Picchio Marcello, Palimento Domenico, Attanasio Ugo, Matarazzo Pietro Filippo, Bambini Chiara, Caliendo Angelo
Department of Surgery, Civil Hospital Dono Svizzero, Latina, Italy.
Arch Surg. 2004 Jul;139(7):755-8; discussion 759. doi: 10.1001/archsurg.139.7.755.
Our study aimed to evaluate the effect of preservation or elective division of the ilioinguinal nerve on pain and postoperative symptoms after open inguinal hernia repair with mesh.
Double-blind, randomized trial.
Four public, government-financed hospitals in Italy.
From January 1, 1997, to June 30, 2002, 813 patients with primary inguinal hernia were randomly allocated to undergo inguinal hernia repair either with ilioinguinal nerve preservation (408 patients, group A) or elective transection (405 patients, group B).
Hernia repair with sutureless apposition of a polypropylene mesh.
The primary outcome was the evaluation of chronic pain 1 year after operation. Secondary outcomes were postoperative symptoms assessment at 1 week and 1, 6, and 12 months after operation. Telephone interview was performed 35.5 months (range, 12-59 months) after operation to assess the presence of chronic pain.
Of the 302 group A and 291 group B patients who made an office visit 1 year postoperatively, pain was absent in 231 (76.5%) and 213 (73%) (difference, 3.30%; 95% confidence interval, -3.68% to 10.28%), mild in 55 (18%) and 60 (21%), moderate in 11 (4%) and 9 (3%), and severe in 5 (2%) and 9 (3%), respectively (P =.55; Pearson chi2(3) test). At 1-month and 6-month follow-up visits, no difference was found between the 2 groups with respect to pain, but loss of pain or touch sensation were significantly greater when the ilioinguinal nerve was divided. One year after operation, the 2 groups were also comparable with respect to loss of pain sensation, but touch sensation remained decreased in group B. At telephone interview, the presence of chronic pain was similar in both groups.
Pain after open hernia repair with polypropylene mesh is not affected by elective division of the ilioinguinal nerve; sensory disturbances in the area of distribution of the transected nerve are significantly increased.
我们的研究旨在评估保留或选择性切断髂腹股沟神经对开放腹股沟疝修补术后疼痛及术后症状的影响。
双盲随机试验。
意大利四家公立政府资助医院。
1997年1月1日至2002年6月30日，813例原发性腹股沟疝患者被随机分配接受腹股沟疝修补术，其中408例患者保留髂腹股沟神经（A组），405例患者选择性切断该神经（B组）。
采用聚丙烯网片无缝合贴合法进行疝修补。
主要观察指标为术后1年慢性疼痛的评估。次要观察指标为术后1周、1个月、6个月和12个月的术后症状评估。术后35.5个月（范围12 - 59个月）进行电话随访以评估慢性疼痛情况。
术后1年进行门诊复查的302例A组患者和291例B组患者中，无痛者分别为231例（76.5%）和213例（73%）（差异3.30%；95%置信区间为 - 3.68%至10.28%），轻度疼痛者分别为55例（18%）和60例（21%），中度疼痛者分别为11例（4%）和9例（3%），重度疼痛者分别为5例（2%）和9例（3%）（P = 0.55；Pearson卡方(3)检验）。在1个月和6个月的随访中，两组在疼痛方面无差异，但切断髂腹股沟神经时疼痛或触觉丧失明显更严重。术后1年，两组在痛觉丧失方面也具有可比性，但B组触觉仍减退。电话随访时，两组慢性疼痛情况相似。
聚丙烯网片开放疝修补术后疼痛不受髂腹股沟神经选择性切断的影响；切断神经分布区域的感觉障碍显著增加。
