Nienhuijs Simon Willem, Boelens Oliver B A, Strobbe Luc J A
Department of Surgery, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands.
J Am Coll Surg. 2005 Jun;200(6):885-9. doi: 10.1016/j.jamcollsurg.2005.02.005.
The results of a randomized clinical trial comparing the Lichtenstein procedure, mesh plug repair, and the Prolene Hernia System provided a database for analyzing chronic pain after anterior mesh hernia repair to determine the characteristics and identify risk factors.
A total of 334 patients with primary inguinal hernia were randomly allocated to receive one of the three meshes. Data on patient characteristics, hernia, and procedure were collected. Longterm followup was completed for 319 of 333 (95.8 %) patients with a postal questionnaire that included a Visual Analog Scale pain score, pain descriptions, and questions about numbness and prosthesis awareness. Chronic pain was analyzed irrespective of the technique used.
With increasing age, significantly less intense chronic pain was reported (R = -0.267, p < 0.001) and pain descriptors were used less frequently (p < 0.001). This indirectly reflected the significance of employment (p = 0.019) and body mass index (R = -0.166, p = 0.005) in a univariate analysis because the elderly were, for the most part, unemployed and had a higher body mass index. Longterm Visual Analog Scale pain score correlated significantly with pain directly after an operation (R = 0.253, p = < 0.001). Reported pain increased with the presence of numbness (p < 0.001) and the number of descriptions used (R = 0.389, p < 0.001). Patients using only neuropathic descriptions (n = 56) suffered significantly more intense pain (Visual Analog Scale 26.5 versus 16.6, p = 0.014) than those using only words indicating nociceptive pain (n = 47).
Chronic pain after anterior mesh hernia repair is determined by younger age and stronger pain directly after the operation. Especially in patients with chronic neuropathic pain, its intensity is aggravated when numbness is present and the number of words to describe pain increases.
一项比较Lichtenstein手术、网塞修补术和普理灵疝修补系统的随机临床试验结果为分析前路疝修补术后慢性疼痛提供了一个数据库，以确定其特征并识别风险因素。
总共334例原发性腹股沟疝患者被随机分配接受三种补片之一。收集了患者特征、疝和手术的数据。通过邮寄问卷对333例患者中的319例（95.8%）进行了长期随访，问卷包括视觉模拟评分疼痛评分、疼痛描述以及关于麻木和补片感知的问题。无论采用何种技术，均对慢性疼痛进行了分析。
随着年龄的增加，报告的慢性疼痛强度显著降低（R = -0.267，p < 0.001），且疼痛描述使用频率降低（p < 0.001）。这在单因素分析中间接反映了就业情况（p = 0.019）和体重指数（R = -0.166，p = 0.005）的重要性，因为老年人大多失业且体重指数较高。长期视觉模拟评分疼痛评分与术后即刻疼痛显著相关（R = 0.253，p = < 0.001）。报告的疼痛随着麻木的出现（p < 0.001）和使用的描述数量增加（R = 0.389，p < 0.001）而增加。仅使用神经性描述的患者（n = 56）比仅使用表示伤害性疼痛的词语的患者（n = 47）遭受的疼痛强度显著更高（视觉模拟评分为26.5对16.6，p = 0.014）。
前路疝修补术后的慢性疼痛由年龄较轻和术后即刻疼痛较强烈所决定。尤其是在患有慢性神经性疼痛的患者中，当出现麻木且描述疼痛的词语数量增加时，疼痛强度会加重。
