腹股沟疝修补术术后疼痛.ppt

腹股沟疝修补术后疼痛的防治 浙江大学医学院附属邵逸夫医院麻醉科 田素明 tengtongzhongxin@163.com 概 述 腹股沟疝修补术后慢性疼痛可严重影响患者生活质量 发病率0-63%，其中10%的患者为中重度疼痛 2-5%患者生活受到严重负面影响 已成为备受关注的公共卫生问题 van Hanswijck de Jonge P, et al. The measurement of chronic pain and healthrelated quality of life following inguinal hernia repair: a review of the literature. Hernia 2008; 12: 561-569 Kehlet H, et al. Persistent postsurgical pain: risk factors and prevention. Lancet 2006; 367: 1618-1625 Poobalan AS, et al. Chronic pain and quality of life following open inguinal hernia repair. Br J Surg 2001; 88: 1122-1126 腹股沟疝修补术后慢性疼痛（Chronic Groin Pain ,Inguinodynia） 腹股沟、阴囊和会阴部疼痛 持续超过3个月；甚至数年不缓解； 药物、理疗或神经阻滞无效； ODwyer PJ, Alani A, McConnachie A. Groin hernia repair: postherniorrhaphy pain. World J Surg 2005; 29: 1062-1065 Aasvang E, Kehlet H. Surgical management of chronic pain after inguinal hernia repair. Br J Surg 2005; 92: 795-801 Merskey H, Bogduk N. Classification of chroc pain: descriptions of chronic pain syndromes and definitions of pain terms. InTask Force on Taxonomy of the IASP. 2nd ed. Seattle, WA: IASP Press, 1994: 209-214 Loos MJ, Houterman S, Scheltinga MR, Roumen RM. Evaluating postherniorrhaphy groin pain: Visual Analogue or Verbal Rating Scale? Hernia 2008; 12: 147-151 Assessment of Chronic Groin Pain 自发的沿腹股沟神经分布的钝痛或电击样痛 扭曲身体或髋关节过伸可触发疼痛 卧床休息、蜷曲身体或固定的姿势可以缓解疼痛 叩击髂前上棘前内侧或轻触压痛点可诱发神经性疼痛 可有局部感觉异常、感觉减退或缺失 Bodian CA, et al . The visual analog scale for pain: clinical significance in postoperative patients. Anesthesiology 2001; 95: 1356-1361 Hakeem A et al . Inguinodynia following Lichtenstein tension-free hernia repair. World J Gastroenterol 2011 April 14; 17(14): 1791-1796 Sexual dysfunction secondary to chronic groin pain 性生活时疼痛发生率为22.6%，其中6.7%为中重度疼痛。 ?的术后疼痛患者因为疼痛而主动避免性活动。 术后纤维化或补片与输精管接触导致的无菌性炎症会引起射精痛。 仅1.8%的患者向医生报告性活动疼痛，报告率非常低。 Ducic I, Dellon AL. Testicular pain after inguinal hernia repair: an approach to resection of the genital branch of genitofemoral nerve. J Am Coll Surg 2004; 198: 181-184 Aasvang EK, et al. E