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急性和慢性术后腹股沟疼痛（CPIP）的预防和治疗——疼痛与压迫性神经病变的关联

Prophylaxis and treatment of acute and chronic postoperative inguinal pain (CPIP)-association of pain with compression neuropathy.

作者信息

Holzheimer René Gordon, Gaschütz Nikolai

机构信息

Surgeon/Sportsmedicine - Chirurgische Tagesklinik Sauerlach/München - Ludwig-Maximilians-Universität München Germany - Sant Anna Klinik Meran Italy.

General Practitioner D-97500 Ebelsbach.

出版信息

J Surg Case Rep. 2020 Jul 14;2020(7):rjaa143. doi: 10.1093/jscr/rjaa143. eCollection 2020 Jul.

DOI:10.1093/jscr/rjaa143
PMID:32699595
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7365039/
Abstract

Can open inguinal hernia repair (OIHR) and tailored neurectomy (TN) be effective for prophylaxis of chronic postoperative inguinal hernia repair (CPIP) (I) and treatment of CPIP (II)? Patients with symptomatic primary inguinal hernia (I group 1) and secondary hernia with CPIP (II, groups 2-5) were investigated for postoperative complications and nerve damage. About, 98% of patients with OIHR with TN reported preoperative pain (I group 1,  = 388, recurrence rate 1%). There were 73 cases (II) of CPIP after laparoscopic inguinal hernia repair (LIHR) (group 2,  = 22), OIHR (group 3,  = 37), LIHR followed by OIHR/LIHR (group 4,  = 5) and OIHR followed by LIHR/OIHR (group 5,  = 9). The results were as follows: preoperative pain: 33-100%, recurrence rate 0-11% (II, groups 2-5), nerve damage 92-100% and persistent CPIP:  = 1 after trocar perforation of inguinal nerve elsewhere. OIHR is effective to avoid CPIP with compression neuropathy. This is the largest series of histological nerve damage in CPIP.

摘要

开放式腹股沟疝修补术（OIHR）和定制神经切除术（TN）对预防慢性术后腹股沟疝修补术（CPIP）（I）和治疗CPIP（II）是否有效？对有症状的原发性腹股沟疝患者（I组1）和患有CPIP的继发性疝患者（II，2 - 5组）进行术后并发症和神经损伤调查。约98%接受OIHR联合TN的患者术前有疼痛（I组1，n = 388，复发率1%）。腹腔镜腹股沟疝修补术（LIHR）后有73例CPIP（II）（2组，n = 22），OIHR后（3组，n = 37），LIHR后行OIHR/LIHR（4组，n = 5）以及OIHR后行LIHR/OIHR（5组，n = 9）。结果如下：术前疼痛：33% - 100%，复发率0% - 11%（II，2 - 5组），神经损伤92% - 100%，持续性CPIP：腹股沟神经在其他部位经套管针穿刺后n = 1。OIHR对于避免CPIP伴压迫性神经病变有效。这是CPIP中最大系列的组织学神经损伤研究。