腹腔镜腹股沟疝术后慢性疼痛预防的研究进展

Prevention of Chronic Pain after Laparoscopic Inguinal Hernia Repair:A Review

摘要: 腹腔镜腹股沟疝修补术(Laparoscopic Inguinal Hernia Repair, LIHR)是一种操作创伤小、术后恢复快、复发率较低的手术方式，已成为腹股沟疝的主流手术方式之一。然而，术后慢性疼痛(Chronic Post-Inguinal Pain, CPIP)作为一种常见的严重并发症，持续困扰着部分患者，其发生率在国内外文献中报道不一，严重影响患者的生活质量。本文主要总结目前LIHR术后慢性疼痛的发生情况、预防手段等研究结果，探讨最新的研究进展，并针对LIHR术后慢性疼痛的预防进行叙述性综述与分析。研究发现，有效的预防需要从多维度综合实施，包括术前的患者风险评估、术中的精细化神经保护操作、补片类型和固定方式的优化，以及围手术期多模式镇痛管理。目前临床的预防手段已经从单一的术后的止痛转变为术前预防为主、整体治疗为辅、预后更优为主的综合性的预防。未来还需通过高质量多中心研究解决争议，根据患者的个体差异来寻找最合适的预防措施，尽可能避免术后慢性疼痛的发生。

Abstract: Background: Laparoscopic Inguinal Hernia Repair (LIHR) has become a mainstream surgical procedure for inguinal hernia due to its minimal invasiveness, rapid recovery, and low recurrence rate. However, chronic postoperative inguinal pain (CPIP) remains a common and challenging complication that can significantly impair patients' quality of life. The reported incidence of CPIP varies across the literature, necessitating effective prevention strategies. Objective: This article aims to summarize current research findings regarding the incidence of CPIP following LIHR and provides a narrative review of preventive measures. Results: Current evidence suggests that effective prevention requires a comprehensive, multidimensional approach. Key strategies include preoperative risk assessment, refined intraoperative nerve protection techniques, optimization of mesh selection and fixation methods, and perioperative multimodal analgesia. The clinical paradigm is shifting from simple postoperative pain management to a proactive, prevention-oriented strategy that integrates preoperative planning with holistic perioperative care. Conclusion: Future efforts should prioritize high-quality, multi-center studies to resolve existing controversies regarding mesh selection and fixation. The ultimate goal is to develop individualized preventive protocols tailored to patient-specific risk factors, thereby minimizing the incidence of CPIP.