Al-Jaroudi Dania, Tulandi Togas
McGill University, Montreal, Quebec, Canada.
Obstet Gynecol Surv. 2004 May;59(5):360-7. doi: 10.1097/00006254-200405000-00024.
The objectives of this study are to evaluate the magnitude of postsurgical adhesions clinically, their impact on the hospital budget, and the available adhesion-reducing substances. We conducted a review of relevant literature on intraabdominal adhesion, adhesion-reducing substances, and their related cost. The relevance of adhesions to gynecology not only relates to infertility and abdominal pain, but also to the occurrence of bowel obstruction. There have been many substances and materials used to decrease the adhesion formation. However, there is still no adhesion-reducing substance that is unequivocally effective. Its use is also costly. The most common cause of small-bowel obstruction is postsurgical adhesions. Indeed, more than one half of patients with adhesion-related small-bowel obstruction had previous gynecologic operations, and a high percentage occurs after abdominal hysterectomy. To date, there has been no study suggesting that the use of adhesion-reducing substances decreases the risk of bowel obstruction or the long-term costs to the healthcare system. The long-awaited substance or barrier that unequivocally prevents adhesion formation is yet to come.
Obstetricians & Gynecologists, Family Physicians.
After completion of this article, the reader should be able to list the causes of small bowel obstruction, to describe the commercially available adhesion-reducing substances, and to compare the efficacy of the various adhesion-reducing substances.
本研究的目的是从临床角度评估术后粘连的程度、其对医院预算的影响以及现有的减少粘连的物质。我们对有关腹腔内粘连、减少粘连的物质及其相关成本的相关文献进行了综述。粘连与妇科的相关性不仅涉及不孕症和腹痛，还涉及肠梗阻的发生。已经有许多物质和材料用于减少粘连的形成。然而，仍然没有一种明确有效的减少粘连的物质。其使用成本也很高。小肠梗阻最常见的原因是术后粘连。事实上，超过一半的粘连相关小肠梗阻患者曾接受过妇科手术，且很大比例发生在腹式子宫切除术后。迄今为止，尚无研究表明使用减少粘连的物质可降低肠梗阻风险或医疗系统的长期成本。人们期待已久的能明确防止粘连形成的物质或屏障尚未出现。
产科医生和妇科医生、家庭医生。
阅读本文后，读者应能够列出小肠梗阻的原因，描述市面上可获得的减少粘连的物质，并比较各种减少粘连物质的疗效。
