腹股沟管补片放置与Gilbert术后疼痛

Different effect of with and without mesh placement in inguinal canal on pain after Gilbert repair:A comparative study

目的比较腹股沟管补片放置与否对Gilbert术后疼痛发生的影响。方法选择2014年2月至2017年2月,嘉兴市第二医院施行部分单侧Gilbert术式患者269例。按手术方式分为传统Gilbert组(腹膜前间隙及腹股沟管中均放置补片)与改良Gilbert组(仅腹膜前间隙放置补片,对腹股沟管补片修剪去大部分,仅在内环口处留下少量补片用于缝合固定)。比较各组术后近期疼痛、术后慢性疼痛、不同慢性疼痛性质的发生率及随访期间的复发率等。结果 2组随访期内的术后复发率比较,差异无统计学意义(P=1.000)。传统Gilber组术后发生近期疼痛158例,其中中度30例,重度7例;发生术后腹股沟区慢性疼痛(chronic postoperative inguinal pain,CPIP)44例,其中中度17例,重度6例。改良Gilber组术后发生近期疼痛32例,其中中度2例,重度1例;发生CPIP4例,其中中度1例,重度0例。改良Gilbert组较传统Gilbert组,术后近期的中重度疼痛发生率、CPIP的总体发生率、术后中重度CPIP的发生率、表现为活动时诱发疼痛的CPIP的发生率均明显较传统Gilbert组低,差异均有统计学意义(P=0.034、0.048、0.036、0.049)。结论仅腹膜前间隙放置补片而剪去大部分腹股沟管补片改良Gilbert术可以有效减少Gilbert术后中重度近期疼痛的发生率、慢性疼痛的总发生率及中重度慢性疼痛的发生率,能够降低术后慢性疼痛中活动时诱发疼痛的发生率,且随访期间未增加疝复发率。

Objective To compare the different effect of with or without mesh placement in inguinal canal on pain after Gilbert repair.Methods From February 2014 to February 2017,269 cases unilateral hernia underwent Gilbert repair in the second hospital of Jiaxing were divided into traditional Gilbert group（meshes were placed in preperitoneal space and in the inguinal canal） and modified Gilbert group（the mesh was placed in the preperitoneal space only）.The postoperative short-term pain,postoperative chronic pain,incidence of different pain nature and recurrence rate during the short-term follow-up were compared between the two groups.Results And there were no significant differences in the recurrence rate between the two groups during the short-term follow-up period（P=1.000）.In the traditional Gilbert group,there were 158 cases of short-term pain,of which 30 cases were moderate and 7 cases were severe.There were 44 cases of CPIP,of which 17 cases were moderate and 6 cases were severe.In the modified Gilbert group,there were 32 cases of short-term pain,of which 2 cases were moderate and 1 cases were severe.There were 4 cases of CPIP,of which 1 case were moderate and none was severe.The modified Gilbert group showed lower incidence of short-term moderate and severe pain,lower overall incidence of CPIP,lower incidence of moderate and severe CPIP,and lower incidence of CPIP induced by the activities than the traditional Gilbert group,the differences were statistically significant（P=0.034,0.048,0.036,0.049）.Conclusion The modified Gilbert which mesh is placed in preperitoneal space only without mesh placed in the inguinal canal can effectively reduce the incidence of moderate and severe pain in the short-term after Gilbert repair,the overall incidence of postoperative chronic pain,and the incidence of moderate and severe chronic pain after Gilbert repair,and the incidence of chronic pain induced by the activities after Gilbert repair.Moreover,it doesn＇t increase in the rate of hernia recurrence during the short-term in follow-up after Gilbert repair.