不同腹股沟疝修补术式术后慢性疼痛的比较及风险预测模型构建-现代医学

不同腹股沟疝修补术式术后慢性疼痛的比较及风险预测模型构建

单位：1. 南京市中心医院普外科, 江苏南京 210018;
2. 南京市中心医院护理部, 江苏南京 210018

分类号：R656.21;R441.1

出版年·卷·期（页码）：2026·54·第二期（288-295）

摘要：

目的： 比较腹股沟疝患者经腹腔腹膜前修补术(TAPP)与Lichtenstein术的术后疼痛轨迹，分析腹股沟疝修补式术术后慢性疼痛(CPIP)的相关因素，并构建及验证风险预测模型。方法： 选取2021年8月至2024年12月于南京市中心医院收治的340例腹股沟疝修补术后患者作为研究对象，其中TAPP组185例，Lichtenstein组155例。采用单因素及多因素Logistic回归分析慢性疼痛的影响因素，利用Hosmer-Lemeshow(H-L检验)及接受者操作特性(ROC)曲线构建风险预测模型并进行验证，通过动态VAS评分比较两组患者疼痛轨迹，并基于模型计算风险分层。结果： 术后3个月CPIP发生率为8.2%(28/340)。TAPP组在术后24 h及7 d的VAS评分[(4.5±1.2)分 vs. (5.2±1.5)分；(2.8±0.9)分 vs. (3.2±1.0)分]均显著低于Lichtenstein组(均P<0.001)。多因素分析显示，与CPIP显著相关的因素包括：年龄<55岁(OR=2.981,95%CI 1.376～6.458)、BMI≥28 kg·m^-2(OR=2.670,95%CI 1.180～6.041)、Lichtenstein手术(OR=2.450,95%CI 1.137～5.279)、术前疝源性疼痛史(OR=2.319,95%CI 1.043～5.155)、术后急性疼痛(VAS≥4)(OR=2.223,95%CI 1.013～4.879)。基于上述因素所构建的预测模型区分度良好(AUC=0.791，95%CI 0.690～0.869)。风险分层显示，携带相关因素的数量与预测风险呈正相关(0～5个因素对应的风险分别为2%、3%、9%、20%、38%、60%)。结论： Lichtenstein手术、年龄<55岁、BMI≥28 kg·m^-2、术前疼痛史及术后急性疼痛与CPIP显著相关，基于此构建的模型能有效量化风险并识别高危患者，为围手术期个体化疼痛管理提供依据。

Objective: To compare the postoperative pain trajectories between transabdominal preperitoneal prosthetic repair(TAPP) and Lichtenstein repair, analyze factors associated with chronic postoperative inguinal pain(CPIP), and develop and validate a risk prediction model. Methods: A total of 340 patients who underwent inguinal hernia repair in Nanjing Central Hospital from August 2021 to December 2024 were enrolled in this study, including 185 cases in the TAPP group and 155 cases in the Lichtenstein group. Univariate and multivariate Logistic regression analyses were used to screen for factors influencing chronic pain. A risk prediction model was constructed based on these factors and validated using the Hosmer-Lemeshow(H-L) test and receiver operating characteristic(ROC) curve analysis. Pain trajectories between the two groups were compared using dynamic Visual Analogue Scale(VAS) scores, and risk stratification was calculated based on the model. Results: The incidence of CPIP at 3 months postoperatively was 8.2%(28/340). VAS scores in the TAPP group were significantly lower than those in the Lichtenstein group at both 24 hours[(4.5±1.2) scores vs. (5.2±1.5) scores] and 7 days[(2.8±0.9)scores vs. (3.2±1.0)scores] postoperatively(all P<0.001). Multivariate analysis revealed that factors significantly associated with CPIP included: age <55 years(OR=2.981,95%CI 1.376-6.458), BMI ≥28 kg·m^-2(OR=2.670,95%CI 1.180-6.041), Lichtenstein repair(OR=2.450,95%CI 1.137-5.279), preoperative hernia-related pain history(OR=2.319,95%CI 1.043-5.155), and postoperative acute pain(VAS≥4)(OR=2.223,95%CI 1.013-4.879)(all P<0.05). The prediction model constructed based on these factors demonstrated good discriminatory ability(AUC=0.791, 95%CI 0.690-0.869). Risk stratification showed that the number of associated factors carried was positively correlated with the predicted risk(corresponding risks for 0 to 5 factors: 2%, 3%, 9%, 20%, 38%, and 60%, respectively). Conclusion: Lichtenstein repair, age <55 years, BMI ≥28 kg·m^-2, preoperative pain history, and postoperative acute pain are significantly associated with CPIP. The model developed based on these factors can effectively quantify individual risk and identify high-risk patients, providing a basis for individualized perioperative pain management.

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