Department of Obstetrics and Gynecology, UZ Gasthuisberg, KULeuven, Leuven B-3000, Belgium.
J Ovarian Res. 2013 Dec 11;6(1):90. doi: 10.1186/1757-2215-6-90.
To translate the concept of full-conditioning (FC) from animal experiments to the human, and to evaluate the efficacy for adhesion prevention. FC consisted of decreasing acute inflammation by 86% CO2+ 10% N2O + 4% O2 for the pneumoperitoneum, cooling of the peritoneal cavity, humidification, heparinized rinsing solution and 5 mg of dexamethasone as demonstrated in animal models.
A randomized controlled trial (RCT: NCT01344486) comparing standard laparoscopy with full conditioning together with a barrier in a 2/3 ratio in 44 women undergoing deep endometriosis surgery at KULeuven. The primary aim was reduction of adhesions. Secondary aims were CO2 resorption, postoperative pain and recovery. Randomization was performed after signing informed consent. Adhesion scoring during second look laparoscopy and pain scoring were done blindly.
In the FC group (n = 16) adhesions were completely prevented in 12/16 women whereas in the control group (n = 11) all women had severe adhesions (P < 0.0005). Also the area, density and severity of adhesions were less. (P <0.001). In the control group, severity, density and area of adhesions were strongly interrelated (P = 0.0001 for all areas) suggesting a common enhancing factor. In the FC group CO2 resorption (P < 0.001), postoperative pain (P < 0.001), and CRP concentrations (P < 0.01) were lower while clinical recovery was faster (P < 0.0001) and time to first flatus (P < 0.002) shorter.
This translational research confirms in the human the efficacy of FC in reducing CO2 resorption and adhesions with in addition less postoperative pain, lower postoperative CRP concentrations and an accelerated recovery.
将完全条件化（FC）的概念从动物实验转化为人类，并评估其预防粘连的效果。FC 包括通过 86%CO2+10%N2O+4%O2 减少急性炎症、冷却腹腔、加湿、肝素冲洗液和 5mg 地塞米松，这在动物模型中得到了验证。
一项随机对照试验（RCT：NCT01344486）比较了标准腹腔镜手术与 FC 联合屏障在 44 名接受深部子宫内膜异位症手术的女性中的效果，比例为 2/3。主要目的是减少粘连。次要目的是 CO2 吸收、术后疼痛和恢复。在签署知情同意书后进行随机分组。在第二次腹腔镜检查时进行粘连评分，在术后进行疼痛评分，均为盲法。
在 FC 组（n=16）中，12/16 名女性的粘连完全预防，而在对照组（n=11）中，所有女性均有严重粘连（P<0.0005）。此外，粘连的面积、密度和严重程度也较低（P<0.001）。在对照组中，粘连的严重程度、密度和面积之间存在强烈的相关性（P=0.0001 用于所有区域），提示存在共同的增强因素。在 FC 组中，CO2 吸收（P<0.001）、术后疼痛（P<0.001）和 CRP 浓度（P<0.01）较低，而临床恢复更快（P<0.0001），首次排气时间（P<0.002）更短。
这项转化研究在人类中证实了 FC 减少 CO2 吸收和粘连的效果，此外还能减少术后疼痛、降低术后 CRP 浓度和加速恢复。
