腹膜后三联神经切除术治疗难治性神经性腹股沟疼痛的疗效

Efficacy of retroperitoneal triple neurectomy for refractory neuropathic inguinodynia.

作者信息

Moore Alexandra M, Bjurstrom Martin F, Hiatt Jonathan R, Amid Parviz K, Chen David C

机构信息

Department of Surgery, David Geffen School of Medicine, University of California, 1304 15th Street, Suite 102, Santa Monica, CA 90404, USA.

Department of Anesthesiology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.

出版信息

Am J Surg. 2016 Dec;212(6):1126-1132. doi: 10.1016/j.amjsurg.2016.09.012. Epub 2016 Sep 30.

DOI:10.1016/j.amjsurg.2016.09.012

PMID:27771034

Abstract

BACKGROUND

Refractory neuropathic inguinodynia following inguinal herniorrhaphy is a common and debilitating complication. This prospective study evaluated long-term outcomes associated with laparoscopic retroperitoneal triple neurectomy.

METHODS

Sixty-two consecutive patients (51 male; mean age, 47); all failing pain management; prior reoperation in 35, prior neurectomy in 26; average follow-up 681 days (range: 90 days to 3 years). Measured outcomes include numeric pain ratings, dermatomal mapping, histologic confirmation, quantitative sensory testing, complications, narcotic usage, and activity level.

RESULTS

Mean numerical pain scores were significantly decreased (baseline, 8.6) at all postoperative time points (POD 1, 3.6; P < .001: POD 90, 2.3, P < .001) with durable efficacy from POD 90 to 3 years (P < .001). Quantitative sensory testing showed marked group-level increases of sensory thresholds. Narcotic dependence decreased in 57/62 and was eliminated in 44/62 and activity level improved in 58/62.

CONCLUSIONS

Retroperitoneal triple neurectomy is an effective and durable treatment for refractory neuropathic inguinodynia.

摘要

背景

腹股沟疝修补术后难治性神经性腹股沟疼痛是一种常见且使人衰弱的并发症。这项前瞻性研究评估了腹腔镜腹膜后三联神经切除术的长期疗效。

方法

连续纳入62例患者（51例男性；平均年龄47岁）；所有患者疼痛管理均失败；35例曾接受再次手术，26例曾接受神经切除术；平均随访681天（范围：90天至3年）。测量的结果包括数字疼痛评分、皮节映射、组织学确认、定量感觉测试、并发症、麻醉药物使用情况和活动水平。

结果

所有术后时间点的平均数字疼痛评分均显著降低（基线时为8.6）（术后第1天为3.6；P <.001；术后第90天为2.3，P <.001），从术后第90天至3年疗效持久（P <.001）。定量感觉测试显示感觉阈值在组水平上显著提高。57/62例患者的麻醉药物依赖减少，44/62例患者的麻醉药物依赖消除，58/62例患者的活动水平改善。