Department of Surgery, Kumamoto Regional Medical Center, 5-16-10 Honjo, Kumamoto, 860-0811, Japan.
Surg Today. 2012 Sep;42(9):863-7. doi: 10.1007/s00595-012-0191-z. Epub 2012 May 16.
Hyaluronate carboxymethylcellulose-based bioresorbable membrane (HC membrane; Seprafilm(®)) is used to prevent postoperative adhesion. We conducted this study to assess the effectiveness of the HC membrane in reducing the severity of adhesions in patients undergoing unplanned re-laparotomy.
Between February, 2002 and December, 2010, 123 patients underwent abdominal surgery followed by a re-laparotomy in Kumamoto Regional Medical Center. The HC membrane was placed under the first abdominal incision in 60 patients (HC membrane group), whereas it was not used in the other 63 patients (control group). We compared the medical and operative records of these two groups.
At the second laparotomy, adhesion under the incision was severe in many of the control group patients, but was significantly reduced in the HC membrane group. Postoperative small-bowel obstruction was significantly less frequent in the HC membrane group. According to univariate analysis of the risk factors for adhesion, prolonged operation time, blood loss, and not using an HC membrane were significantly associated with severe adhesion. Multivariate analysis revealed that only not using the HC membrane was significant.
The HC membrane effectively reduces the severity of wound adhesion, making unplanned repeated laparotomy safer.
透明质酸羧甲基纤维素基生物可吸收膜（HC 膜；Seprafilm(®)）用于预防术后粘连。我们进行这项研究是为了评估 HC 膜在减轻计划外再次剖腹手术患者粘连严重程度方面的有效性。
2002 年 2 月至 2010 年 12 月，123 例患者在熊本地区医疗中心接受腹部手术后再次行剖腹术。60 例患者（HC 膜组）在首次腹部切口下放置 HC 膜，而另外 63 例患者（对照组）未使用 HC 膜。我们比较了这两组的医疗和手术记录。
在第二次剖腹术中，对照组患者的切口下粘连严重，但在 HC 膜组中明显减轻。HC 膜组术后小肠梗阻的发生率明显较低。对粘连的危险因素进行单因素分析显示，手术时间延长、出血量和不使用 HC 膜与严重粘连显著相关。多因素分析显示，只有不使用 HC 膜是显著的。
HC 膜可有效减轻伤口粘连的严重程度，使计划外重复剖腹术更安全。
