腹股沟疝修补手术后慢性疼痛研究进展

doi:10.19538/j.cjps.issn1005-2208.2025.10.21

中国实用外科杂志 ›› 2025, Vol. 45 ›› Issue (10) : 1181-1185. DOI: 10.19538/j.cjps.issn1005-2208.2025.10.21

文献综述

腹股沟疝修补手术后慢性疼痛研究进展

景文潇1，刘雨辰2，王明刚2

作者信息 +

文章历史 +

摘要

腹股沟疝修补手术后慢性疼痛是临床关注的焦点之一，术后慢性疼痛的原因包括手术技术、网片使用以及病人个体差异等因素。腹腔镜手术较开放手术更有利于减少慢性疼痛的发生。同时，性别、年龄等病人因素对疼痛的感受和恢复也有重要影响。因此，采用个体化治疗策略十分重要，良好的心理治疗、药物治疗、局部麻醉阻滞以及微波消融术等均有一定积极效果，同时也可通过手术缓解改善疼痛症状。未来的研究应进一步探索术后慢性疼痛的详细机制，并开发更精确的预测模型识别高风险病人，以便实施有效的预防措施。此外，改进手术材料和技术、优化疼痛管理策略等，将对提高病人术后恢复质量和减轻疼痛症状起到关键作用。

Abstract

Chronic pain following inguinal hernia repair surgery is one of the key concerns in clinical practice. The causes of postoperative chronic pain include surgical techniques, mesh usage, and patient-related factors. Laparoscopic surgery is more effective in reducing the incidence of chronic pain compared to open surgery. Additionally, patient factors such as gender and age significantly influence pain perception and recovery. Therefore, adopting individualized treatment strategies is crucial. Approaches such as psychological therapy, pharmacological treatment, local anesthetic blocks, and microwave ablation have shown positive effects, while surgical interventions can also help alleviate pain symptoms. Future research should further explore the detailed mechanisms of postoperative chronic pain and develop more accurate predictive models to identify high-risk patients for effective preventive measures. Moreover, advancements in surgical materials and techniques, along with optimized pain management strategies, will play a crucial role in improving postoperative recovery quality and reducing pain symptoms.

导出引用

景文潇1, 刘雨辰2, 王明刚2. 腹股沟疝修补手术后慢性疼痛研究进展[J]. 中国实用外科杂志. 2025, 45(10): 1181-1185 https://doi.org/10.19538/j.cjps.issn1005-2208.2025.10.21

