Fisher Hilaire W, Lotze Peter M
Women’s Pelvic Health & Continence Center, 7900 Fannin, Suite 4602, Houston, TX 77054, USA.
Int Urogynecol J. 2011 Apr;22(4):439-41. doi: 10.1007/s00192-010-1298-7.
The risk of persistent pain following a retropubic sling is rare (1%). Nerve injuries have been suspected as a cause of persistent postoperative pain. We present two cases of postoperative pain thought to be secondary to injury or mechanical distortion of two different pelvic nerves. Visual exam, cystoscopy, and MRI studies demonstrated no abnormal findings. Manual examination produced site-specific tenderness thought to be associated with a specific nerve distribution. Each patient's pain was first relieved with a local anesthetic block at the site of the pain. One patient required surgical excision of the mesh, and the second patient only required conservative management. Both patients' pain completely resolved. Based on these and other reported cases, along with cadaveric dissections, we hypothesize that retropubic slings can potentially injure the pudendal, ilioinguinal, and iliohypogastric nerve branches.
耻骨后吊带术后持续疼痛的风险很罕见（1%）。神经损伤被怀疑是术后持续疼痛的一个原因。我们报告两例术后疼痛病例，认为是由两条不同的盆腔神经损伤或机械性扭曲所致。视觉检查、膀胱镜检查和磁共振成像研究均未发现异常。手法检查产生了与特定神经分布相关的部位特异性压痛。每位患者的疼痛最初通过在疼痛部位进行局部麻醉阻滞得到缓解。一名患者需要手术切除补片，第二名患者仅需保守治疗。两名患者的疼痛均完全缓解。基于这些及其他报告的病例，以及尸体解剖，我们推测耻骨后吊带可能会损伤阴部神经、髂腹股沟神经和髂腹下神经分支。
