目的：分析腹横肌平面阻滞（TAPB）联合舒芬太尼及布托啡诺静脉自控镇痛在 3D 腹腔镜结直肠癌术后的应用。 方法：选取 2018 年 1 月—2023 年 12 月于淄博市临淄区人民医院收治的 120 例行 3D 腹腔镜结直肠癌手术患者，采用随机数 字表法将其分为对照组（n=60，采用舒芬太尼及布托啡诺静脉自控镇痛）和观察组（n=60，采用 TAPB 联合舒芬太尼及布托 啡诺静脉自控镇痛）。比较分析两组患者的围手术期指标、血流动力学、呼吸功能、术后镇痛效果及炎症水平。结果：观 察组的苏醒时间、自主呼吸恢复时间、舒芬太尼用量、脑电双频指数（BIS）、镇痛泵按压次数均低于对照组（P<0.05）。 与 T0 时点（术前）比较，两组患者在 T1（术中 15 min）、T2（术中 30 min）及 T3（术中 45 min）时点的 HR、MAP 及 PETCO2 均显著降低，且观察组在 T1、T2 及 T3 时点的 HR、MAP 及 PETCO2 均高于对照组（P<0.05）。观察组在术后 8 h、 12 h、24 h 的 VAS 评分均低于对照组（P<0.05）。术后，两组患者白细胞计数、淋巴细胞计数及中性粒细胞百分比均上升， 但观察组各项指标均低于对照组（P<0.05）。结论：3D 腹腔镜结直肠癌手术患者采用 TAPB 联合舒芬太尼及布托啡诺静脉自 控镇痛能缩短患者苏醒时间与自主呼吸恢复时间，减少舒芬太尼用量与镇痛泵按压次数，提升患者镇静满意度。同时，该方 法有助于患者维持 HR、MAP、PETCO2 的平稳，还能有效减轻术后疼痛、缓解术后炎症。

Objective: To analyze the application effect of transversus abdominis plane block (TAPB) combined with sufentanil and butorphanol in patient-controlled intravenous analgesia (PCIA) after 3D laparoscopic surgery for colorectal cancer. Methods: 120 patients who underwent 3D laparoscopic surgery for colorectal cancer at Linzi District People’s Hospital of Zibo City from January 2018 to December 2023 were selected. They were divided into the control group (n=60, receiving sufentanil and butorphanol PCIA) and the observation group (n=60, receiving TAPB combined with sufentanil and butorphanol PCIA) using a random number table. Perioperative indicators, hemodynamics, respiratory function, postoperative analgesic efficacy, and inflammatory levels were compared between the two groups of patients. Results: The observation group showed significantly shorter recovery time, spontaneous breathing recovery time, reduced sufentanil consumption, lower bispectral index (BIS), and fewer PCA pump presses than the control group (P<0.05). Compared to the T0 timepoint (preoperative), both groups showed decreased HR, MAP, and PETCO2 levels at T1 (intraoperative 15 min), T2 (intraoperative 30 min), and T3 (intraoperative 45 min). However, the observation group maintained higher HR, MAP, and PETCO2 levels at T1, T2, and T3 than the control group (P<0.05). Lower VAS scores at 8 h, 12 h, and 24 h after surgery were observed in the observation group than the control group (P<0.05). WBC count, lymphocyte count, and neutrophil percentage were increased in the two groups after surgery, while they were lower in the observation group than the control group (P<0.05). Conclusion: The combination of TAPB with sufentanil and butorphanol PCIA in 3D laparoscopic surgery for colorectal cancer can shorten recovery and spontaneous breathing recovery times, reduce sufentanil consumption and PCA pump usage, and improve sedation satisfaction. Additionally, this approach can stabilize hemodynamic and respiratory parameters (HR, MAP, PETCO2), alleviate postoperative pain, and mitigate inflammatory responses.

基金项目：吴阶平医学基金会临床科研专项资助基金 (320.6750.2023-19-15)；2023 年度全省中医药调研课题（ZYY2023019） 

Foundation Item: Wu Jieping Medical Foundation Clinical Research Special Fund (320.6750.2023-19-15); 2023 Annual Provincial  Traditional Chinese Medicine (TCM) Research Projects（ZYY2023019） 

引用格式：卢军伟，赵莹莹，李凤芸，等 . 腹横肌平面阻滞联合舒芬太尼及布托啡诺静脉自控镇痛在 3D 腹腔镜结直肠癌手术中的应用 [J].  机器人外科学杂志（中英文），2025，6（5）：813-818. 

