJ.Incidence and risk factors for rectal pain after laparoscopic rectal cancer surgery[J].J Int Med Res,2017,45(2):781-791. [25] Taillefer MC,Carrier M,Belisle S,Levesque S,Lanctot H,Boisvert AM,Choiniere M.Prevalence,characteristics,and predictors of chronic nonanginal postoperative pain after a cardiac operation:a cross-sectional study[J].J Thorac Cardiovasc Surg,2006,131(6):1274-1280. [26] 王少英,杨立静,王丽娜,王哲.血清炎性因子水平变化与牙髓炎根管治疗术后疼痛及生存质量相关性研究[J].河北医药,2018, 40(18):2734-2738. [27] 雷光林,李媛媛,李智,洪智贤.腹腔镜肝切除术与开腹肝切除术治疗肝细胞癌的疗效评估[J].肝胆胰外科杂志,2020,32(05):280-285. [28] 李秋月,许海玉,杨洪军.促炎因子TNF-α,IL-1β,IL-6在神经病理性疼痛中的研究进展[J].中国中药杂志,2017,42(19):3709-3712.

点击下载PDF