视频腹腔镜下生殖手术后粘连的形成
Adhesion reformation after reproductive surgery by videolaseroscopy.
作者信息
Nezhat C R, Nezhat F R, Metzger D A, Luciano A A
机构信息
Fertility and Endocrinology Center, Atlanta, Georgia.
出版信息
Fertil Steril. 1990 Jun;53(6):1008-11. doi: 10.1016/s0015-0282(16)53576-6.
After initial videolaseroscopy for the treatment of endometriosis-associated infertility, 157 patients underwent a second-look laparoscopy to evaluate and treat recurrence of disease and/or adhesions. The patients were divided into two groups. Group 1 consisted of 135 patients who underwent second-look laparoscopy for persistent infertility and/or recurrence of pain. Group 2 consisted of 22 patients who achieved pregnancy after initial surgery and underwent second-look laparoscopy for evaluation of ectopic pregnancy or in association with uterine evacuation for first trimester spontaneous abortion. Both groups of patients demonstrated a significant reduction in adhesion scores involving the ovaries, tubes, posterior cul-de-sac, anterior cul-de-sac, and omentum/bowel. Although the initial mean adhesion scores were similar for both groups, at second-look laparoscopy the mean adhesion scores were significantly lower for group 2, particularly for ovarian and tubal adhesions. None of the patients formed de novo adhesions. From these results we may conclude that videolaseroscopy: (1) is effective in reducing peritoneal adhesions; (2) is associated with a low frequency of postoperative adhesion recurrence; and (3) appears to completely avoid de novo adhesion formation.
在初次采用视频腹腔镜检查法治疗子宫内膜异位症相关性不孕后,157例患者接受了二次腹腔镜检查,以评估和治疗疾病复发及/或粘连情况。患者被分为两组。第1组由135例因持续性不孕和/或疼痛复发而接受二次腹腔镜检查的患者组成。第2组由22例在初次手术后成功妊娠且因宫外孕评估或与孕早期自然流产清宫相关而接受二次腹腔镜检查的患者组成。两组患者卵巢、输卵管、后穹窿、前穹窿以及网膜/肠管的粘连评分均显著降低。尽管两组患者的初始平均粘连评分相似,但在二次腹腔镜检查时,第2组的平均粘连评分显著更低,尤其是卵巢和输卵管粘连方面。所有患者均未形成新的粘连。从这些结果我们可以得出结论:视频腹腔镜检查法:(1)在减少腹膜粘连方面有效;(2)术后粘连复发频率低;(3)似乎能完全避免新粘连的形成。