参考文献

［1］中华医学会外科学分会疝与腹壁外科学组，中国医师协会外科医师分会疝和腹壁外科专家工作组. 腹股沟疝诊疗指南（2024版）［J］. 中国实用外科杂志，2025，45(2):121-127. DOI:10.19538/j.cjps.issn1005-2208.2025.02.01.
［2］ Courtney CA, Duffy K, Serpell MG, et al. Outcome of patients with severe chronic pain following repair of groin hernia［J］. Br J Surg, 2002, 89(10): 1310-1314. DOI:10.1046/j.1365-2168.2002.02206.x.
［3］ Watkins LR, Milligan ED, Maier SF. Glial activation: A driving force for pathological pain ［J］. Trends Neurosci, 2001, 24(8): 450-455. DOI:10.1016/s0166-2236(00)01854-3.
［4］ Jiang W, Zhang LX, Tan XY, et al. Inflammation and histone modification in chronic pain ［J］. Front Immunol, 2023, 13: 1087648. DOI:10.3389/fimmu.2022.1087648.
［5］ Velasco E, Flores-Cortés M, Guerra-Armas J, et al. Is chronic pain caused by central sensitization? A review and critical point of view ［J］. Neurosci Biobehav Rev, 2024, 167: 105886. DOI:10.1016/j.neubiorev.2024.105886.
［6］ Ji RR, Nackley A, Huh Y, et al. Neuroinflammation and central sensitization in chronic and widespread pain ［J］. Anesthesiology, 2018, 129(2): 343-366. DOI:10.1097/aln.0000000000002130.
［7］ Cancer Genome Center. Surgical technique and chronic postoperative inguinal pain in patients undergoing open inguinal hernioplasty in portugal: A prospective multicentric cohort study ［J］. Acta Médica Portuguesa, 2024, 37(7-8): 507-517. DOI:10.20344/amp.20277.
［8］ Lillo-Albert G, Villa EB, Boscà-Robledo A, et al. Chronic inguinal pain post-hernioplasty. Laparo-endoscopic surgery vs lichtenstein repair: Systematic review and Meta-analysis ［J］. Hernia, 2024, 28(4): 1427-1439. DOI: 10.1007/s10029-024-03077-x.
［9］ Li J, Ji Z, Cheng T. Lightweight versus heavyweight in inguinal hernia repair: A Meta-analysis ［J］. Hernia, 2012, 16(5): 529-539. DOI:10.1007/s10029-012-0928-z.
［10］ Olsen MA, Nickel KB, Wallace AE, et al. Stratification of surgical site infection by operative factors and comparison of infection rates after hernia repair［J］. Infect Control Hosp Epidemiol，2014, 36(3): 329-335. DOI:10.1017/ice.2014.44.
［11］ Krauß M, Heinzel-Gutenbrunner M, Krönung L, et al. Comparing large pore lightweight mesh versus small pore heavyweight mesh in open mesh plug repair of primary and recurrent unilateral inguinal hernia: A questionnaire study for a retrospective analysis of a cohort of elective groin hernia patients using propensity score matching ［J］. Int J Surg, 2020, 75: 93-98. DOI:10.1016/j.ijsu.2020.01.130.
［12］ Sajid MS, Ladwa N, Kalra L, et al. A Meta-analysis examining the use of tacker mesh fixation versus glue mesh fixation in laparoscopic inguinal hernia repair ［J］. Am J Surg, 2013, 206(1): 103-111. DOI: 10.1016/j.amjsurg.2012.09.003.
［13］ Hu N, Xie H, Wang DC, et al. Efficacy and safety of glue mesh fixation for laparoscopic inguinal hernia: A Meta-analysis of randomized controlled trials ［J］. Asian J Surg, 2023, 46(9): 3417-3425. DOI:10.1016/j.asjsur.2023.03.146.
［14］ De Goede B, Klitsie PJ, van Kempen BJH, et al. Meta-analysis of glue versus sutured mesh fixation for Lichtenstein inguinal hernia repair ［J］. Br J Surg, 2013, 100(6): 735-742. DOI:10.1002/bjs.9072.
［15］ Kim-Fuchs C, Angst E, Vorburger S, et al. Prospective randomized trial comparing sutured with sutureless mesh fixation for Lichtenstein hernia repair: Long-term results ［J］. Hernia, 2012, 16(1): 21-27. DOI:10.1007/s10029-011-0856-3
［16］ Woo KP, Ellis RC, Maskal SM, et al. The association of permanent versus absorbable fixation on developing chronic post-herniorrhaphy groin pain in patients undergoing laparoscopic inguinal hernia repair ［J］. Surg Endosc, 2024, 38(6): 3433-3440. DOI:10.1007/s00464-024-10866-z.
［17］ Katkhouda N, Mavor E, Friedlander MH, et al. Use of fibrin sealant for prosthetic mesh fixation in laparoscopic extraperitoneal inguinal hernia repair ［J］. Ann Surg, 2001, 233(1): 18-25. DOI:10.1097/00000658-200101000-00004.
［18］ Fumagalli Romario U, Puccetti F, et al. Self-gripping mesh versus staple fixation in laparoscopic inguinal hernia repair: A prospective comparison ［J］. Surg Endosc, 2013, 27(5): 1798-1802. DOI: 10.1007/s00464-012-2683-8.
［19］ Molegraaf M, Kaufmann R, Lange J. Comparison of self-gripping mesh and sutured mesh in open inguinal hernia repair: A Meta-analysis of long-term results ［J］. Surgery, 2018, 163(2): 351-360. DOI:10.1016/j.surg.2017.08.003.
［20］ Forester B, Attaar M, Chirayil S, et al. Predictors of chronic pain after laparoscopic inguinal hernia repair ［J］. Surgery, 2021, 169(3): 586-594. DOI:10.1016/j.surg.2020.07.049.
［21］ Mogil JS. Sex differences in pain and pain inhibition: Multiple explanations of a controversial phenomenon ［J］. Nat Rev Neurosci, 2012, 13(12): 859-866. DOI:10.1038/nrn3360.
