腹腔镜腹股沟疝修补术后疼痛的长期模式及预测因素：一项以患者为中心的分析
Long-term patterns and predictors of pain following laparoscopic inguinal hernia repair: a patient-centered analysis.
作者信息
Patel Lava Y, Lapin Brittany, Gitelis Matthew E, Brown Craig, Linn John G, Haggerty Stephen, Denham Woody, Butt Zeeshan, Barrera Ermilo, Joehl Ray, Carbray JoAnn, Hall Tyler, Ujiki Michael B
机构信息
Section of Minimally Invasive Surgery, Department of Surgery, Grainger Center for Simulation and Innovation, NorthShore University HealthSystem, 2650 Ridge Avenue, Evanston, IL, 60201, USA.
Department of Medical Social Sciences, Surgery and Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 633 N. Saint Clair Street, 19th Floor, Chicago, IL, 60611, USA.
出版信息
Surg Endosc. 2017 May;31(5):2109-2121. doi: 10.1007/s00464-016-5207-0. Epub 2016 Sep 1.
BACKGROUND
Laparoscopic inguinal hernia repair has been shown to offer patients the benefit of less postoperative pain as compared to traditional open techniques. However, the risk of experiencing significant postoperative pain may affect patient's decision making. We aimed to elucidate potential patterns of pain and the predictors of such, up to 2 years postoperatively, using both generic and specific quality of life tools.
METHODS
Patients undergoing laparoscopic totally extra-peritoneal inguinal hernia repair were identified from a prospectively maintained database. Short form-36, Surgical Outcomes Measurement System (SOMS) and Carolinas Comfort Scale (CCS) surveys were administered pre- and postoperatively at 3 weeks, 6 months, 1 and 2 years. Patients with concomitant procedures were excluded. Significant pain was considered mild but bothersome or worse on either specific tool (SOMS scores ≥3/4, CCS scores ≥2). Predictors of significant pain were determined by logistic regression.
RESULTS
From 2009 to 2015, 482 patients enrolled in our database underwent elective TEP repair of 626 hernias and completed an assessment tool. Mean age was 57 (±15) years, with 93 % male. Reported pain on all three tools improved significantly from baseline over time (p < 0.01). Significant pain on either specific tool, related or unrelated to surgery, was reported by 52 % of respondents (158/301) preoperatively, and postoperatively by 50 % at 3 weeks (111/220), 21 % at 6 months (15/70), 13 % at 1 year (14/108), and 25 % at 2 years (30/121). Significant pain at 6 months-2 years correlated more significantly with general health status than surgical factors.
CONCLUSIONS
Significant pain can be as high as 50 % at 3 weeks on surgery-specific quality of life measures, but with significant improvement by 6 months which is maintained through 2 years. Poor quality of life and general health were the main predictors of pain after 6 months.
背景
与传统开放手术相比，腹腔镜腹股沟疝修补术已被证明能让患者术后疼痛减轻。然而，术后出现明显疼痛的风险可能会影响患者的决策。我们旨在使用通用和特定的生活质量工具，阐明术后长达2年的潜在疼痛模式及其预测因素。
方法
从一个前瞻性维护的数据库中识别出接受腹腔镜完全腹膜外腹股沟疝修补术的患者。在术前以及术后3周、6个月、1年和2年进行简短健康调查问卷-36（Short form-36）、手术结果测量系统（Surgical Outcomes Measurement System，SOMS）和卡罗来纳舒适度量表（Carolinas Comfort Scale，CCS）调查。排除同时进行其他手术的患者。明显疼痛被定义为在任何一种特定工具上为轻度但令人烦恼或更严重（SOMS评分≥3/4，CCS评分≥2）。通过逻辑回归确定明显疼痛的预测因素。
结果
2009年至2015年，我们数据库中的482例患者接受了626例疝的择期经腹膜外修补术，并完成了一项评估工具。平均年龄为57（±15）岁，93%为男性。随着时间推移，所有三种工具报告的疼痛均较基线水平显著改善（p<0.01）。术前，52%的受访者（158/301）在任何一种特定工具上报告了与手术相关或无关的明显疼痛；术后3周为50%（111/220），6个月为21%（15/70），1年为13%（14/108），2年为25%（30/121）。6个月至2年时的明显疼痛与总体健康状况的相关性比手术因素更显著。
结论
在针对手术的生活质量测量中，术后3周时明显疼痛发生率可高达50%，但6个月时显著改善，并持续至2年。生活质量差和总体健康状况不佳是6个月后疼痛的主要预测因素。
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