Moreno-Egea A
Abdominal Wall Unit, La Vega University Hospital, Avda Primo de Rivera 7, 5ºD, 3008, Murcia, Spain.
School of Medicine, San Antonio University, Murcia, Spain.
Surg Endosc. 2016 Dec;30(12):5222-5227. doi: 10.1007/s00464-016-4867-0. Epub 2016 Mar 22.
The avoidance of postoperative chronic pain is of the foremost importance and has a deep impact on patient satisfaction. The objective of this study is to evaluate the selective transabdominal preperitoneal laparoscopic neurectomy for treatment of refractory inguinodynia.
Prospective study in a University Hernia Center included 16 consecutive patients with chronic pain. Primary endpoint was pain control (measured by appropriate questionnaire and need of analgesics). Secondary endpoint was surgical morbidity. Follow-up was 2 years (range 12 months-4 years).
The mean operating time was 52 (range 36-68) minutes, and there were no intraoperative complications. All patients had histologic confirmation of neurectomy. Anatomical variation was found in ten patients (62.5 %), being a common trunk ilioinguinal/iliohypogastric nerve the most frequent (nine patients, 56.25 %). One patient developed hypoesthesia in the territory of the femorocutaneous nerve by nerve injury. Reoperation was performed 6 months afterward to complete ilioinguinal nerve neurectomy. Neuropathic pain medications were continued by five patients. Pain was completely eliminated in 11 (68.75 %).
Management of patients with neural groin pain should be done in a multidisciplinary unit. Selective neurectomy by a transabdominal preperitoneal laparoscopic approach is a safe and highly effective option in selected patients for the treatment of refractory postoperative chronic pain. Careful anatomical planning is essential to avoid inadvertent injuries and more suffering to these patients.
避免术后慢性疼痛至关重要，对患者满意度有深远影响。本研究的目的是评估选择性经腹腹膜前腹腔镜神经切除术治疗难治性腹股沟疼痛的效果。
在一所大学疝中心进行的前瞻性研究纳入了16例连续的慢性疼痛患者。主要终点是疼痛控制（通过适当的问卷和镇痛药需求来衡量）。次要终点是手术并发症。随访时间为2年（范围12个月至4年）。
平均手术时间为52（范围36 - 68）分钟，术中无并发症。所有患者均经组织学证实为神经切除术。10例患者（62.5%）发现解剖变异，最常见的是髂腹股沟/髂腹下神经共干（9例患者，56.25%）。1例患者因神经损伤出现股外侧皮神经支配区域感觉减退。6个月后进行再次手术以完成髂腹股沟神经切除术。5例患者继续服用神经性疼痛药物。11例患者（68.75%）疼痛完全消除。
腹股沟神经痛患者的管理应在多学科单位进行。经腹腹膜前腹腔镜选择性神经切除术是治疗难治性术后慢性疼痛的选定患者的一种安全且高效的选择。仔细的解剖学规划对于避免这些患者的意外损伤和更多痛苦至关重要。
