Department of Obstetrics and Gynecology, 12 Bayit Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, 91031, Jerusalem, Israel.
Department of Nursing, Jerusalem College of Technology, Jerusalem, Israel.
Arch Gynecol Obstet. 2020 Jul;302(1):101-108. doi: 10.1007/s00404-020-05591-6. Epub 2020 May 15.
We aimed to evaluate the effect of an absorbable adhesion barrier (oxidized regenerated cellulose) for the prevention of peritoneal adhesions in women undergoing repeat cesarean delivery (CD).
This is a retrospective, single center study that included all women who underwent two consecutive CDs, 2011-2018. Women in whom an absorbable adhesion barrier (oxidized regenerated cellulose) was placed at the time of the initial CD (index CD) were compared to women in whom no such barrier was placed. The association between absorbable adhesion barrier placement at index CD and the presence of intraperitoneal adhesions at subsequent CD was assessed. Factors evaluated included intraperitoneal adhesion severity, time from skin incision to newborn delivery and total duration of surgery.
We identified 2125 women that met the inclusion criteria. They were divided into two groups; those in whom an absorbable adhesion barrier was placed at index CD and those in whom no such absorbable barrier was placed. 161 (7.6%) had an absorbable adhesion barrier placed at index CD. At the time of index CD, the rate of intra-peritoneal adhesions was 34.8% in the absorbable adhesion barrier group vs 26.5% in the group without the absorbable adhesion barrier (p = 0.02). At the time of subsequent CD, the rate of intraperitoneal adhesions was 39.8% in the absorbable adhesion barrier group vs 46% in the group without the absorbable adhesion barrier (p = 0.13). Notably, the use of an absorbable adhesion barrier lowered the mean increase in adhesions rate 0.05 ± 0.55 vs 0.20 ± 0.55 (p < 0.01). Absorbable adhesion barrier placement at index CD was found to be independently associated with a lower rate of intraperitoneal adhesions at subsequent CD, aOR 0.67 (0.47-0.96). Overall, absorbable adhesion barrier placement at index CD was associated with a shorter mean duration of subsequent surgery (min), 37.7 ± 18.9 vs. 42.7 ± 27.1 (p = 0.02).
Absorbable adhesion barrier placement is associated with reduction in intraperitoneal adhesions and duration of surgery in subsequent CD.
我们旨在评估可吸收粘连屏障（氧化再生纤维素）在预防行重复剖宫产术（CD）的女性发生腹膜粘连中的作用。
这是一项回顾性、单中心研究，纳入了 2011 年至 2018 年间所有连续行两次剖宫产术的女性。比较在首次 CD（索引 CD）时放置可吸收粘连屏障（氧化再生纤维素）的女性与未放置此类屏障的女性。评估索引 CD 时放置可吸收粘连屏障与随后 CD 时出现腹腔内粘连之间的关联。评估的因素包括腹腔内粘连严重程度、从皮肤切开至新生儿分娩的时间以及手术总持续时间。
我们确定了 2125 名符合纳入标准的女性。她们分为两组；一组在索引 CD 时放置了可吸收粘连屏障，另一组未放置此类可吸收屏障。161 名（7.6%）在索引 CD 时放置了可吸收粘连屏障。在索引 CD 时，可吸收粘连屏障组的腹腔内粘连发生率为 34.8%，而无可吸收粘连屏障组的发生率为 26.5%（p=0.02）。在随后的 CD 时，可吸收粘连屏障组的腹腔内粘连发生率为 39.8%，而无可吸收粘连屏障组的发生率为 46%（p=0.13）。值得注意的是，使用可吸收粘连屏障可使粘连发生率的平均增加降低 0.05±0.55，而无屏障组为 0.20±0.55（p<0.01）。索引 CD 时放置可吸收粘连屏障与随后 CD 时腹腔内粘连发生率较低独立相关，优势比为 0.67（0.47-0.96）。总体而言，索引 CD 时放置可吸收粘连屏障与随后手术的平均持续时间较短相关（分钟），分别为 37.7±18.9 和 42.7±27.1（p=0.02）。
在随后的 CD 中，放置可吸收粘连屏障与减少腹腔内粘连和手术持续时间相关。
