大网孔部分可吸收低质量人工网对减轻腹股沟疝患者术后疼痛的临床分析

Macroporous partially absorbable light-weight mesh materials reduce postoperative pain for patients with groin hernia repair

目的评估大网孔部分可吸收低质量人工网是否可减少腹股沟疝患者的术后疼痛。方法前瞻性收集1159例(1321侧)以双层人工网修补腹股沟疝患者的术后1、6、90d的疼痛指数资料,比较一般聚丙烯人工网(prolene hernia system,PHS)905例与大网孔部分可吸收低质量人工网(UHS)254例二组患者的疼痛指数差异。回顾性访查500例接受过此二种人工网疝修补手术已达半年以上的患者,统计目前还有慢性腹壁疼痛患者的比例,并以统计学方法做分析。结果二组术后1d的VAS(0～5分)疼痛指数分别为:PHS(1.84±1.02),UHS(1.14±0.09)(P<0.001);术后6d疼痛指数分别为:PHS(0.92±0.86),UHS(0.43±0.65)(P<0.001);90d后的疼痛指数分别为:PHS(0.13±0.54),UHS(0.04±0.25)(P=0.04)。在三个测量时间点上UHS的疼痛指数均低于PHS组,慢性腹壁疼痛的发生率分别为PHS6/235(2.5%),UHS6/210(2.8%)。结论使用大网孔部分可吸收低质量人工网相较于一般聚丙烯人工网可减少患者术后手术部位的疼痛。这种优势在术后1d与6d较为明显,慢性腹壁疼痛发生率则无明显差异。

Objective The purpose of this study is to evaluate if use of macroporous partially absorbable light-weight mesh can reduce postoperative groin pain. Methods The postoperative VAS（0 -5 ） pain scores at postoperative day 1 ,day 6 and day 90 of 1 159 patients （ 1 321 sides） of groin hernia repair using bilayer mesh device were prospectively collected. These patients were divided into two groups：prolene bilayer mesh （PHS） （N = 905 ） group and macroporoous partially absorbable light-weight mesh （UHS） （N = 254） group, the differences of pain score at each check point between these two groups were calculated and statistically analyzed. The occurrences of chronic abdominal wall pain or discomfort were also retrospectively surveyed. Results The postoperative day 1, day 6 and day 90 pain scores of PHS group and UHS group were as follows ： day 1 ： PHS （ 1.84 ± 1.02） vs UHS （ 1.14 ± 0. 09 ） （ P 〈 0. 001 ）, day 6 ： PHS （ 0. 92 ± 0. 86 ） vs UHS（0.43±0.65） （P〈0.001）,dayg0：PHS（0.13±0.54） vs UHS（0.04±0.25） （P=0.04）.The occurrences of chronic abdominal wall pain were ： PHS ： 2.5% and UHS ： 2.8%. Conclusions Compared with the PHS, UHS can reduce postoperative pain in patients who receive an anterior open repair with bilayer mesh device, however, it seems no difference in the occurrence of chronic pain.