Wright Robert, Born Donald E, D'Souza Natasha, Hurd Larissa, Gill Rachel, Wright Daniel
Cascade Hernia Institute, Puyallup, WA, USA.
Department of Pathology, Stanford University, School of Medicine, Stanford, CA, USA.
Am J Surg. 2017 May;213(5):975-982. doi: 10.1016/j.amjsurg.2017.03.013. Epub 2017 Mar 22.
The purpose of this study is to describe the known soft tissue neuro-histology factors associated with compression neuropathy in relation to the incidence of preoperative pain in primary inguinal hernia. Enlargement of the ilioinguinal nerve occurs in 63% of patients with primary inguinal hernia; compression neuropathy has similar gross features.
Patients completed pain questionnaires pertaining to preoperative pain and the quality of pain experienced. During routine inguinal hernia repair, nerve segments were sampled for histologic evaluation.
Twenty-two thickened nerve segments (63% of total) with proximal and distal specimens were resected for examination and comparison. We quantified various histologic indicators including nerve diameter, fascicle count, myxoid content within the epineurium, perineurium and endoneurium. Increased preoperative patient pain scores correlate with increased nerve diameter, increased fascicle count and increased myxoid material both within the perineurium and endoneurium.
These findings support the concept that preoperative hernia pain is associated with compression neuropathy.
本研究旨在描述与原发性腹股沟疝术前疼痛发生率相关的、已知的与压迫性神经病变有关的软组织神经组织学因素。63%的原发性腹股沟疝患者存在髂腹股沟神经增粗；压迫性神经病变具有相似的大体特征。
患者完成与术前疼痛及所经历疼痛性质相关的疼痛问卷。在常规腹股沟疝修补术中，采集神经节段进行组织学评估。
切除22个增厚的神经节段（占总数的63%）及其近端和远端标本进行检查和比较。我们对各种组织学指标进行了量化，包括神经直径、束状结构数量、神经外膜、神经束膜和神经内膜内的黏液样物质含量。术前患者疼痛评分增加与神经直径增大、束状结构数量增加以及神经束膜和神经内膜内黏液样物质增多相关。
这些发现支持术前疝痛与压迫性神经病变相关的观点。
