Page B, Paterson C, Young D, O'Dwyer P J
University Department of Surgery, Western Infirmary and Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK.
Br J Surg. 2002 Oct;89(10):1315-8. doi: 10.1046/j.1365-2168.2002.02186.x.
No previous study has attempted to quantify pain from a primary inguinal hernia. The aim of this study was to quantify patients' pain from inguinal hernia at rest and on moving, and to assess the effect of hernia repair on the pain.
Linear analogue pain scores at rest and on moving were recorded before operation and at 1 year after surgery in a consecutive series of patients undergoing elective repair of a primary inguinal hernia.
During the study period 323 patients underwent inguinal hernia repair. Eighty-six patients (26.6 per cent) recorded no pain at rest from the hernia, and 174 (53.9 per cent) had mild pain only (score less than 10). On moving, 53 patients (16.4 per cent) had no pain and 137 (42.4 per cent) had mild pain on moving. Only 1.5 per cent experienced severe pain (score greater than 50) at rest, and 10.2 per cent had severe pain on moving. There was no association between pain and hernia type, direct or indirect, or patient occupation. One year after operation only 24.5 per cent of patients had no pain from the hernia repair site at rest, and 21.6 per cent had no pain from the site on moving. Overall there was a significant reduction in pain score at rest (mean(s.e.m.) decrease from baseline - 2.9(1.2), P = 0.019) and on moving (- 9.2(1.8), P = 0.001) compared with preoperative values, and this was due mainly to the large effect observed in patients with high preoperative values. Patients who had no pain at rest before operation had significant pain scores at rest at 1 year (P = 0.001).
Clinical trials are required to evaluate hernia repair in patients with an asymptomatic inguinal hernia. Results from such trials should help to determine whether repair is the treatment of choice for these patients.
此前尚无研究试图对原发性腹股沟疝引起的疼痛进行量化。本研究的目的是量化患者在静息和活动时腹股沟疝引起的疼痛，并评估疝修补术对疼痛的影响。
在一系列连续接受原发性腹股沟疝择期修补术的患者中，记录术前及术后1年静息和活动时的线性模拟疼痛评分。
在研究期间，323例患者接受了腹股沟疝修补术。86例患者（26.6%）静息时无疝痛，174例（53.9%）仅有轻度疼痛（评分低于10分）。活动时，53例患者（16.4%）无疼痛，137例（42.4%）活动时有轻度疼痛。仅1.5%的患者静息时经历重度疼痛（评分大于50分），10.2%的患者活动时经历重度疼痛。疼痛与疝的类型（直疝或斜疝）或患者职业之间无关联。术后1年，仅24.5%的患者静息时疝修补部位无疼痛，21.6%的患者活动时该部位无疼痛。总体而言，与术前值相比，静息时疼痛评分显著降低（平均（标准误）从基线下降 - 2.9(1.2)，P = 0.019），活动时也显著降低（ - 9.2(1.8)，P = 0.001），这主要是由于术前评分高的患者观察到的显著效果。术前静息时无疼痛的患者术后1年静息时疼痛评分显著升高（P = 0.001）。
需要进行临床试验来评估无症状腹股沟疝患者的疝修补术。此类试验的结果应有助于确定修补术是否是这些患者的首选治疗方法。