［22］ Bjurström MF, Irwin MR, Chen DC, et al. Sex differences, sleep disturbance and risk of persistent pain associated with groin hernia surgery: A nationwide register-based cohort study［J］. J Pain, 2021, 22(11): 1360-1370. DOI:10.1016/j.jpain.2021.04.008.
［23］ Langeveld HR, Klitsie P, Smedinga H, et al. Prognostic value of age for chronic postoperative inguinal pain ［J］. Hernia, 2014, 19(4): 549-555. DOI:10.1007/s10029-014-1282-0.
［24］ Olsson A, Sandblom G, Fränneby U, et al. Impact of postoperative complications on the risk for chronic groin pain after open inguinal hernia repair ［J］. Surgery, 2017, 161(2): 509-516. DOI:10.1016/j.surg.2016.08.011.
［25］ Verdú E, Ceballos D, Vilches JJ, et al. Influence of aging on peripheral nerve function and regeneration［J］. J Peripher Nerv Syst, 2000, 5(4): 191-208. DOI:10.1046/j.1529-8027.2000.00026.x.
［26］ Aasvang EK, Kehlet H. Chronic pain after childhood groin hernia repair ［J］. J Pediatr Surg, 2007, 42(8): 1403-1408. DOI:10.1016/j.jpedsurg.2007.03.042.
［27］ Miserez M, Alexandre JH, Campanelli G, et al. The European hernia society groin hernia classication: simple and easy to remember ［J］. Hernia, 2007, 11(2): 113-116. DOI:10.1007/s10029-007-0198-3.
［28］ Hoffmann H, Walther D, Bittner R, et al. Smaller inguinal hernias are independent risk factors for developing chronic postoperative inguinal pain (CPIP) ［J］. Ann Surg, 2020, 271(4): 756-764. DOI:10.1097/sla.0000000000003065.
［29］ Ergönenç T, Beyaz SG, Özocak H, et al. Persistent postherniorrhaphy pain following inguinal hernia repair: A cross-sectional study of prevalence, pain characteristics, and effects on quality of life ［J］. Int J Surg, 2017, 46: 126-132. DOI:10.1016/j.ijsu.2017.08.588.
［30］ Olsson A, Sandblom G, Franneby U, et al. Do postoperative complications correlate to chronic pain following inguinal hernia repair? A prospective cohort study from the Swedish Hernia Register ［J］. Hernia, 2021, 27(1): 21-29. DOI:10.1007/s10029-021-02545-y.
［31］ Reinpold WMJ, Nehls J, Eggert A. Nerve management and chronic pain after open inguinal hernia repair ［J］. Ann Surg, 2011, 254(1): 163-168. DOI:10.1097/SLA.0b013e31821d4a2d.
［32］ Heniford BT, Walters AL, Lincourt AE, et al. Comparison of generic versus specific quality-of-life scales for mesh hernia repairs ［J］. J Am Coll Surg, 2008, 206(4): 638-644. DOI:10.1016/j.jamcollsurg.2007.11.025.
［33］ Grimes CE, Law RS, Borgstein ES, et al. Systematic review of met and unmet need of surgical disease in rural sub-Saharan Africa ［J］. World J Surg, 2012, 36(1): 8-23. DOI:10.1007/s00268-011-1330-1.
［34］ Miller BT, Scheman J, Petro CC, et al. Psychological disorders in patients with chronic postoperative inguinal pain ［J］. Hernia, 2022, 27(1): 35-40. DOI:10.1007/s10029-022-02662-2.
［35］ Bande D, Moltó L, Pereira JA, et al. Chronic pain after groin hernia repair: pain characteristics and impact on quality of life ［J］. BMC Surgery, 2020, 20(1):147. DOI:10.1186/s12893-020-00805-9.
［36］ Andresen K, Rosenberg J. Management of chronic pain after hernia repair ［J］. J Pain Res, 2018, 11: 675-681. DOI:10.2147/jpr.S127820.
［37］ Wong AK, Ng AT. Review of ilioinguinal nerve blocks for ilioinguinal neuralgia post hernia surgery ［J］. Curr Pain Headache Rep, 2020, 24(12)：80. DOI:10.1007/s11916-020-00913-4.
［38］ Paasch C, Fiebelkorn J, De Santo G, et al. The transversus abdominis plane block may reduce chronic postoperative pain one year after TAPP ingunial hernia repair ［J］. Ann Med Surg, 2020, 55: 190-194. DOI:10.1016/j.amsu.2020.04.011.
［39］ Daniels SP, Xu HS, Hanna A, et al. Ultrasound-guided microwave ablation in the treatment of inguinal neuralgia ［J］. Skelet Radiol, 2020, 50(3): 475-483. DOI:10.1007/s00256-020-03618-2.
［40］ Taha-Mehlitz S, Taha A, Janzen A, et al. Is pain control for chronic neuropathic pain after inguinal hernia repair using endoscopic retroperitoneal neurectomy effective? A meta-analysis of 142 patients from 1995 to 2022 ［J］. Langenbecks Arch Surg, 2023, 408(1): 39. DOI:10.1007/s00423-022-02748-6.
［41］ Feng X, Fadaee N, Huynh D, et al. Risks of therapeutic versus prophylactic neurectomies ［J］. Surg Endosc, 2022, 36(9): 6809-6814. DOI:10.1007/s00464-021-08967-0.
［42］ Slooter GD, Zwaans WAR, Perquin CW, et al. Laparoscopic mesh removal for otherwise intractable inguinal pain following endoscopic hernia repair is feasible, safe and may be effective in selected patients ［J］. Surg Endosc, 2017, 32(3): 1613-1619. DOI:10.1007/s00464-017-5824-2.
［43］ Slooter CD, Perquin CW, Zwaans WA, et al. Laparoscopic mesh removal for chronic postoperative inguinal pain following endoscopic hernia repair: A cohort study on the effect on pain ［J］. Hernia, 2022, 27(1): 77-84. DOI:10.1007/s10029-022-02712-9.