Verhagen Tim, Loos Maarten J, Mulders Leon G, Scheltinga Marc R, Roumen Rudi M
The SolviMáx Center for Chronic Abdominal Wall and Groin Pain, Department of General Surgery, Máxima Medical Center, Veldhoven, The Netherlands.
Department of Obstetrics and Gynaecology, Máxima Medical Center, Veldhoven, The Netherlands.
Eur J Obstet Gynecol Reprod Biol. 2018 Dec;231:248-254. doi: 10.1016/j.ejogrb.2018.10.045. Epub 2018 Oct 26.
Up to 8% of patients undergoing surgery via a Pfannenstiel incision may develop chronic inguinal pain. This type of pain is frequently caused by inguinal nerve entrapment and may strongly interfere with daily functioning. We report our long term experience of a step up approach using tender point infiltration and surgical neurectomy for intractable neuropathic post-Pfannenstiel groin pain.
A retrospective database analysis identified patients with neuropathic groin pain due to iliohypogastric and/or ilioinguinal nerve entrapment following a Pfannenstiel incision in a single center between 2000 and 2015. Patients who underwent a neurectomy completed a previously published questionnaire including preoperative pain characteristics, pain reduction (5-point Verbal Rating Scale (VRS) and percentages), functional impairment, complications, recurrence of pain and current need for pain medication.
Data of 186 women treated for chronic post-Pfannenstiel neuralgia during this 15 year time period were available. Pain reduction following tender point infiltration was successful in 24 patients (13%). In total, 134 of 144 women who underwent a neurectomy were available for follow up via the questionnaire, and 101 responded (response rate 75%). Median age was 52 years (49-54). Before operation, 87% (n = 88) suffered from (very) severe pain (median VRS of 4, range 3-5). Almost 5 years after the operation (median 57 months, range 8-189), 54% (n = 55) had no or only mild pain (p < 0.001). Two of three women reported at least >50% pain reduction and improvement of daily functioning. Eight patients (8%) experienced recurrence of pain after an initial substantial pain reduction.
A step-up approach of tender point infiltration and surgical neurectomy is an effective treatment option in the majority of women with chronic post-Pfannenstiel pain syndrome. Surgeons, gynecologists and pain specialists should consider adopting this treatment regimen for chronic post-Pfannenstiel pain due to nerve entrapment.
通过耻骨联合上横切口进行手术的患者中，高达8%可能会出现慢性腹股沟疼痛。这类疼痛常由腹股沟神经卡压引起，可能严重影响日常功能。我们报告了采用痛点浸润和手术神经切除术逐步治疗耻骨联合上横切口术后顽固性神经性腹股沟疼痛的长期经验。
一项回顾性数据库分析确定了2000年至2015年期间在单一中心因耻骨联合上横切口后髂腹下神经和/或髂腹股沟神经卡压导致神经性腹股沟疼痛的患者。接受神经切除术的患者完成了一份先前发表的问卷，内容包括术前疼痛特征、疼痛减轻情况（5分制语言评定量表（VRS）及百分比）、功能障碍、并发症、疼痛复发情况以及当前对止痛药物的需求。
在这15年期间，有186名接受慢性耻骨联合上横切口术后神经痛治疗的女性的数据可供分析。24例患者（13%）痛点浸润后疼痛减轻。在接受神经切除术的144名女性中，共有134名可通过问卷进行随访，101名作出了回应（回应率75%）。中位年龄为52岁（49 - 54岁）。术前，87%（n = 88）患有（非常）严重疼痛（VRS中位数为4，范围3 - 5）。术后近5年（中位时间57个月，范围8 - 189个月），54%（n = 55）无疼痛或仅有轻微疼痛（p < 0.001）。三分之二的女性报告疼痛减轻至少>50%且日常功能有所改善。8例患者（8%）在最初疼痛大幅减轻后出现疼痛复发。
对于大多数患有慢性耻骨联合上横切口术后疼痛综合征的女性，痛点浸润和手术神经切除术的逐步治疗方法是一种有效的治疗选择。外科医生、妇科医生和疼痛专家应考虑对因神经卡压导致的慢性耻骨联合上横切口术后疼痛采用这种治疗方案。
