Department of Radiology, NYU Langone Heath, 660 First Avenue, New York, NY, 10016, USA.
Department of Radiology, New York Presbyterian Hospital-Weill Cornell Medical Center, 525 East 68th Street, Box 141, New York, NY, 10065, USA.
Skeletal Radiol. 2021 Mar;50(3):475-483. doi: 10.1007/s00256-020-03618-2. Epub 2020 Sep 30.
Chronic groin pain can be due to a variety of causes and is the most common complication of inguinal hernia repair surgery. The etiology of pain after inguinal hernia repair surgery is often multifactorial though injury to or scarring around the nerves in the operative region, namely the ilioinguinal nerve, genital branch of the genitofemoral nerve, and the iliohypogastric nerve, is thought to be a key factor in causing chronic post-operative hernia pain or inguinal neuralgia. Inguinal neuralgia is difficult to treat and requires a multidisciplinary approach. Radiologists play a key role in the management of these patients by providing accurate image-guided injections to alleviate patient symptoms and identify the pain generator. Recently, ultrasound-guided microwave ablation has emerged as a safe technique, capable of providing durable pain relief in the majority of patients with this difficult to treat condition. The objectives of this paper are to review the complex nerve anatomy of the groin, discuss diagnostic ultrasound-guided nerve injection and patient selection for nerve ablation, and illustrate the microwave ablation technique used at our institution.
慢性腹股沟疼痛可能由多种原因引起，是腹股沟疝修补术后最常见的并发症。尽管手术区域的神经（即髂腹股沟神经、生殖股神经的生殖支和髂腹下神经）损伤或瘢痕形成被认为是导致慢性术后疝痛或腹股沟神经痛的关键因素，但腹股沟疝修补术后疼痛的病因往往是多因素的。腹股沟神经痛难以治疗，需要多学科方法。放射科医生通过提供准确的图像引导注射来缓解患者症状并确定疼痛源，在这些患者的治疗中发挥着关键作用。最近，超声引导下微波消融作为一种安全的技术出现，能够为大多数这种难以治疗的疾病患者提供持久的疼痛缓解。本文的目的是复习腹股沟区复杂的神经解剖结构，讨论超声引导下神经注射的诊断和神经消融的患者选择，并介绍我们机构使用的微波消融技术。
