小编说明：这篇CPIP（即疝术后慢性疼痛）处理国际共识，源自近期的Hernia杂志，最为核心的地方是处理流程图。由杭州市一院王平提供。
腹股沟疝术后慢性疼痛的处理流程（国际共识）
from:Hernia.2015V19N1:33-43
LangeJF;Kaufmann R;Wijsmuller AR;Pierie JP;Ploeg RJ;Chen DC;Amid PK
【中文摘要】
目的 普遍认为无张力腹股沟疝修补术复发率低，手术相关并发症主要是慢性疼痛，目前对其处理尚无共识指南，本研究的目的是对腹股沟疝术后慢性疼痛（chronic postoperative inguinal pain CPIP)诊断和治疗设计一个基于专家共识的处理流程。
方法 邀请一组疝外科专家制定处理流程，专家们提出的每一步处理流程均通过Delphi方法进行征询调查，最终修订制定一个基于专家共识的处理流程。
结果 共邀请28位国际专家加入，制定了一个CPIP的阶梯式处理流程，26位专家同意将最终达成的处理流程作为共识，1位专家不同意，1位专家在期限内未表态。
结果 CPIP处理指南的制定是十分必要的。本处理流程，对CPIP病人的诊断、处理及治疗可以起到指导性作用，从而改善临床治疗效果。如果在几个月的观察期过去后，CPIP没有任何改善，就需要咨询疼痛治疗团队进行多学科的处理。常见的保守治疗方法有药物、行为医学以及介入治疗，包括各种神经阻滞。如果保守治疗失败，应该考虑手术治疗。根据相应指征，实施三神经切除术，复发疝修补术（或同时行神经切除），以及补片瘤切除术。对CPIP再次手术缺乏经验的外科医生，应毫不犹豫将病人转诊至疝外科专科医生处理。
关键词慢性疼痛 腹股沟疝 李金斯坦 神经切除 腹股沟疝术后慢性疼痛（CPIP）
附：德尔菲法( Delphi Method)，又称专家规定程序调查法。该方法主要是由调查者拟定调查表，按照既定程序，以函件的方式分别向专家组成员进行征询；而专家组成员又以匿名的方式（函件）提交意见。经过几次反复征询和反馈，专家组成员的意见逐步趋于集中，最后获得具有很高准确率的集体判断结果。
注：中文翻译 王平 黄永刚（杭州市一疝和腹壁外科）
英文原文：
An international consensus algorithm for management of chronic postoperative inguinal pain.
[Abstract]
PURPOSE: Tension-freemesh repair of inguinal herniahas led to uniformly low recurrence rates. Morbidity associated with thisoperation is mainly related to chronic pain. No consensus guidelines exist for the management of this condition. The goal of this studyis to design an expert-basedalgorithm for diagnostic and therapeutic management of chronic inguinal postoperative pain (CPIP).
METHODS: A group ofsurgeons considered experts on inguinal hernia surgery was solicited to develop the algorithm. Consensus regarding each step of an algorithm proposed by the authors was sought bymeans of the Delphi method leading to a revised expert-based algorithm.
RESULTS: With theinput of 28 international experts,an algorithm for a stepwise approach for management of CPIP was created. 26 participantsaccepted the final algorithm asa consensus model. One participant could not agreewith the final concept. One expert did not respond during the final phase.
CONCLUSION: Thereis a need for guidelines with regard to management of CPIP. This algorithm can serve as a guide with regard to thediagnosis,management, andtreatment of these patients and improve clinical outcomes. If an expectativephase of a few months has passed without any amelioration of CPIP, amultidisciplinary approach is indicated and a pain management team should be consulted. Pharmacologic,behavioral, and interventional modalities including nerve blocks are essential.If conservative measures fail and surgery is considered, triple neurectomy,correction for recurrence with or without neurectomy, and meshoma removal ifindicated should be performed. Surgeons less experienced with remedialoperations for CPIP should not hesitate to refer their patients to dedicatedhernia surgeons.
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