Metwally M, Watson A, Lilford R, Vandekerckhove P
Cairo University, Faculty of Medicine, Department of Obstetrics & Gynaecology, No 1, Rd 7, Maadi, Cairo, Egypt.
Cochrane Database Syst Rev. 2006 Apr 19(2):CD001298. doi: 10.1002/14651858.CD001298.pub3.
Pelvic surgery is associated with high rates of both de novo adhesion formation and adhesion reformation. Since subsequent fertility is reduced with increasing severity of periadnexal adhesions, pelvic adhesions will remain a clinical problem in infertility patients. Steroids, antihistamines and heparin were amongst the first substances to be advocated for adhesion prevention. More recently icodextrin 4%, hyaluronic acid agents and SprayGel have been used. This review aims to evaluate the role of fluid and pharmacological agents in the prevention of adhesions in fertility-conserving gynaecological surgery.
To investigate fluid and pharmacological agents for adhesion prevention when used as adjuvants during pelvic surgery.
This review has drawn on the search strategy developed for the Menstrual Disorders and Subfertility Group. The following databases were searched: the Cochrane Menstrual Disorders and Subfertility Group Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE.
Randomised controlled trials investigating the use of fluid and pharmacological agents to prevent adhesion formation after fertility-conserving gynaecological surgery.
Data extraction and analysis was performed independently by two authors (Metwally M and Watson A). Two-by-two tables were generated for dichotomous outcomes and expressed as odds ratios (OR) with 95% confidence intervals (CI). For continuous outcomes a standardised mean difference was used.
There is no evidence of benefit from the use of steroids, dextran or other pharmacological agents in any of the outcomes. The use of hyaluronic acid agents may decrease adhesion formation (OR 0.31, 95% CI 0.19 to 0.51) and prevent the deterioration of pre-existing adhesions (OR 0.28 (95% CI 0.12 to 0.66). There is insufficient evidence for the use of icodextrin 4% or SprayGel as adhesion-preventing agents. None of the studied agents has been shown to improve the pregnancy rate when used as an adjunct during pelvic surgery.
AUTHORS' CONCLUSIONS: The current evidence for the use of fluid and pharmacological agents for the prevention of adhesions is limited. There is no evidence on any benefit for improving pregnancy outcomes when pharmacological and fluid agents are used as an adjunct during pelvic surgery. There is insufficient evidence for the use of the following agents: steroids, icodextrin 4%, SprayGel and dextran in improving adhesions following surgery. There is some evidence that hyaluronic acid agents may decrease the proportion of adhesions and prevent the deterioration of pre existing adhesions. However, due to the limited number of studies available, this evidence should be interpreted with caution and further studies are needed.
盆腔手术与新发粘连形成和粘连再形成的高发生率相关。由于随着附件周围粘连严重程度的增加，后续生育能力会降低，盆腔粘连在不孕患者中仍将是一个临床问题。类固醇、抗组胺药和肝素是最早被提倡用于预防粘连的物质。最近，4%的艾考糊精、透明质酸制剂和喷雾凝胶已被使用。本综述旨在评估液体和药物制剂在保留生育功能的妇科手术中预防粘连的作用。
研究液体和药物制剂在盆腔手术中作为辅助剂预防粘连的效果。
本综述借鉴了为月经紊乱和生育力低下组制定的检索策略。检索了以下数据库：Cochrane月经紊乱和生育力低下组专业注册库、Cochrane对照试验中心注册库（CENTRAL）、MEDLINE和EMBASE。
研究液体和药物制剂用于预防保留生育功能的妇科手术后粘连形成的随机对照试验。
由两位作者（梅特瓦利M和沃森A）独立进行数据提取和分析。对于二分法结果生成二乘二表，并以比值比（OR）和95%置信区间（CI）表示。对于连续结果，使用标准化均数差。
在任何结局中，均未发现使用类固醇、右旋糖酐或其他药物制剂有获益的证据。使用透明质酸制剂可能会减少粘连形成（OR 0.31，95%CI 0.19至0.51）并防止已存在粘连的恶化（OR 0.28（95%CI 0.12至0.66）。没有足够的证据证明4%的艾考糊精或喷雾凝胶可作为粘连预防剂。在盆腔手术中作为辅助剂使用时，没有一种研究药物被证明能提高妊娠率。
目前关于使用液体和药物制剂预防粘连的证据有限。没有证据表明在盆腔手术中使用药物和液体制剂作为辅助剂对改善妊娠结局有任何益处。没有足够的证据证明以下制剂在改善术后粘连方面的作用：类固醇、4%的艾考糊精、喷雾凝胶和右旋糖酐。有一些证据表明透明质酸制剂可能会减少粘连比例并防止已存在粘连的恶化。然而，由于现有研究数量有限，应谨慎解读该证据，还需要进一步研究。
