Azziz R
Department of Obstetrics and Gynecology, University of Alabama, Birmingham 35233-7333.
Surg Gynecol Obstet. 1993 Aug;177(2):135-9.
Adhesion re-formation after a reproductive operation, particularly involving the pelvic sidewall, is a prominent cause of failure in the surgical treatment of infertility. This study was done to evaluate the impact of standard microsurgery through laparotomy and the additional benefit of an oxidized regenerated cellulose adhesion barrier (INTERCEED [TC7] Absorbable Adhesion Barrier [Ethicon Inc.]), in reducing pelvic sidewall adhesion re-formation. One hundred and thirty-four patients with bilateral pelvic sidewall adhesions undergoing adhesiolysis by standard microsurgical techniques through laparotomy were treated during a prospective randomized trial involving 13 centers. After adhesiolysis, the deperitonealized surface of one pelvic sidewall was randomly assigned to be covered with INTERCEED Barrier, the contralateral sidewall serving as control. A second-look laparoscopy was performed ten days to 14 weeks postoperatively. Microsurgical adhesiolysis alone resulted in 24 percent of the sidewalls becoming free of adhesions and a 55.6 percent reduction in the area of adherent peritoneum. With microsurgery alone, 60 and 39 percent of adhesions initially characterized as filmy or severe, respectively, were not seen at second-look laparoscopy. The use of INTERCEED Barrier increased the incidence of adhesion-free sidewalls twofold. The treatment was also associated with a statistically significant reduction in the area of peritoneum affected by adhesion re-formation, compared with the control wall. Of the adhesions originally graded as severe, 61 percent of those treated with INTERCEED Barrier did not re-form at all. When evaluated on filmy adhesions, the use of the barrier was associated with a 72 percent reduction in adhesion re-formation. A measurable reduction in adhesion re-formation was found, depending on the initial adhesion type, with microsurgery alone. The addition of INTERCEED Barrier further reduced the incidence, extent and severity of postoperative adhesion re-formation. In this study, 90 percent of the patients benefited from the use of INTERCEED Barrier.
生殖手术后粘连再形成，尤其是涉及盆腔侧壁的粘连再形成，是不育症外科治疗失败的一个突出原因。本研究旨在评估经腹标准显微手术以及氧化再生纤维素粘连屏障（INTERCEED [TC7] 可吸收粘连屏障 [强生公司]）在减少盆腔侧壁粘连再形成方面的额外益处。在一项涉及13个中心的前瞻性随机试验中，对134例因双侧盆腔侧壁粘连而接受经腹标准显微手术粘连松解术的患者进行了治疗。粘连松解术后，一侧盆腔侧壁的去腹膜表面被随机分配覆盖INTERCEED屏障，对侧侧壁作为对照。术后10天至14周进行二次腹腔镜检查。单纯显微手术粘连松解使24%的侧壁无粘连，粘连腹膜面积减少55.6%。单纯显微手术时, 二次腹腔镜检查时最初分别被归类为薄膜状或重度的粘连中，有60%和39%未再出现。使用INTERCEED屏障使无粘连侧壁的发生率增加了一倍。与对照侧壁相比，该治疗还使粘连再形成所累及的腹膜面积在统计学上显著减少。最初分级为重度的粘连中，接受INTERCEED屏障治疗的粘连有61%根本没有再形成。在评估薄膜状粘连时，使用该屏障使粘连再形成减少了72%。单独使用显微手术时，根据初始粘连类型，粘连再形成有可测量的减少。添加INTERCEED屏障进一步降低了术后粘连再形成的发生率、范围和严重程度。在本研究中，90%的患者从使用INTERCEED屏障中获益。
