开放式前入路腹股沟疝修补术后慢性疼痛的超声诊断

Ultrasonography in diagnosis and analysis of chronic pain following anterior open inguinal herniorrhaphy

目的分析开放式前入路腹股沟疝修补术后慢性疼痛的超声诊断意义。方法选取2009年8月至2014年5月,复旦大学附属华东医院164侧因开放式前入路腹股沟疝修补术后持续慢性疼痛病例,通过超声检查明确慢性疼痛的病因,对合并出现的各项病因进行分组比较。结果超声检查发现引起术后慢性疼痛的阳性诊断有:包裹性积液、阴囊壁水肿、睾丸炎症、睾丸鞘膜腔积液、精索在重建内环口处活动受限、精索静脉曲张、耻骨处瘢痕增生、补片皱缩变形、补片或网塞堆积、复发疝、精索囊肿、附睾头囊肿。在两两合并出现的阳性诊断各组中,包裹性积液合并阴囊壁水肿、精索静脉曲张合并精索在重建内环口处活动受限、补片变形皱缩合并和复发疝的发生率在各自分组内存在显著差异(χ~2=41.37、20.07、13.19、7.36,P均<0.05)。结论超声检查对于开放式前入路腹股沟疝修补术后慢性疼痛的诊断具有重要价值,部分阳性诊断因病程发展常合并出现,临床医师诊断时需全面考虑。

Objective Chronic pain as a complication following inguinal herniorrhaphy has attracted increasing attention in recent years. There is evidence that chronic pain seriously affects patients’ quality of life. However, there are few studies and data regarding imaging-based diagnosis of the etiology of chronic pain. Objective To explore the etiology as well as to analysis ultrasonographic imaging description of chronic pain following anterior open inguinal herniorrhaphy. Methods Ultrasonography was performed on 164 sites at which chronic pain was felt following anterior open inguinal herniorrhaphy to identify the main causes of the chronic postoperative pain. Positive ultrasound findings which appeared at the same time were grouped for comparisons. Results There are positive ultrasound diagnoses of chronic postoperative pain： encapsulated effusion, edema of the scrotal wall, testitis, hydrocele testis, limited motion of the spermatic cord at the reconstructed deep inguinal ring, varicocele, scar hyperplasia at pubic sutures, mesh shrinkage, patch or mesh plug accumulation, recurrent hernia, spermatic cord cyst as well as cyst of the caput epididymis. In terms of the pairwise merge of positive ultrasound diagnoses, there were significant differences between the respective groups in encapsulated effusion with scrotal wall edema, varicocele with limited motion of the spermatic cord at the reconstructed deep inguinal ring, and mesh shrinkage with recurrent hernia（χ~2=41.37、20.07、13.19、7.36,P〈0.05）. Conclusion Ultrasonography offer important benefits in the diagnosis of chronic pain following anterior open inguinal herniorrhaphy. Some positive findings cause chronic pain at the same time, which is necessary for doctors to consider comprehensively while making a diagnosis.