Kinoshita Shoichi, Ohyama Takao, Kawaguchi Chihiro, Ikeda Naoya, Sho Masayuki
Department of Surgery, Heisei Memorial Hospital, Kashihara, Japan.
Department of Surgery, Nara Medical University, Kashihara, Japan.
Asian J Endosc Surg. 2021 Jan;14(1):63-69. doi: 10.1111/ases.12813. Epub 2020 May 28.
Laparoscopic inguinal hernia repair is reported to be associated with lower postoperative pain than open repair. However, in the actual clinical setting, some patients experience relatively severe pain. This study aimed to elucidate surgical factors that affect pain after transabdominal preperitoneal (TAPP) repair.
We evaluated 199 patients who underwent elective TAPP for inguinal hernia from 2014 to 2019 in Heisei Memorial Hospital. The umbilical trocar size was changed from 12 to 5 mm from October 2017. The pneumoperitoneum intra-abdominal pressure was changed from 10 to 8 mmHg from 2019. Postoperative pain scores and analgesics were compared between patients who were grouped according to trocar size and intra-abdominal pressure, as well as 80 patients who received open repair.
Patients with a 12 mm trocar had significantly higher pain than open repair patients (P < .0001). Patients with a 5 mm umbilical trocar and 8 mm Hg intra-abdominal pressure had significantly lower pain than a 12 mm trocar (P = .025) and did not significantly differ with pain after open repair. Analgesic use significantly decreased in patients using a 5 mm trocar than 12 mm (P = .002).
Umbilical trocar size and pneumoperitoneum intra-abdominal pressure were significantly associated with post-TAPP pain. Using a 5 mm umbilical trocar and 8 mm Hg intra-abdominal pressure achieved pain levels as comparatively low as open repair.
据报道，腹腔镜腹股沟疝修补术术后疼痛比开放修补术轻。然而，在实际临床环境中，一些患者仍会经历相对严重的疼痛。本研究旨在阐明经腹腹膜前修补术（TAPP）后影响疼痛的手术因素。
我们评估了2014年至2019年在平成纪念医院接受择期TAPP治疗腹股沟疝的199例患者。2017年10月起，脐部套管针尺寸从12毫米改为5毫米。2019年起，气腹腹腔内压力从10毫米汞柱改为8毫米汞柱。比较了根据套管针尺寸和腹腔内压力分组的患者以及80例接受开放修补术患者的术后疼痛评分和镇痛药使用情况。
使用12毫米套管针的患者疼痛明显高于开放修补术患者（P＜0.0001）。使用5毫米脐部套管针且腹腔内压力为8毫米汞柱的患者疼痛明显低于使用12毫米套管针的患者（P = 0.025），且与开放修补术后疼痛无显著差异。使用5毫米套管针的患者镇痛药使用量比使用12毫米套管针的患者明显减少（P = 0.002）。
脐部套管针尺寸和气腹腹腔内压力与TAPP术后疼痛显著相关。使用5毫米脐部套管针和8毫米汞柱腹腔内压力可使疼痛程度与开放修补术相当低。
