随机比较腹腔镜与李金斯坦腹股沟疝修补术后 5 年的慢性疼痛。

Chronic pain 5 years after randomized comparison of laparoscopic and Lichtenstein inguinal hernia repair.

机构信息

Department of Surgery, Central Hospital, Västerås Sweden.

出版信息

Br J Surg. 2010 Apr;97(4):600-8. doi: 10.1002/bjs.6904.

DOI:10.1002/bjs.6904

PMID:20186889

Abstract

BACKGROUND

Chronic postoperative pain is a major drawback of inguinal hernia repair. This study compared the frequency of chronic pain after laparoscopic (totally extraperitoneal patch, TEP) and open (Lichtenstein) repairs.

METHODS

A randomized multicentre study with 5 years' follow-up was conducted on men with a primary inguinal hernia. Chronic pain was categorized as mild, moderate or severe by blinded observers. A subgroup analysis was performed on 121 patients who experienced moderate or severe pain at any time during follow-up.

RESULTS

Overall, 1370 of 1512 randomized patients underwent surgery, 665 in the TEP and 705 in the Lichtenstein group. The total incidence of chronic pain was 11.0 versus 21.7 per cent at 1 year, 11.0 versus 24.8 per cent at 2 years, 9.9 versus 20.2 per cent at 3 years and 9.4 versus 18.8 per cent at 5 years in the TEP and Lichtenstein groups respectively (P < 0.001). After 5 years, 1.9 per cent of patients in the TEP and 3.5 per cent in the Lichtenstein group reported moderate or severe pain (P = 0.092). Of the 121 patients, 72 (59.5 per cent) no longer reported pain a median of 9.4 (range 6.7-10.8) years after operation.

CONCLUSION

Five years after surgery only a small proportion of patients still report moderate to severe chronic pain. Laparoscopic inguinal hernia repair leads to less chronic pain than open repair.

REGISTRATION NUMBER

NCT00568269 (http://www.clinicaltrials.gov).

摘要

背景

慢性术后疼痛是腹股沟疝修补术的主要缺点。本研究比较了腹腔镜（完全腹膜外补片，TEP）和开放式（Lichtenstein）修补术后慢性疼痛的发生率。

方法

对 1512 名原发性腹股沟疝男性患者进行了一项随机多中心研究，随访时间为 5 年。慢性疼痛由盲法观察者分为轻度、中度或重度。对 121 名在随访期间任何时候经历中度或重度疼痛的患者进行了亚组分析。

结果

总体而言，1512 名随机患者中有 1370 名接受了手术，TEP 组 665 名，Lichtenstein 组 705 名。1 年时慢性疼痛总发生率分别为 11.0%和 21.7%，2 年时分别为 11.0%和 24.8%，3 年时分别为 9.9%和 20.2%，5 年时分别为 9.4%和 18.8%（P<0.001）。5 年后，TEP 组和 Lichtenstein 组分别有 1.9%和 3.5%的患者报告中度或重度疼痛（P=0.092）。在 121 名患者中，72 名（59.5%）在手术后中位数 9.4 年（范围 6.7-10.8）后不再报告疼痛。