疝修补术后慢性疼痛的临床特征和诊断治疗

doi:10.3969/j.issn.1005-6483.2019.09.007

摘要/Abstract

摘要： 目的:观察疝修补术后慢性疼痛病人的临床特征，完善其临床诊断及治疗分析。方法:回顾性分析2014年1月～2019年6月期间，疝修补（包括腹股沟疝、切口疝疾病）术后≥3个月，术区及手术周围（包括下肢，腰部，扩展至颈部等肢体区域）疼痛就诊治疗的病人47例，影像学检查后进行精神心理学分析治疗，观察其临床特征，完善相关临床诊断和进一步分析处理。结果:47例病人中，影像学检查发现股骨头坏死1例，前列腺癌耻骨转移1例，感染1例，其余病人均被诊断心因性疼痛。其中25例病人诊断攻击（控制）人格冲突（男性19人，女性6人），12例病人诊断依赖人格冲突（男性6人，女性6人），4例病人诊断孤独人格冲突（男性4人）。3例病人（男性2人，女性1人）拒绝接受访谈分析治疗。11例病人访谈后予以抗焦虑及抑郁药物治疗，再次自行于门诊复诊，主诉疼痛缓解，30例病人接受1次访谈后失联，3例病人仍反复门诊就诊并诉慢性疼痛持续无缓解， 1例病人先后接受过3次手术治疗，每次术后均表现疼痛立刻缓解，但3个月后疼痛均再次复发及加重。1例病人右侧腹腔镜完全腹膜外疝修补术（TEP）后发生疼痛，再次因左侧腹股沟疝行腹腔镜经腹腹膜前疝修补术（TAPP）治疗，术后病人疼痛加重导致医患纠纷。结论:疝修补术后慢性疼痛绝大多数属于心因性疼痛，躯体化症状多样化，正确认识心因性疼痛的本质并结合抗焦虑抑郁治疗，有助于疝修补术后慢性心因性疼痛的治疗和缓解。

关键词: 慢性疼痛, 心因性疼痛, 疝修补术, 焦虑, 抑郁, 睡眠障碍

Abstract: Objective:To observe the clinical features of patients with chronic pain after hernia repair，and to improve their clinical diagnosis and treatment analysis.Methods:A retrospective analysis was implemented from January 2014 to June 2019，and 47 patients of more than 3 months after hernia repair（including inguinal hernia and incisional hernia）still complained pain in surgery area and surgery around（including lower limbs，waist，expanded to the neck and other limb areas）in the outpatient clinic.All patients were treated and analyzed with Consultationliaison psychiatry research，in order to observe the clinical characteristics of patients and improve the relevant clinical diagnosis，further analysis and treatment.Results:Of the 47 patients，1 case of femoral head necrosis patient，1 case of pubic metastasis of prostate cancer patient，and 1 case of infectious patient were diagnosed by imaging diagnosis.The rest were diagnosed with "psychogenic pain".Among them，25 patients were diagnosed with “aggressive（control）personality conflict”（including 19 males and 6 females），12 patients were diagnosed with “dependednt personality conflicts”（including 6 males and 6 females），and 4 patients were diagnosed with “lonely personality conflicts”（including 4 males）.3 patients（2 males and 1 female）refused to be interview treatment.11 patients were treated with antianxiety and antidepression drugs，and they were again referred to the outpatient clinic with pain relief.30 patients lost contact after one interview treatment.3 patients still had repeated outpatient visits and complained that chronic pain persisted without relief.One patient had received three surgical treatments，and the pain was relieved immediately after each operation，but the pain recurred and aggravated after 3 months of surgery.One patient developed pain after TEP for the right inguinal hernia，and was again treated with TAPP for the left inguinal hernia.The postoperative aggravated pain in the patient caused a medical dispute.Conclusion:Patients with chronic psychogenic pain after hernia repair had different degrees of anxiety and depression，and the somatization were diverse.Correct understanding of the nature of psychogenic pain combined with antianxiety and depression treatment can 〖LM〗contribute to treating and improving the chronic psychogenic pain after hernia repair.

Key words: chronic pain, psychogenic pain, hernia repair, anxiety, depression, somnipathy

罗文, 段鑫, 柯文杰等. 疝修补术后慢性疼痛的临床特征和诊断治疗[J]. 临床外科杂志, 2019, 27(9): 748-750.

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