预防性切断髂腹下神经对Lichtenstein手术术后疼痛影响的分析

Prophylactic iliohypogastric neurectomy in Lichtenstein procedure:A prospective randomized controlled trial of 100 patients

目的:研究预防性切断髂腹下神经对于腹股沟疝修补术后慢性疼痛的影响。方法:对100例原发单侧腹股沟疝病人采用单盲法进行此项研究,将病人随机分为两组,实施Lichtenstein平片式无张力疝修补术,一组预防性切断髂腹下神经,另一组保留髂腹下神经。在术后3、6、12个月进行随访,对比两组病人的疼痛及其他不适感。结果:两组病人术后3、6、12个月时慢性疼痛发生率无统计学差异,术后6个月切断神经组病人局部麻木的发生率较高。结论:为预防术后慢性疼痛,应当规范手术操作,术中注意辨认、保护腹股沟区神经。常规切断髂腹下神经不能降低术后慢性疼痛的发生率。

Objective In this prospective trial,we evaluate the impact of elective iliohypogastric nerve resection on the incidence of pain,numbness,and sensory loss following anterior,＂tension-free＂ herniorrhaphy.Methods One hundred patients were enrolled and were followed 3 months,6 months,and 1 year postoperatively.Pain,numbness,or any loss of sensation were recorded and categorized on a ＂mild＂,＂moderate＂,or ＂severe＂ scale.Results No persistent pain syndrome was encountered.The incidence of chronic pain has no significant difference between the 2 groups.The group of iliohypogastric nerve resection has a higher rate of numbness at the 6 months after operation.Conclusions Standard surgical procedure such as identification of inguinal nerves results in low incidence of chronic pain.Routine elective neurectomy is not associated with lower incidence of chronic postoperative inguinal pain.