1年和3年时性行为相关疼痛：在随机对照环境下比较完全腹膜外修补术与Lichtenstein腹股沟疝修补术（TEPLICH试验）。

Pain with sexual activity at 1 and 3 years: Comparing total extraperitoneal with Lichtenstein inguinal hernia repair in a randomized setting (TEPLICH trial).

作者信息

Gutlic Allan, Rogmark Peder, Gutlic Nihad, Petersson Ulf, Montgomery Agneta

机构信息

Department of Surgery, Skåne University Hospital, University of Lund, Malmö, Sweden.

出版信息

Surgery. 2022 Nov;172(5):1463-1470. doi: 10.1016/j.surg.2022.07.013. Epub 2022 Aug 27.

DOI:10.1016/j.surg.2022.07.013

PMID:36038370

Abstract

BACKGROUND

Pain at sexual activity induced by an inguinal hernia or as a cause of its repair is not thoroughly studied. Reported frequencies are between 25% and 30% preoperatively and 10% and 15% postoperatively. The primary aim was to analyze pain at sexual activity at 1 year comparing total extraperitoneal with Lichtenstein repair in a randomized setting.

METHODS

Men, 30 to 60 years old, with a primary inguinal hernia were randomized to total extraperitoneal without mesh fixation or Lichtenstein repair. A questionnaire on pain prevalence, frequency, intensity, and impairment of sexual functions caused by pain at sexual activity was introduced. Clinical examination, a questionnaire on sexual function, and the 36-Item Short Form Survey were performed preoperatively and at 1 and 3 years postoperatively. A risk factor analysis for pain at sexual activity as performed.

RESULTS

A total of 243 patients (111 total extraperitoneal and 132 Lichtenstein) were included between 2008 and 2014; 97% remained for 1-year and 90% for 3-year analysis. Preoperative pain at sexual activity was reported in 35%, with a reduction to 5.9% in total extraperitoneal and 12.5% in Lichtenstein (P = .098) at 1 year and 7.0% in total extraperitoneal and 9.3% in Lichtenstein (P = .566) at 3 years. Quality of life preoperatively was markedly reduced in patients with pain at sexual activity but restored almost to norm levels at 1 and 3 years. New pain at sexual activity (harm) was seen in 8 patients (3.6%) at 1 year. Risk factors for having postoperative pain at sexual activity were preoperative pain and Lichtenstein technique.

CONCLUSION

Pain at sexual activity in inguinal hernia patients is more common than suspected and reduces quality of life. Repair will markedly reduce pain at sexual activity and restore quality of life in most patients without difference between techniques. Patients should be informed on a potential relation between having an inguinal hernia and sexual impairment.

摘要

背景

由腹股沟疝引起或作为其修复原因导致的性活动疼痛尚未得到充分研究。术前报告的发生率在25%至30%之间，术后为10%至15%。主要目的是在随机对照的情况下，比较完全腹膜外修补术和Lichtenstein修补术在术后1年时性活动疼痛的情况。

方法

将年龄在30至60岁的原发性腹股沟疝男性患者随机分为不使用补片固定的完全腹膜外修补组或Lichtenstein修补组。引入了一份关于性活动疼痛的患病率、频率、强度以及性功能受损情况的问卷。术前、术后1年和3年进行临床检查、性功能问卷以及36项简明健康调查。对性活动疼痛进行了危险因素分析。

结果

2008年至2014年间共纳入243例患者（111例完全腹膜外修补，132例Lichtenstein修补）；97%的患者完成了1年分析，90%的患者完成了3年分析。术前报告性活动疼痛的患者占35%，术后1年时完全腹膜外修补组降至5.9%，Lichtenstein修补组降至12.5%（P = 0.098），术后3年时完全腹膜外修补组为7.0%，Lichtenstein修补组为9.3%（P = 0.566）。术前有性活动疼痛的患者生活质量明显降低，但在术后1年和3年几乎恢复到正常水平。术后1年有8例患者（3.6%）出现新的性活动疼痛（不良影响）。术后性活动疼痛的危险因素为术前疼痛和Lichtenstein修补技术。