Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.
J Minim Invasive Gynecol. 2012 Jul-Aug;19(4):448-53. doi: 10.1016/j.jmig.2012.03.009. Epub 2012 May 3.
To determine the incidence and clinical significance of iliohypogastric-ilioinguinal neuropathy from lower abdominal lateral port placement and fascial closure during laparoscopic gynecologic surgery.
Retrospective cohort study (Canadian Task Force classification II-2).
University-based referral center specializing in minimally invasive gynecologic surgery and chronic abdominopelvic pain.
Women who underwent a laparoscopic procedure because of benign gynecologic indications during a 3-year study period from 2008 to 2011. A total of 317 women met study criteria.
Operative laparoscopy using a lateral port in the lower abdomen. Closure of port-site fascial defects was achieved using either a Carter-Thomason or EndoClose suture device.
Nerve injury was identified by symptoms, and was confirmed with a nerve block after a positive test for allodynia in the distribution of the iliohypogastric-ilioinguinal nerve. Of 173 cases that did not involve fascial closure of a port-site defect, none were associated with nerve injury. Of 144 cases that involved fascial closure, 7 (4.9%) included nerve injury that resulted in pain requiring treatment (p = .004). In 1 patient, symptoms improved with medical management alone. Six patients required surgical management, and 5 of them had resolution of pain after removal of the fascial suture. There was no statistically significant difference in the incidence of nerve injury between the Carter-Thomason and EndoClose groups (4.7% vs 5.4%; p = .87).
There is an estimated 5% risk of clinically significant postoperative neuropathic pain due to injury of the iliohypogastric-ilioinguinal nerve with fascial closure of laparoscopic incisions in the lower abdomen. Pain seems to be due to suture entrapment of sensory fibers because it is usually resolved by removal of the suture. Prompt recognition and treatment may prevent subsequent development of chronic abdominopelvic pain.
确定下腹部侧入路和筋膜缝合时腹侧皮神经-髂腹股沟神经损伤的发生率和临床意义。
回顾性队列研究（加拿大任务组分类 II-2）。
一家专门从事微创妇科手术和慢性腹盆疼痛的大学附属转诊中心。
2008 年至 2011 年期间，317 名因良性妇科指征接受腹腔镜手术的女性符合研究标准。
下腹部侧入路手术腹腔镜。采用 Carter-Thomason 或 EndoClose 缝合器闭合切口筋膜缺损。
根据症状确定神经损伤，在髂腹下神经-髂腹股沟神经分布区出现痛觉过敏阳性试验后，用神经阻滞确认。173 例未行筋膜缝合的病例中，无一例发生神经损伤。144 例行筋膜缝合的病例中，7 例（4.9%）发生疼痛需治疗的神经损伤（p =.004）。1 例患者症状仅通过药物治疗改善。6 例患者需要手术治疗，其中 5 例在筋膜缝线取出后疼痛缓解。Carter-Thomason 组和 EndoClose 组神经损伤发生率无统计学差异（4.7%比 5.4%；p =.87）。
下腹部腹腔镜切口筋膜缝合时，髂腹下神经-髂腹股沟神经损伤导致术后神经病理性疼痛的风险估计为 5%。疼痛似乎是由于缝合线对感觉纤维的束缚所致，因为通常通过去除缝线即可缓解。及时识别和治疗可能防止随后发生慢性腹盆痛。
