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首页> 外文期刊>Surgical Endoscopy >Cryoanalgesic ablation for the treatment of chronic postherniorrhaphy neuropathic pain.
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Cryoanalgesic ablation for the treatment of chronic postherniorrhaphy neuropathic pain.

机译：冷冻止痛消融治疗慢性疝气后神经性疼痛。

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BACKGROUND: Chronic postoperative pain has been reported in as many as 62.9% of patients after inguinal herniorrhaphy. Moderate to severe neuropathic pain requiring intervention develops in 2.2% to 11.9% of patients as a result of ileoinguinal and genitofemoral nerve entrapment. Cryoanalgesic ablation has been successful in treating chronic pain from craniofacial neuralgia, facet joint syndrome, and malignant pain syndromes. We report our experience using cryoanalgesic ablation for chronic ileoinguinal and genitofemoral neuralgia after inguinal herniorrhaphy. METHODS: Ten patients with ileoinguinal, genitofemoral, or combined neuralgia underwent 12 cryoanalgesic ablations between April 1996 and June 2001. These patients were referred from a multidisciplinary pain clinic, and focused low-volume nerve blocks were used to map nerve involvement preoperatively. After surgical exposure, nerves and surrounding tissues were cooled to ?70 degrees C for 3 min using the Lloyd Neurostat. Patients were seen 2 weekspostoperatively and offered monthly follow-up assessments. RESULTS: Nine men and one woman, ages 20 to 54 (mean, 42.6 years) were treated during 58 months, with a mean follow-up period of 8.2 months, for ileoinguinal (n = 4), genitofemoral (n = 1), and combined (n = 5) neuralgia. Patients reported one to five prior herniorrhaphies (mean, 1.8), experienced neuropathic pain 0 to 14 years (mean, 6.3 years), and underwent up to 3 (mean, 1.3) ablative pain procedures before referral. After cryotherapy, patients reported overall pain reduction of 0% to 100% (mean, 77.5%; median, 100%); 80% reported decreased analgesic use, and 90% reported increased physical capacity. Two patients underwent additional cryotherapy, one for incomplete relief and one for recurrent pain, both with 100% efficacy. Wound infection (n = 1) was the only complication. CONCLUSIONS: Cryoanalgesic ablation successfully eliminates ileoinguinal and genitofemoral neuralgia in most patients, and should be considered early in the treatment of patients with postherniorrhaphy neuropathic pain.
机译：背景：腹股沟疝气术后有高达62.9％的患者发生了慢性术后疼痛。回肠和生殖器股神经夹带导致中度至重度神经性疼痛，需要干预的患者占2.2％至11.9％。冷冻镇痛消融已成功治疗了颅面神经痛，小关节综合征和恶性疼痛综合征等慢性疼痛。我们报告了使用腹股沟疝气治疗慢性回肠和生殖器股神经痛的冷冻镇痛消融的经验。方法：1996年4月至2001年6月之间，对10例回肠，股腓或神经痛合并神经痛的患者进行了12次冷冻镇痛消融。这些患者从多学科疼痛诊所转诊，并采用聚焦小体积神经阻滞术前绘制了神经受累情况。手术暴露后，使用Lloyd Neurostat将神经和周围组织冷却至约70摄氏度3分钟。术后2周对患者进行了观察，并提供每月的随访评估。结果：9例男性和1例女性，年龄20至54岁（平均42.6岁），在58个月内接受了治疗，平均随访时间为8.2个月，其中回肠股沟（n = 4），股骨股骨（n = 1），并合并（n = 5）神经痛。患者报告有1-5例先天性疝气（平均1.8），经历过0至14年的神经性疼痛（平均6.3年），并且在转诊前经历了3次（平均1.3）消融性疼痛手术。冷冻治疗后，患者报告总体疼痛减轻了0％至100％（平均值为77.5％;中位数为100％）; 80％的人报告了止痛药的使用减少，而90％的人报告了身体容量的增加。两名患者接受了额外的冷冻治疗，一名患者获得完全缓解，另一名患者复发疼痛，均具有100％的疗效。唯一的并发症是伤口感染（n = 1）。结论：冷冻镇痛消融术可以成功消除大多数患者的回肠和股骨神经痛，因此应在治疗带状疱疹后神经性疼痛的患者中早期考虑。

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