腹腔镜下腹股沟疝修补术后急慢性疼痛的影响因素

Factors associated with postoperative acute and chronic pain after laparoscopic inguinal hernia repair

目的研究腹腔镜下腹股沟疝修补术后患者的急慢性疼痛情况及影响因素。方法前瞻性分析2014年2月至2015年4月,中南大学湘雅医院收治的181例采用腹腔镜下经腹腹膜前修补术治疗的腹股沟疝病例,通过数字评分法(NRS)和腹股沟疼痛调查表(IPQ)分别了解术后次日、1个月以及1年时的疼痛情况,并对相关影响因素进行研究。结果全组均顺利完成腹腔镜手术。术后次日,NRS评分为(2.0±1.5)分,年龄<65岁者NRS评分显著高于年龄≥65岁者(P<0.05)。术后1个月,中位IPQ评分为1.7分。90.2%的患者IPQ评分<5分,21.3%的患者IPQ评分为0分。术后1年,中位IPQ评分为0.5分,所有患者IPQ评分均小于5分,68.8%的患者IPQ评分为0分。性别、年龄、初发/复发、单侧/双侧、疝环大小以及术者经验等6项因素均与术后1月时IPQ评分差异无统计学意义(P>0.05)。结论腹腔镜下腹股沟疝修补术后急慢性疼痛较轻微,且随着时间的延长,疼痛感逐渐减轻。年轻患者的急性疼痛强于老年患者,提示对年轻患者术后早期可予以适当止痛治疗。

Objective To investigate the factors associated with postoperative acute and chronic pain after laparoscopic inguinal hernia repair. Methods A total of 181 cases of inguinal hernia with laparoscopic trans-abdominal pre-peritoneal repair （TAPP） in Xiangya hospital from February 2014 to April 2015 were enrolled and analyzed prospectively. Numerical Rating Scale （NRS） and Inguinal pain questionnaire （IPQ） were used to collect the pain data at the first postoperative day, 1 month and 1 year after the surgery. Results All cases completed the operations successfully, without conversion to the open surgery. The NRS score at the first postoperative day was （2.0 ± 1.5 ）. NRS score was higher in the patients with age 〈 65 （ P 〈 0.05 ）. One month after the surgery, the median IPQ score was 1.7. IPQ score was less than 5 in 90.2% of the patients and was zero in 21.3% of the patients. One year after the surgery, the median IPQ score was 0.5. IPQ score was less than 5 in all of the patients and was zero in 68.8% of the patients. None of the factors which included gender, age, primary/recurrent, unilateral/bilateral, size of hernia ring and surgeon experience were associated with the IPQ score （P 〉 0.05 ）. Conclusion Acute and chronic pain after laparoscopic inguinal hernia repair is mild and will become less annoying with the time going. The acute pain postoperatively in younger patients is more severe than the elder patients, which supports analgetic therapy for the younger patients.