小編說明：這篇CPIP（即疝術後慢性疼痛）處理國際共識，源自近期的Hernia雜誌，最為核心的地方是處理流程圖。由杭州市一院王平提供。
腹股溝疝術後慢性疼痛的處理流程（國際共識）
from:Hernia.2015V19N1:33-43
LangeJF;Kaufmann R;Wijsmuller AR;Pierie JP;Ploeg RJ;Chen DC;Amid PK
【中文摘要】
目的 普遍認為無張力腹股溝疝修補術復發率低，手術相關併發症主要是慢性疼痛，目前對其處理尚無共識指南，本研究的目的是對腹股溝疝術後慢性疼痛（chronic postoperative inguinal pain CPIP)診斷和治療設計一個基於專家共識的處理流程。
方法 邀請一組疝外科專家制定處理流程，專家們提出的每一步處理流程均通過Delphi方法進行徵詢調查，最終修訂製定一個基於專家共識的處理流程。
結果 共邀請28位國際專家加入，制定了一個CPIP的階梯式處理流程，26位專家同意將最終達成的處理流程作為共識，1位專家不同意，1位專家在期限內未表態。
結果 CPIP處理指南的制定是十分必要的。本處理流程，對CPIP病人的診斷、處理及治療可以起到指導性作用，從而改善臨床治療效果。如果在幾個月的觀察期過去後，CPIP沒有任何改善，就需要諮詢疼痛治療團隊進行多學科的處理。常見的保守治療方法有藥物、行為醫學以及介入治療，包括各種神經阻滯。如果保守治療失敗，應該考慮手術治療。根據相應指徵，實施三神經切除術，復發疝修補術（或同時行神經切除），以及補片瘤切除術。對CPIP再次手術缺乏經驗的外科醫生，應毫不猶豫將病人轉診至疝外科專科醫生處理。
關鍵詞慢性疼痛 腹股溝疝 李金斯坦 神經切除 腹股溝疝術後慢性疼痛（CPIP）
附：德爾菲法( Delphi Method)，又稱專家規定程序調查法。該方法主要是由調查者擬定調查表，按照既定程序，以函件的方式分別向專家組成員進行徵詢；而專家組成員又以匿名的方式（函件）提交意見。經過幾次反覆徵詢和反饋，專家組成員的意見逐步趨於集中，最後獲得具有很高準確率的集體判斷結果。
註：中文翻譯 王平 黃永剛（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.