腹股沟疝无张力修补术后慢性疼痛原因分析

目的探讨腹股沟疝无张力修补术后慢性疼痛的原因。方法对我院2005年1月至2010年1月收治的548例各型腹股沟疝行无张力修补术病例的临床资料进行回顾性分析。结果共65例（11.9%）有不同程度的疼痛,其中Ⅱ度或以下疼痛为46例,Ⅲ度疼痛18例,Ⅳ度疼痛1例。中青年患者（〈48.5岁）术后疼痛发生率和疼痛程度高于高龄患者（〉48.5岁）,（P〈0.05）;复发疝再手术后疼痛发生率和疼痛程度高于首次疝手术（P〈0.01）;局部浸润麻醉手术术后疼痛发生率和疼痛程度高于椎管内麻醉（P〈0.01）;术中未保护或切断腹股沟神经的术后疼痛发生率高于术中保护腹股沟神经的患者（P〈0.01）。不同疝分型术后慢性疼痛发生率有显著性差异（P〈0.01）。性别以及是否预防性使用抗生素对术后慢性疼痛无明显影响。结论无张力疝修补术后慢性疼痛大多数与挫伤、血肿、麻醉以及神经损伤有关。术中有效麻醉、精细操作、避免钝性分离、妥善止血以及保护神经可减少术后慢性疼痛发生率以及降低疼痛程度。

Analysis of chronic pain after inguinal hernia tension-free repairs

Objective To investigate the cause of chronic pains after inguinal hernia tension-free repairs.Methods The clinical data of 548 cases with inguinal hernias undergoing tension-free procedures were analyzed retrospectively.Results 65 cases （11.9%） had chronic pains after operations,among which degree-II or Ⅰwere 46 cases,degree-III 18 cases and degrees-Ⅳ 1 cases.The ratio and severity of pains about young-middle age,recurrent hernias,under local infiltration anesthesia,and without inguinal nerves protection were more than that of older persons,first procedure,intraspinal anesthesia and with protection of inguinal nerves.The chronic pain for different type of hernias had a significant difference in the rate.There was no significant difference about gender,systemic diseases and prophylactic use of antibiotic for local pain after operation.Conclusions The local pains after tension-free procedures are mostly relative with contusion,hematoma,anesthesia and injury of nerve.The effective anesthesia,subtle procedures,avoiding blunt dissection and protection of nerve are favorable to reduce ratio of pain and lessen severity of pains after operation for inguinal hernias.