聚丙烯带网塞补片无张力修补腹股沟疝后腹壁力学和疼痛变化  

Changes of abdominal wall mechanics and pain after tension-free inguinal hernia repair with polypropylene mesh

作　　者：立全晰[1] 沈宇 万伟 孙善志[2] Li Quanxi;Shen Yu;Wan Wei;Sun Shanzhi(Department of Hepatobiliary Surgery,Second People’s Hospital of Lianyungang,Lianyungang 222023,Jiangsu Province,China;Information Center,Second People’s Hospital of Lianyungang,Lianyungang 222023,Jiangsu Province,China)

机构地区：[1]连云港市第二人民医院肝胆外科,江苏省连云港市222023 [2]连云港市第二人民医院信息中心,江苏省连云港市222023

出　　处：《中国组织工程研究》2021年第4期548-552,共5页Chinese Journal of Tissue Engineering Research

摘　　要：背景:腹股沟疝无张力修补后慢性疼痛是常见的术后并发症,引起慢性疼痛的重要原因是神经受累及。目的:观察髂腹下神经前置对于腹股沟疝修补术后慢性疼痛的影响,分析其力学等原理。方法:选择连云港市第二人民医院2013年8月至2016年11月收治的76例男性腹股沟疝患者,年龄36-95岁,均接受大号聚丙烯不可吸收带网塞补片植入治疗,术中将髂腹下神经置于补片前方,术后3,6,12个月随访疼痛情况。研究经连云港市第二人民医院伦理委员会批准。结果与结论:①76例患者术后3,6,12个月时均无慢性疼痛发生,无复发病例;②腹压力作用于腹壁形成包括垂直压力和切线压力,对腹壁及人工修补材料形成直接作用力,亦是导致神经和补片形成相对力学关系的基本原因;③结果表明,髂腹下神经前置在腹股沟疝无张力修补中能降低术后慢性疼痛的发生率,其与术后腹压对组织修复尤其是补片周围组织修复或许有关。BACKGROUND:Chronic pain after tension-free inguinal hernia repair is a common postoperative complication.An important cause of chronic pain is nerve injury.OBJECTIVE:To observe the effect of iliohypogastric nerve preposition on chronic pain after inguinal hernia repair and analyze its mechanics.METHODS:Totally 76 male inguinal hernia patients,from August 2013 to November 2016,aged 36-95 years in Second People’s Hospital of Lianyungang were selected.The patients were all treated with large-size polypropylene non-absorbable mesh insertion.The iliohypogastric nerve was placed in front of the mesh.Pain was followed up at 3,6,and 12 months after operation.This study was approved by the Ethics Committee of Second People’s Hospital of Lianyungang.RESULTS AND CONCLUSION:(1)No chronic pain or recurrence was found in the 76 patients at 3,6 and 12 months after surgery.(2)The pressure included vertical pressure and tangent pressure formed from intra-abdominal pressure on abdominal wall,directly affecting abdominal wall and artificial repair materials.This was the basic cause of the relative mechanical relationship between nerve and mesh.(3)The results showed that the tension-free inguinal hernia repair with the iliohypogastric nerve preposition could reduce the incidence of postoperative chronic pain,which may be related to the effect of postoperative abdominal pressure on tissue repair,especially the repair around the mesh.

关 键 词：材料 聚丙烯补片 腹股沟疝 髂腹下神经 疝无张力修补术 术后慢性疼痛 腹压力 

分 类 号：R459.9[医药卫生—治疗学] R318.08[医药卫生—临床医学]