Medicinskt Centrum, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, 581 85, Linköping, Sweden.
Hernia. 2010 Jun;14(3):265-70. doi: 10.1007/s10029-010-0632-9. Epub 2010 Feb 10.
Surgical strategy regarding nerve identification and resection in relation to chronic postoperative pain remains controversial. A central question is whether nerves in the operation field, when identified, should be preserved or resected. In the present study, the hypotheses that the identification and consequent resection of nerves 'at risk' have no influence on postoperative pain has been tested.
A single-centre study was conducted in 525 patients undergoing Lichtenstein hernioplasty. One surgeon (364 operations, Group A) consequently resected nerves 'at risk' for being injured and nine surgeons (161 operations, Group B) adhered to the general routine of nerve preservation. All cases were ambulatory surgery on anaesthetised patients and the groups were similar with regard to age, body mass index (BMI) and preoperative pain. Self-reported pain at 3 months was recorded on a 10-box visual analogue scale (VAS). The identification and resection of nerves were continuously registered. Statistical calculations were performed with Fisher's exact test and ordinal logistic regression.
There was no significant difference in the number of identified nerves in the two groups of patients (iliohypogastricus, P = 0.555; ilioinguinalis, P = 0.831; genital branch, P = 0.214). However, the number of resected nerves was significantly higher in Group A for the iliohypogastric nerve, P < 0.001, but not for ilioinguinalis, P = 0.064, and genital branch, P = 0.362. Non-identification of the ilioinguinal nerve correlated to the highest level of self-reported postoperative pain at 3 months. Patients in Group A, who had nerves 'at risk' resected from the operation field, reported significantly less postoperative pain at 3 months, P = 0.007.
This register study confirms the importance of nerve identification. Nerve resection strategy with the consequent removal of nerves 'at risk' gives a significantly better outcome in Lichtenstein hernioplasty.
在慢性术后疼痛的情况下，有关神经识别和切除的手术策略仍然存在争议。一个核心问题是，在手术区域中识别出的神经是否应保留或切除。在本研究中，测试了“风险”神经的识别和随后切除对术后疼痛没有影响的假设。
对 525 名接受 Lichtenstein 疝修补术的患者进行了单中心研究。一位外科医生（364 例手术，A 组）随后切除了“风险”神经，以防止受伤，而九位外科医生（161 例手术，B 组）则遵循神经保护的常规程序。所有病例均为麻醉患者的日间手术，两组在年龄、体重指数（BMI）和术前疼痛方面相似。术后 3 个月时，通过 10 个框视觉模拟量表（VAS）记录自我报告的疼痛。持续记录神经的识别和切除情况。Fisher 精确检验和有序逻辑回归用于统计计算。
两组患者识别的神经数量没有显著差异（腹下神经，P=0.555；髂腹股沟神经，P=0.831；生殖支，P=0.214）。然而，A 组切除的神经数量显著更高，腹下神经 P<0.001，而髂腹股沟神经 P=0.064，生殖支 P=0.362。未识别髂腹股沟神经与术后 3 个月时自我报告的最高水平疼痛相关。A 组患者将“风险”神经从手术区域切除，术后 3 个月报告的疼痛明显减轻，P=0.007。
这项登记研究证实了神经识别的重要性。神经切除策略，随后切除“风险”神经，可显著改善 Lichtenstein 疝修补术的结果。
