Malekpour Fatemeh, Mirhashemi Seyyed Hadi, Hajinasrolah Esmaeil, Salehi Nourollah, Khoshkar Ali, Kolahi Ali Asghar
Department of General Surgery, Loghman Medical Center, Tehran, Iran.
Am J Surg. 2008 Jun;195(6):735-40. doi: 10.1016/j.amjsurg.2007.09.037. Epub 2008 Apr 28.
Inguinodynia is the second most common complication occurring after inguinal hernia repair. This study was undertaken to evaluate the effect of ilioinguinal nerve excision, a concept previously proposed to be performed during open hernia mesh repair, on postsurgical pain and hyposthesia.
A double-blind randomized clinical trial was performed on 121 patients undergoing open anterior mesh repair of inguinal hernia in 1 center from April 2005 through June 2006. The ilioinguinal nerve was excised in half of the patients and preserved in the other half. Pain and hyposthesia at POD 1, 1 and 6 months after surgery, and 1 year after surgery was evaluated in both groups using a visual analog scale. Results were compared using chi-square analysis.
Of the total number of 121 patients who entered the study, with an age range of 18 to 86 years (mean +/- SD 45 +/- 18), 115 (95%) were male. Sixty-one were in the nerve-excision group, and 60 were in the nerve-preservation group. One hundred patients were followed-up until the end of the first year. Using the visual analog scale to detect pain severity on postsurgical day 1, mean scores in the nerve-excision and nerve-preservation groups were 2.2 +/- .8 (range 1 to 4) versus 2.8 +/- .7 (range 2 to 4.5), respectively (P < .001). At 1 month after surgery, these scores were .7 +/- .7 (range 0 to 3) versus 1.5 +/- .7 (range 0 to 3.5), respectively (P < .001). Between 6 months and 1 year after surgery, median scores of zero were detected in both groups. After postsurgical day 1, the median score of hyposthesia was near zero in both groups. Thirteen patients developed chronic inguinodynia (13%), 10 of whom were in the nerve-preservation group. Chronic postsurgical inguinodynia was seen in 6% of patients in the ilioinguinal nerve-excision and 21% of the patients in the ilioinguinal nerve-preservation group (P = .033).
Neurectomy decreases postsurgical pain after elective inguinal hernia repair. Although chronic inguinodynia was less frequent in our study than reported by many previous studies, it is still wise to recommend ilioinguinal neurectomy in patients undergoing anterior inguinal hernia mesh repair.
腹股沟区疼痛是腹股沟疝修补术后第二常见的并发症。本研究旨在评估髂腹股沟神经切除术（一种先前提出在开放疝修补术中进行的术式）对术后疼痛和感觉减退的影响。
2005年4月至2006年6月，在1个中心对121例行腹股沟疝开放前路修补术的患者进行了一项双盲随机临床试验。一半患者切除髂腹股沟神经，另一半予以保留。两组均使用视觉模拟量表评估术后第1天、1个月、6个月及1年时的疼痛和感觉减退情况。结果采用卡方分析进行比较。
纳入研究的121例患者年龄范围为18至86岁（平均±标准差45±18），其中115例（95%）为男性。神经切除组61例，神经保留组60例。100例患者随访至第1年末。使用视觉模拟量表检测术后第1天的疼痛严重程度，神经切除组和神经保留组的平均评分分别为2.2±0.8（范围1至4）和2.8±0.7（范围2至4.5）（P<0.001）。术后1个月，这些评分分别为0.7±0.7（范围0至3）和1.5±0.7（范围0至3.5）（P<0.001）。术后6个月至1年，两组的中位数评分均为零。术后第1天后，两组感觉减退的中位数评分均接近零。13例患者出现慢性腹股沟区疼痛（13%）,其中10例在神经保留组。髂腹股沟神经切除组6%的患者和髂腹股沟神经保留组21%的患者出现慢性术后腹股沟区疼痛（P=0.033）。
神经切除术可减轻择期腹股沟疝修补术后的疼痛。尽管本研究中慢性腹股沟区疼痛的发生率低于许多先前研究报道，但对于接受腹股沟疝前路修补术的患者，推荐进行髂腹股沟神经切除术仍是明智之举。
