Canis M, Botchorishvili R, Bourdel N, Gremeau A-S, Curinier S, Rabischong B
Department of Gynecologic Surgery, CHU Estaing, 1, place Lucie et Raymond Aubrac, 63000 Clermont-Ferrand, France.
Department of Gynecologic Surgery, CHU Estaing, 1, place Lucie et Raymond Aubrac, 63000 Clermont-Ferrand, France.
J Visc Surg. 2018 Jun;155 Suppl 1:S11-S15. doi: 10.1016/j.jviscsurg.2018.02.004. Epub 2018 May 18.
Peritoneal adhesions remain a major public health problem despite the development of laparoscopy. The rules of microsurgery must be known and followed during any pelvic surgery, even in patients who no longer have a desire for pregnancy. Anti-adhesion products are numerous. All have interest, confirmed by anatomical studies showing a smaller extent or a lesser severity of adhesions associated with their use. No studies, however, show clinical benefit in terms of improved pain or postoperative fertility. Pneumoperitoneum parameters, humidification, and lower abdominal pressure should be optimized to limit peritoneal trauma. Peri-operative corticosteroids, whose benefit has been has been demonstrated in at least one randomized trial, should be systematically used.
尽管腹腔镜技术有所发展，但腹膜粘连仍是一个重大的公共卫生问题。在任何盆腔手术中，即使是对于不再有生育意愿的患者，也必须了解并遵循显微外科手术的规则。抗粘连产品种类繁多。解剖学研究证实，所有这些产品都有一定作用，表明使用它们可使粘连范围更小或严重程度更低。然而，尚无研究表明在改善疼痛或术后生育能力方面有临床益处。应优化气腹参数、加湿和降低腹压，以减少腹膜创伤。围手术期应系统使用皮质类固醇，至少一项随机试验已证明其益处。