Citation: LU J W, ZHAO Y Y, LI F Y, et al. Application of transversus abdominis plane block combined with sufentanil and butorphanol in  patient-controlled intravenous analgesia after 3D laparoscopic surgery for colorectal cancer [J]. Chinese Journal of Robotic Surgery, 2025,  6(5): 813-818. 

通讯作者（Corresponding Author）：卢军伟（LU Junwei），Email：sdzblujw@163.com

[1] 廖星雨 , 田思雨 , 陈敏 . 1990—2021 年中国与全球不同性别早发 型结直肠癌的疾病负担和危险因素及预测研究 [J]. 中国全科医学 , 2025, 28(8): 1004-1011. 

[2] ZHAN S, ZHU Z, YU H, et al. Comparison of therapeutic effects between conventional 2D laparoscopy and 3D laparoscopy in the treatment of colorectal cancer: a systematic review and meta-analysis[J]. Am Surg, 2024, 90(11): 3102-3112. 

[3] TANG J C, MA J W, JIAN J J, et al. Effect of different anesthetic modalities with multimodal analgesia on postoperative pain level in colorectal tumor patients[J]. World J Gastrointest Oncol, 2024, 16(2): 364-371. 

[4] 崔皖晋 , 褚亮 , 周少波 . 人工扶镜与机器人辅助扶镜下腹腔镜结直肠 癌手术患者的临床疗效比较 [J]. 机器人外科学杂志 ( 中英文 ), 2024, 5(3): 447-453. 

[5] DENG B, WANG D, XIE Z, et al. Comparison of the analgesic effect of dezocine and esketamine in combination with sufentanil respectively after laparoscopic cholecystectomy: a prospective randomized controlled study[J]. BMC Anesthesiol, 2024, 24(1): 51. 

[6] 闫云 , 徐利 , 杨明全 . 纳布啡联合舒芬太尼对腹腔镜结直肠癌手术 患者术后镇痛效果及应激反应的影响 [J]. 中国内镜杂志 , 2024, 30(2): 33-40. 

[7] 刘祥祥 , 王娟 . 全麻复合不同浓度罗哌卡因腹横肌平面阻滞在腹 腔镜下阑尾切除术中的镇痛效果及安全性分析 [J]. 中国医药导报 , 2024, 21(10): 90-93. 

[8] Benson A B, Venook A P, Adam M, et al. Colon Cancer, Version 3.2024, NCCN clinical practice guidelines in oncology[J]. J Natl Compr Canc Netw, 2024, 22(2): e240029. 

[9] 中华医学会外科学分会腹腔镜与内镜外科学组 , 中华医学会外科学 分会结直肠外科学组 , 中国医师协会外科医师分会结直肠外科专家 工作组 , 等 . 腹腔镜结直肠癌根治术操作指南 (2023 版 )[J]. 中华消化 外科杂志 , 2024, 23(1): 10-22. 

[10] Sharma Bhattarai A, Bista N R, Basnet M B, et al. Interrater variability among anaesthesiologists using american society of anesthesiologists physical status classification system. J Nepal[J]. Health Res Counc, 2024, 21(4): 543-549. 

[11] 黎建金 , 黎治滔 . BISpro 指数和 Narcotrend 指数监测丙泊酚镇静 深度的准确性对比研究 [J]. 国际麻醉学与复苏杂志 , 2024, 45(03): 270-275. 

[12] 史亚丽 , 于宏伟 , 王丽慧 , 等 . 机器人辅助下结直肠癌根治术患者 强化康复护理干预体会 [J]. 机器人外科学杂志 ( 中英文 ), 2024, 5(3): 386-391. 

[13] 徐清华 , 李中安 . 右美托咪定超前镇痛对腹腔镜手术患者术后疼痛 及应激反应的影响 [J]. 河北医药 , 2023, 45(19): 2920-2924. 

[14] 姚增鹏 , 罗斌 , 周自立 , 等 . 机器人与普通腹腔镜辅助结直肠癌 D3 根治术短期临床疗效比较 [J]. 实用医院临床杂志 , 2023, 20(5): 45-51. 

[15] 唐贞贞 , 张燕 , 王曼曼 , 等 . 安宁疗护联合舒芬太尼患者自控静脉镇 痛对晚期结直肠癌患者疼痛程度 , 焦虑情绪和主观幸福感的影响 [J]. 癌症进展 , 2024, 22(15): 1648-1651, 1688. 

