Institute of Endocrine-Related Cancer, Matsunami General Hospital, Kasamatsu Gifu 501-6062, Japan.
Eur J Obstet Gynecol Reprod Biol. 2010 Apr;149(2):131-5. doi: 10.1016/j.ejogrb.2009.12.026. Epub 2010 Jan 13.
Pelvic adhesion can form as a result of inflammation, endometriosis or surgical trauma. Most surgical procedures performed by obstetrician-gynecologists are associated with pelvic adhesions that may cause subsequent serious sequelae, including small bowel obstruction, infertility, chronic pelvic pain, and difficulty in postoperative treatment, including complexity during subsequent surgical procedures. An increasing number of adhesion reduction agents, in the form of site-specific and broad-coverage barriers and solutions, are becoming available to surgical teams. The most widely studied strategies include placing synthetic barrier agents between the pelvic structures. Most of the adhesions in the barrier-treated patients develop in uncovered areas in the abdomen. This fact suggests that the application of liquid or gel anti-adhesive agents to cover all potential peritoneal lesions, together with the use of barrier agents, may reduce the formation of postoperative adhesions. This article introduces the topical choices available for adhesion prevention mentioned in preliminary clinical applications and animal models. To date there is no substantial evidence that their use reduces the incidence of postoperative adhesions. In combination with good surgical techniques, these non-barrier agents may play an important role in adhesion reduction.
盆腔粘连可由炎症、子宫内膜异位症或手术创伤引起。大多数妇产科医生进行的手术都与盆腔粘连有关，这可能导致随后的严重后遗症，包括小肠梗阻、不孕、慢性盆腔疼痛以及术后治疗困难，包括后续手术过程中的复杂性。越来越多的粘连减少剂，以特定部位和广泛覆盖的屏障和溶液的形式，正可供手术团队使用。研究最多的策略包括在盆腔结构之间放置合成屏障剂。在接受屏障治疗的患者中，大多数粘连发生在腹部未覆盖的区域。这一事实表明，应用液体或凝胶型防粘连剂覆盖所有潜在的腹膜损伤，并同时使用屏障剂，可能会减少术后粘连的形成。本文介绍了初步临床应用和动物模型中提到的用于预防粘连的局部选择。迄今为止，没有确凿的证据表明它们的使用可以降低术后粘连的发生率。这些非屏障剂与良好的手术技术相结合，可能在减少粘连方面发挥重要作用。
