Yong Paul J, Williams Christina, Allaire Catherine
Department of Obstetrics and Gynecology, University of British Columbia; Vancouver, BC, Canada.
JSLS. 2013 Jan-Mar;17(1):74-81. doi: 10.4293/108680812X13517013317310.
Chronic pelvic pain affects 15% of women. Our objective was to evaluate empiric laparoscopic inguinal exploration and mesh placement in this population.
Retrospective cohort with follow-up questionnaire of women with lateralizing chronic pelvic pain (right or left), ipsilateral inguinal tenderness on pelvic examination, no clinical hernia on abdominal examination, and ipsilateral empiric laparoscopic inguinal exploration with mesh placement (2003-2009). Primary outcome was pain level at the last postoperative visit. Secondary outcomes were pain level and SF-36 scores from the follow-up questionnaire.
Forty-eight cases met the study criteria. Surgery was done empirically for all patients, with only 7 patients (15%) found to have an ipsilateral patent processus vaginalis (shallow peritoneal dimple or a deeper defect (occult hernia)). Of 43 cases informative for the primary outcome, there was pain improvement in 15 patients (35%); pain improvement then return of the pain in 18 patients (42%); and pain unchanged in 9 patients (21%) and worse in 1 patient (2%). Improvement in pain was associated with a positive Carnett's test in the ipsilateral abdominal lower quadrant (P = .024). Thirteen patients returned the questionnaire (27%), and the pain was now described as improved in 9 patients (69%), unchanged in 4 patients (31%), and worse in none. Three SF-36 subscales showed improvement (physical functioning, social functioning, and pain).
In select women with chronic pelvic pain, empiric laparoscopic inguinal exploration and mesh placement results in moderate improvement in outcome. A positive Carnett's test in the ipsilateral abdominal lower quadrant is a predictor of better outcome.
慢性盆腔疼痛影响15%的女性。我们的目的是评估对此类人群进行经验性腹腔镜腹股沟探查及放置补片的效果。
对2003年至2009年间患有慢性盆腔疼痛（右侧或左侧）、盆腔检查时同侧腹股沟压痛、腹部检查无临床疝且接受了经验性腹腔镜腹股沟探查及补片放置的女性进行回顾性队列研究，并进行随访问卷调查。主要结局是术后最后一次随访时的疼痛程度。次要结局是随访问卷中的疼痛程度和SF-36评分。
48例符合研究标准。所有患者均进行了经验性手术，仅7例患者（15%）发现同侧鞘突未闭（浅腹膜凹陷或更深的缺损（隐匿性疝））。在43例有主要结局信息的病例中，15例患者（35%）疼痛改善；18例患者（42%）疼痛改善后又复发；9例患者（21%）疼痛无变化，1例患者（2%）疼痛加重。疼痛改善与同侧下腹部象限Carnett试验阳性相关（P = 0.024）。13例患者返回了问卷（27%），现在9例患者（69%）称疼痛有所改善，4例患者（31%）称疼痛未变，无患者称疼痛加重。SF-36的三个分量表显示有所改善（生理功能、社会功能和疼痛）。
对于部分患有慢性盆腔疼痛的女性，经验性腹腔镜腹股沟探查及补片放置可使结局得到中度改善。同侧下腹部象限Carnett试验阳性是结局较好的预测指标。