[16] YANG S, HU J. Comparison of postoperative analgesia between dezocine plus flurbiprofen axetil and sufentanil in patients with CRC undergoing tumor resection: A prospective, observational study[J]. Oncol Lett, 2025, 29(3): 121. 

[17] HOU P, LIU W, CHEN R, et al. Comparison of erector spinae plane block and transverse abdominis plane block in postoperative recovery after laparoscopic colorectal surgery: a randomized, double-blind, controlled trial[J]. Perioper Med (Lond), 2024, 13(1): 116. 

[18] LIU S, CAO L, ZHANG Y, et al. Application of ultrasound-guided anterior quadratus lumborum block approach at the lateral supra-arcuate ligament in elderly patients undergoing colorectal cancer surgery[J]. Am J Cancer Res, 2024, 14(9): 4248-4264. 

[19] Zewdu D, Tantu T, Eanga S, et al. Analgesic efficacy of erector spinae plane block versus transversus abdominis plane block for laparoscopic cholecystectomy: a systematic review and meta-analysis of randomized controlled trial[J]. Front Med (Lausanne), 2024. DOI: 10.3389/ fmed.2024.1399253. 

[20] 雷碧波 , 樊飞 , 张明强 , 等 . 超声引导下腹横肌平面阻滞联合喉罩通 气在原发性肝癌患者加速康复外科中的有效性和安全性 [J]. 介入放 射学杂志 , 2023, 32(2): 149-153. 

[21] 王翠 , 张月霄 . 腹横肌平面阻滞联合胸椎旁神经阻滞在老年肝切除 术中的效果及安全性 [J]. 医学综述 , 2024, 30(3): 379-384. 

[22] 吴年生 , 王辉 , 张跃东 , 等 . 超声引导下腹横肌平面阻滞联合纳布啡 对腹腔镜胆囊切除术后患者苏醒质量以及疼痛程度的影响 [J]. 中国 医刊 , 2024, 59(7): 801-804. 

[23] CAO J, LUO X L, LIN Q. Remazolam combined with transversus abdominis plane block in gastrointestinal tumor surgery: Have we achieved better anesthetic effects?[J]. World J Gastrointest Oncol, 2024, 16(8): 3368-3371. 

[24] Iaquinandi F, Mongelli F, Christoforidis D, et al. Laparoscopic vs. ultrasound-guided transversus abdominis plane (TAP) block in colorectal surgery: a systematic review and meta-analysis of randomized trials[J]. Surg Endosc, 2024, 38(3): 1119-1130. 

[25] 覃思雨 , 舒斌 , 段光友 , 等 . 腹横肌平面阻滞效果影响因素的研究进 展 [J]. 局解手术学杂志 , 2023, 32(4): 363-367. 

[26] 李开瑜 , 汤敏誉 , 梁鹏 . 靶控输注舒芬太尼或瑞芬太尼对日间腹腔 镜胆囊切除术患者术后镇痛和恢复的影响 [J]. 实用医学杂志 , 2024, 40(8): 1074-1077. 

[27] 先德飞 , 张乐 , 曾义 . 布托啡诺复合咪达唑仑和舒芬太尼适度镇静在 鼾症患者胃镜检查的作用研究 [J]. 四川医学 , 2024, 45(3): 291-295. 

[28] 秦朝生 , 余振卫 , 林澄 , 等 . 超声引导下竖脊肌平面阻滞术与腹横肌 平面阻滞术对腹腔镜肝切手术患者围手术期镇痛效果比较 [J]. 山东 医药 , 2024, 64(2): 52-54. 

[29] Ghani S A, Hussain H U, Wahid M A, et al. Laparoscopic-assisted versus ultrasound-guided transversus abdominis plane block for laparoscopic cholecystectomy: a systematic review and meta-analysis[J]. BMC Surg, 2024, 24(1): 400. 

[30] Yoon J P, Kim H Y, Jung J, et al. Analgesic effect of ultrasound-guided transversus abdominis plane block with or without rectus sheath block in laparoscopic cholecystectomy: a randomized, controlled trial[J]. BMC Anesthesiol, 2024, 24(1): 203. 

[31] 姚红爱 , 谭洪婧 , 王波 , 等 . 超声引导下 TAPB 对老年腹腔镜手术疼 痛应激及胃肠功能的影响 [J]. 中国老年学杂志 , 2024, 44(3): 548-551.