Sippo W C, Gomez A C
Department of Surgery, Keller Army Hospital, West Point, New York 10996.
J Fam Pract. 1987 Dec;25(6):585-7.
Patients with a complaint of lower abdominal pain and a history of lower abdominal surgery, particularly inguinal herniorrhaphy, appendectomy, and procedures incorporating a Pfannenstiel incision, should have nerve entrapment considered in the differential diagnosis. Careful history and physical examination in conjunction with selected use of the ilioinguinal-iliohypogastric nerve block can confirm the diagnosis of nerve entrapment and preclude an unnecessary workup of these patients. Of the patients with nerve entrapment, most will experience complete relief of symptoms following serial injections and require no further treatment. The remainder will experience only temporary relief and require surgical interruption of the nerve involved. In those patients who obtain no relief from the nerve block, further workup for a source of their pain is warranted. Most of these patients were found to have a subclinical recurrence of an inguinal hernia.
主诉下腹部疼痛且有下腹部手术史，特别是腹股沟疝修补术、阑尾切除术以及采用耻骨上横切口的手术的患者，在鉴别诊断时应考虑神经卡压。仔细的病史采集和体格检查，结合选择性使用髂腹股沟-髂腹下神经阻滞，可确诊神经卡压，并避免对这些患者进行不必要的检查。在神经卡压患者中，大多数在进行系列注射后症状会完全缓解，无需进一步治疗。其余患者只会获得暂时缓解，需要对受累神经进行手术切断。对于那些神经阻滞未能缓解疼痛的患者，有必要进一步检查其疼痛来源。这些患者中的大多数被发现存在腹股沟疝的亚临床复发。
