Imparato E, Biffignandi F, Aspesi G, Rovetta E, Piccaluga G, Scarabelli C, Durola R, Russo M, Galbusera M, Pozzi E
Divisione Ostetricia e Ginecologia, Ospedale Civile di Voghera.
Ann Ostet Ginecol Med Perinat. 1993 May-Jun;113(3):148-56.
The Authors after an overview on the most important causes of postsurgical adhesions, drove their attention to the tissue injury determined, during abdominal surgery, by exposure of pelvic serosa to the humidity of operating area. The AA tested body temperature in the Douglas pouch and under the liver on 30 patients who were operated by conservative surgery (myomectomy) and on 8 patient who underwent laparoscopy. A decrease of one degree in the Douglas pouch after one hour on the patient who had a Pfannestiel incision has been detected. While on the patients with longitudinal laparotomy no difference was evidenced. Serosal biopsies done at the beginning of surgery after pelvis exposure to the external conditions (temperature, humidity) showed a marked phlogosis in the tissue of the patients not treated at all. These tissue injuries were almost absent in the group treated with saline tissue irrigation and absent in the group that had parenteral prehydration, too. The AA suggested the use of the two techniques in conservative surgery in order to obtain in the open abdomen surgery results similar to those of the endoscopic one.
作者在概述了术后粘连的最重要原因后，将注意力转向了腹部手术期间盆腔浆膜暴露于手术区域湿度所导致的组织损伤。作者对30例行保守手术（子宫肌瘤切除术）的患者以及8例行腹腔镜手术的患者，检测了Douglas窝和肝脏下方的体温。在采用Pfannenstiel切口的患者中，术后1小时Douglas窝温度下降了1度。而在采用纵行剖腹术的患者中，未发现差异。在骨盆暴露于外部条件（温度、湿度）后手术开始时进行的浆膜活检显示，未接受任何治疗的患者组织有明显炎症。在采用生理盐水组织冲洗治疗的组中，这些组织损伤几乎不存在，在进行肠外预水化的组中也不存在。作者建议在保守手术中使用这两种技术，以便在开腹手术中获得与内镜手术相似的结果。
