无张力疝修补术后疼痛的临床分析

目的探讨无张力疝修补术后慢性疼痛的产生原因。方法对我院近年行腹股沟疝无张力修补术后部分病例产生慢性痛疼的原因的临床资料回顾性分析。结果研究结果表明无张力疝气修补术后疼痛发生率为9.66%;372例首次疝患者疼痛发生率为4.30%,125例复发疝患者中疼痛发生率为25.6%,复发疝术后疼痛发生率明显高于首次疝(χ2=47.95,P=0.001);Ⅰ型疝、Ⅱ型疝、Ⅲ型疝、Ⅳ型疝发生率分别为5%,6.21%,13.93%和20%,随着疝气程度的增加疼痛发生率呈现明显上升趋势,各组间直接存在明显差异(χ2=17.10,P=0.001);174例采用局部浸润麻醉患者中疼痛发生率为17.82%;323例采用硬膜外麻醉患者疼痛发生率为5.26%,局部浸润麻醉术后疼痛发生率明显高于硬膜外麻醉(χ2=20.42,P=0.001);神经切断、未保护神经、神经暴露并保护组疼痛发生率分别为13.33%,16.34%,5.28%,各组之间比较存在显著统计学差异(χ2=14.99,P=0.001);多因素分析发现疝气复发(OR=1.429,95%CI:1.150~2.057)、Ⅳ型(OR=1.889,95%CI:1.247~2.900)、局部浸润麻醉(OR=1.586,95%CI:1.184~1.832)、术后未保护神经(OR=2.197,95%CI:1.110~4.349)为疝气术后发生疼痛的独立危险因素。结论疝气复发、疝气类型、麻醉方式、手术方式均对无张力疝气修补术后疼痛的发生具有重要影响,为减少术后疼痛的发生应针对不同的类型采取不同的手术和麻醉方式。

Clinical analysis of pain after tension-free hernioplasty

Objective To investigate the causes of chronic pain after tension-free hernioplasty. Methods The clinical data of causes of chronic pain in some patients after tension-free inguinal hernia repair in our hospital in recent years were retrospectively analyzed. Results The results showed that the incidence of pain after tension-free hernioplasty was 9.66%; the incidence of pain in 372 cases with first hernia was 4.30%, while that in 125 cases with recurrent hernia was 25.6%, and the incidence of postoperative pain in patients with recurrent hernia was significantly higher than that in patients with first hernia （χ2=47.95, P=0.001）; The incidence of pain in the type I , II, III, IV hernia were 5%, 6.21%, 13.93%, 20% respectively, and with the increase of hernia degree, the incidence of pain increased obviously, and there were significant differences among each group （χ2=17.10, P=0.001）; The incidence of pain in 174 cases with local infiltration anesthesia was 17.82%, while that in 323 patients with epidural anesthesia was 5.26%, and the incidence of pain in patients after local infihration anesthesia was significantly higher than that in patients after epidural anesthesia（χ2=20.42, P=0.001）; The incidence of pain in the nerve transection group, unprotected nerve group, nerve exposure and protect group were 13.33%, 16.34%, 5.28% respectively, and there was significant difference among each group（χ2=14.99, P=0.001）;The multi factor analysis showed that the recurrence of hernia（OR=1.429, 95%CI：1.150- 2.057）, type IV（OR=1.889,95%CI：1.247-2.900）, local infiltration anesthesia（OR=1.586,95%CI： 1.184-1.832）, postoperative unprotected nerve （OR =2.197,95% CI：＇1.110-4.349） were independent risk factors for pain after tension-free hernioplasty. Conclusion The recurrence and types of hernia, anesthesia mode, operation mode has important influence on the occurrence of pain after tension-free hernioplasty, and different operation and anesthesia methods should be adopt for different types in order to reduce the occurrence of postoperative pain.