Parker M C, Wilson M S, van Goor H, Moran B J, Jeekel J, Duron J-J, Menzies D, Wexner S D, Ellis H
Darent Valley Hospital, Dartford, Kent, UK.
Colorectal Dis. 2007 Oct;9 Suppl 2:66-72. doi: 10.1111/j.1463-1318.2007.01342.x.
Mounting evidence highlights that adhesions are now the most frequent complication of abdominopelvic surgery, yet many surgeons are still not aware of the extent of the problem and its serious consequences. While many patients go through life without apparent problems, adhesions are the major cause of small bowel obstruction and a leading cause of infertility and chronic pelvic pain in women. Moreover, adhesions complicate future abdominal surgery with important associated morbidity and expense and a considerable risk of mortality. Studies have shown that despite advances in surgical techniques in recent years, the burden of adhesion-related complications has not changed. Adhesiolysis remains the main treatment even though adhesions reform in most patients. Recent developments in adhesion-reduction strategies and new anti-adhesion agents do, however, offer a realistic possibility of reducing the risk of adhesions forming and potentially improving the clinical outcomes for patients and reducing the associated onward burden to healthcare systems. This paper provides a synopsis of the impact and extent of the problem of adhesions with reference to the wider literature and also consideration of the key note papers presented in this special supplement to Colorectal Disease. It considers the evidence of the risk of adhesions in colorectal surgery and the opportunities and strategies for improvement. The paper acts as a 'call for action' to colorectal surgeons to make prevention of adhesions more of a priority and importantly to inform patients of the risks associated with adhesion-related complications during the consent process.
越来越多的证据表明，粘连现已成为腹部盆腔手术最常见的并发症，但许多外科医生仍未意识到该问题的严重程度及其后果。虽然许多患者在生活中没有明显问题，但粘连是小肠梗阻的主要原因，也是女性不孕和慢性盆腔疼痛的主要原因。此外，粘连会使未来的腹部手术变得复杂，带来重要的相关发病率和费用，并存在相当大的死亡风险。研究表明，尽管近年来手术技术有所进步，但粘连相关并发症的负担并未改变。粘连松解术仍然是主要治疗方法，尽管大多数患者的粘连会复发。然而，减少粘连策略和新型抗粘连剂的最新进展确实提供了一种切实可行的可能性，即降低粘连形成的风险，并有可能改善患者的临床结局，减轻医疗系统的相关后续负担。本文结合更广泛的文献，概述了粘连问题的影响和严重程度，并对《结直肠疾病》这一特刊中发表的重点论文进行了思考。本文探讨了结直肠手术中粘连风险的证据以及改善的机会和策略。本文旨在“呼吁采取行动”，促使结直肠外科医生更加重视粘连的预防，并在知情同意过程中，重要的是告知患者与粘连相关并发症的风险。
