目的 探讨弓状韧带上腰方肌阻滞（QLB-LSAL）与肋缘下腹横肌平面阻滞（STAPB）对腹腔镜结直肠癌根治患者围术期镇痛及术后炎症的影响。 方法 纳入2022年10月至2024年10月择期全麻下行腹腔镜结直肠癌根治术患者102例，两组均行全麻联合神经阻滞，根据神经阻滞方式随机分为弓状韧带上腰方肌阻滞组（Q组，n = 51）和肋缘下腹横肌平面阻滞组（S组，n = 51）。记录麻醉诱导前（T₀）、手术开始前（T₁）、手术开始时（T₂）、人工气腹时（T₃）、腹腔冲洗时（T₄）、手术结束时（T₅）、出手术室时（T₆）的平均动脉压（MAP）及心率（HR）；记录瑞芬太尼、镇痛泵使用及补救镇痛情况；记录术后24、48及72 h静息及咳嗽时的VAS评分；记录术前1 d、术后1 d及3 d的白细胞介素-6（IL-6）及系统免疫炎症指数（SII）；记录术后恢复及不良反应发生情况。 结果 Q组在T₃ ~ T₆时MAP及HR低于S组（P < 0.05）；与S组比较，Q组瑞芬太尼用量减少、镇痛泵首次按压时间延长、有效按压次数及补救镇痛例数更少，术后24 h和48 h静息及咳嗽时VAS评分更低（P < 0.05）；与术前1 d比较，两组术后1 d及3 d的IL-6及SII均升高，但Q组低于S组（P < 0.05）；与S组比较，Q组首次下床时间及术后住院时间更短，不良反应发生率更低（P < 0.05）。 结论 QLB-LSAL较STAPB可为腹腔镜结直肠癌根治术患者提供更好的围术期镇痛，降低炎症反应，加速术后恢复。

Objective To compare the effects of quadratus lumborum block at the lateral supra-arcuate ligament （QLB-LSAL） versus subcostal transversus abdominis plane block （STAPB） on perioperative analgesia and postoperative inflammation in patients undergoing laparoscopic radical resection of colorectal cancer. Methods In this prospective randomized study， we recruited 102 patients undergoing laparoscopic colorectal cancer surgery between October 2022 and October 2024 under general anesthesia and randomly assigned them to two groups： QLB-LSAL （Group Q， n = 51） and STAPB （Group S， n = 51）. Mean arterial pressure （MAP） and heart rate （HR） were recorded before anesthesia induction （T₀）， before surgical incision （T₁）， start of surgery （T₂）， during pneumoperitoneum establishment （T₃）， during peritoneal lavage （T₄）， at the end of surgery （T₅）， and upon leaving the operating room （T₆）. Intraoperative remifentanil consumption， time to first patient-controlled analgesia demand， and frequency of effective compression and rescue analgesia were recorded. Visual Analog Scale （VAS） scores at rest and during coughing were assessed at 24， 48， and 72 hours postoperatively. Interleukin-6 （IL-6） and systemic immune-inflammatory index （SII） at 1 day preoperatively， 1， and 3 days postoperatively were recorded. Postoperative recovery indicators and adverse events were also recorded. Results Group Q demonstrated significantly lower MAP and HR compared with Group S from T₃ to T₆ （P < 0.05）. Group Q had significantly lower intraoperative remifentanil consumption， significantly longer time to first analgesic pump demand， fewer effective pump compression， and lower frequency for rescue analgesia requests （all P < 0.05）. VAS scores at rest and during coughing in Group Q were significantly lower at 24 h and 48 h postoperatively （P < 0.05）. As compared with preoperative levels， both IL-6 and SII increased at 1 and 3 days postoperatively， but magnitude of increase in Group Q was smaller than in Group S （P < 0.05）. In comparison to Group S， Group Q demonstrated significantly earlier ambulation， shorter hospital stay， and fewer adverse events （P < 0.05）. Conclusion QLB-LSAL is superior to STAPB in enhancing perioperative analgesia， attenuating inflammatory response， and accelerating postoperative rehabilitation in patients undergoing laparoscopic colorectal cancer resection.