髂腹下神经切除术对腹股沟疝术后慢性疼痛患者的影响

目的探讨髂腹下神经切除术对腹股沟疝修补术后慢性疼痛患者的影响。 方法收集2014年7月至2016年7月，广东省人民医院640例腹股沟疝患者的临床资料，运用腹股沟前入路行Lichtenstein无张力疝修补术，以手术日期确定是否切除髂腹下神经并将入组患者均分为试验组和对照组。试验组患者在术中接受髂腹下神经切除术，而对照组未行神经切除，2组术后治疗及护疼痛水平。 结果本组患者均顺利完成手术。术中试验组切除髂腹下神经患者348例，对照组未切除髂腹下神经患者292例。试验组的患者平均手术时间为（50±12.5）min，平均住院时间为（1.8±0.6）d；理方法相同。随访6个月后应用疼痛数字评价量表（numerical rating scale，NRS），比较2组患者的对照组平均手术时间为（49±14.3）min，平均住院时间为（1.9±0.8）d，2组在住院平均手术时间和住院时间比较，差异无统计学意义（P>0.05）。2组术后随访6个月，试验组NRS评分0分214例，1分53例，2分54例，3分25例，4分2例，5分及5分以上0例。对照组NRS评分0分93例，1分86例，2分32例，3分68例，4分9例，5分及5分以上4例。以3分为界试验组≤3分346例，>3分2例；对照组≤3分279例，>3分13例，2组以3分为界NRS评分比较，差异有统计学意义（P<0.05）。 结论髂腹下神经切除能够在不增加手术时间及住院时间的情况下，显著减少术后慢性疼痛的发生。

Influence of iliohypogastric neurectomy on postoperative chronic pain of inguinal hernia

ObjectiveTo explore the influence of iliohypogastric neurectomy on postoperative chronic pain of inguinal hernia. MethodsA retrospective study was conducted on 640 cases of inguinal hernia patients in Guangdong people's hospital between July 2014 to July 2016 who accepted randomized iliohypogastric neurectomy during Lichtenstein tension-free inguinal hernia repair. Numeric rating scale (NRS) was adopted to conduct a comparison of postoperative pain degree between patients accepting iliohypogastric neurectomy and those not. ResultsA total of 640 patients with inguinal hernia was recorded including 43 females and 597 males. 348 patients received iliohypogastric neurectomy, while the rest 292 cases did not. Based on the overall statistical analysis, the average operation time for experimental group was (50±12.5) minutes and the length of hospitalization was (1.8±0.6) days; the control group had an average operation time as (49±14.3) minutes and hospitalization time as (1.9±0.8) days. No statistical differences were observed in average operation time and length of hospitalization (P>0.05). The Postoperative follow-up time was 6 months. For patients received the neurectomy, 214 cases scored 0 point in NRS scale, 53 scored 1, 54 scored 2, 25 scored 3, 2 scored 4 and none scored 5 points or above. Comparatively, for those patients not receiving the neurectomy, 93 cases scored 0 point in NRS scale, 86 scored 1, 32 scored 2, 68 scored 3, 9 scored 4, and 4 cases reported above 5 points pain degree. No one scored 6 points or above. If 3 points was set as a mark, the amount of patients ≤3 points was 346 and only 2 above 3 points in experimental group while number of patients ≤3 points was 279 and 13 above 3 points in control group, for which a significant difference was indicated (P<0.05 for accurate chi-square test and Fisher test). ConclusionIliohypogastric neurectomy during hernia repair showed an obvious effect in reduction of NRS score and reduced chronic pain without increasing operation time and hospitalization.