全腹膜外疝氣修補術（TEP）後發生嚴重腹股溝疼痛：案例報告及文獻回顧

Severe Groin Pain After Total Extraperitoneal (TEP) Laparoscopic Hernioplasty: Report of A Case And Review of Literatures

症氣修補術後，大約11%的患者可能會發生腹股溝的疼痛。我們在這裡提出一個案例，一名63歲的男性患者經歷TEP症氣修補後發生嚴重的腹股溝疼痛，並且嚴重影響了他的日常活動。疼痛的致病機理可分為神經性和非神經性。神經性疼痛可能是神經損傷或神經受到壓迫；而非神經病性疼痛，則起因於疤痕組織或漿液性腫塊引起。由於處理方式的不同，臨床上區別這兩種類型的疼痛相對重要。在某些情況下，可能有必要經由手術取出釘子，這對於預防這種情況的發生是相當重要的，可降低手術後的疼痛。術中應避免直接將釘子釘於恥骨骨膜上，並避免傷害腹股溝的神經。最重要的當然是對於神經解剖學上的透徹了解及熟練的手術技巧。

Postherniorrhaphy pain may be encountered in approximately 11% of patients following inguinal hernia surgery. Here we reported a 63 years old male patient experienced debilitating pain after TEP, which limited his daily activities. The etiopathogenesis of pain was classified into neuropathic and non-neuropathic. Neuropathic pain may be resulting from nerve injury or compression, of which non neuropathic pain coming from scar tissue or seroma formation. It is clinically importance to distinguish between these two types of pain because treatment can be different. In some cases, it may warrant return to the operating room to remove those foreign material. Prevention of this condition is of great importance and can lowers the TEP incidence of postoperative pain. It is advisable to avoid application of tacks or staples directly to the pubis periosteum, as well as avoid injury to the nerves in the groin. The last measure is certainly the most important in the prevention of postherniorrhaphy pain, involves thorough knowledge of neuroanatomy and the use of refined technique.