腹腔鏡疝氣手術後急性術後以及術後慢性疼痛的危險因子分析
洪肇澤、羅啟文、蔡曜州
台北慈濟醫院 外科部 泌尿科
The risk factor of acute postoperative pain and chronic postoperative in patients received TEP hernia repair: A single surgeon’s experience
Chao-Tze Hung, Chi-Wen, Lo, Yao-Chou, Tsai
Divisions of Urology, Department of Surgery, Taipei Tzu Chi Hospital,
New Taipei City, Taiwan;
Purpose: Compared with open surgery, the better recovery was reported in endoscopic hernia repair. There were still several studies published try to lessen the post operation pain and long-term chronic pain. Because of lacking clinical trial analysis the reasons of post operation pain/ chronic pain, we reported our retrospective study trying to analysis the risk of post operation pain and chronic pain.
Materials and Methods: We performed a retrospective analysis of the medical records of patients who were scheduled for laparoscopic TEP repair from March 2008 to March 2018. A total of 799 patients who received laparoscopic TEP hernia repair by Dr. YCT were reviewed. The data were collected prospective before and after operation in a commercial registery database and were analyzed with MedCalc.
Results: After excluding unsuitable data, a total of 557 patients received laparoscopic TEP repairs were reviewed and analyzed. There were no conversion happened.
The higher acute postoperative pain was related to the age (the mean VAS was 4.1089 in patients with age < 65 year old patients and 3.0191 in patient with age > 65 years old, p< 0.001), type of mesh (the mean VAS was 4.0130 in light weight group and 4.0130 in heavy weight group, p <0.001) and fixation method (3.9343 in permanent tack group and 3.1735 in glue fixation group, p< 0.001).
The incidence of chronic postoperative pain was mainly related to the mesh type (OR: 0.3292, 95% CI: 0.1556~ 0.6964, p: 0.0037) and age (OR: 0.3949, 95% CI: 0.1184~ 0.7851) but not related the method of tack fixation (OR: 11.9558, 95% CI: 9.7281~ 196.329, p: 0.0823). The incidence of chronic post operation was also not higher in patients who previous received open hernia repair with recurrence (OR: 1.6953, 95% CI: 0.8502~ 3.3805).
Conclusions: The etiology of acute postoperative pain and chronic postoperative pain maybe different form our study. The content of mesh and age maybe related both acute and chronic postoperative pain. The tack fixation method leads to higher the VAS at post operation day 1 but does not increase the risk of chronic pain. The postoperative pain scale and the incidence of chronic pain was not higher in patients who ever received open hernia repair with recurrence.