Nienhuijs S W, van Oort I, Keemers-Gels M E, Strobbe L J A, Rosman C
Department of Surgery, Canisius-Wilhelmina Hospital, PO Box 9015, 6500 GS, Nijmegen, The Netherlands.
Br J Surg. 2005 Jan;92(1):33-8. doi: 10.1002/bjs.4702.
Most surgeons favour the use of a mesh for open inguinal hernia repair as it has a low recurrence rate. Procedures used most frequently are the Lichtenstein method, mesh plug repair and the Prolene Hernia System. The choice of technique may be influenced by the effects on postoperative pain and quality of life.
A total of 334 patients were allocated blindly and at random to receive one of these three meshes for open hernia repair. Quality of life was assessed with the Short Form 36 and pain by a visual analogue scale 14 days, and 3 and 15 months after surgery.
Operative complications were rare and comparable between the groups. Long-term follow-up was completed by questionnaire in 95.8 per cent of patients. There were no significant differences in pain parameters between the three meshes; overall, 43.3 per cent of patients reported some form of groin pain. The severity of the chronic pain correlated with a higher pain score in the first 2 weeks after surgery (P < 0.001). A significant reduction in scores for role emotional (short term) and vitality (long term) quality of life domains was found in patients who had a Lichtenstein repair.
These short- and long-term results did not show any clinically significant difference in postoperative pain and quality of life between the three types of mesh hernia repair. Severe early postoperative pain reliably predicted the likelihood of persisting chronic groin pain.
大多数外科医生倾向于使用补片进行开放性腹股沟疝修补术，因为其复发率较低。最常用的手术方法是Lichtenstein法、补片填塞修补术和普理灵疝修补系统。技术的选择可能会受到对术后疼痛和生活质量影响的左右。
总共334例患者被随机盲法分配，接受这三种补片中的一种进行开放性疝修补术。在术后14天、3个月和15个月，使用简短健康调查问卷36项版本评估生活质量，并通过视觉模拟评分法评估疼痛情况。
手术并发症很少见，且各组之间相当。95.8%的患者通过问卷调查完成了长期随访。三种补片之间的疼痛参数没有显著差异；总体而言，43.3%的患者报告有某种形式的腹股沟疼痛。慢性疼痛的严重程度与术后前2周较高的疼痛评分相关（P < 0.001）。接受Lichtenstein修补术的患者在角色情感（短期）和活力（长期）生活质量领域的评分有显著降低。
这些短期和长期结果表明，三种类型的补片疝修补术在术后疼痛和生活质量方面没有任何临床上的显著差异。术后早期的严重疼痛可靠地预测了持续存在慢性腹股沟疼痛的可能性。
