Holmdahl L, Risberg B
Department of Surgery, Ostra Hospital, Sweden.
Eur J Surg. 1997 Mar;163(3):169-74.
To document the incidence of adhesion-related problems and the current concepts on the prevention of adhesions among Swedish surgeons.
Postal questionnaire during 1992.
Sweden.
All surgical units performing abdominal surgery.
Number of patients admitted with or operated on for adhesive small bowel obstruction, methods in use to prevent the formation of adhesions, and costs of adhesion-related complications in abdominal surgery.
At least 4700 patients were admitted annually with symptoms of adhesive small bowel obstruction. Of these, 2200 were operated on to relieve the obstruction. No consistent methods were in use to minimise formation of adhesions. Surgical gloves were not washed before operation by 49 of the 84 units that replied and of those only 12 always used powder-free gloves, which gives a likelihood of starch contamination in 70%-82% of all operations. Only 13 (16%) of the units consistently avoided suturing the peritoneum separately. Yearly, at least 1500 laparotomies were complicated by previously formed adhesions. The annual medical expenditure for adhesive small bowel obstruction was more than US $6 million.
Postoperative adhesion formation created substantial morbidity and workload in surgical units. Efforts to reduce the formation of adhesions must be instituted. To start this process, the suturing of peritoneum and the use of powdered gloves could be omitted from clinical practice.
记录瑞典外科医生中粘连相关问题的发生率以及当前预防粘连的理念。
1992年通过邮寄问卷进行调查。
瑞典。
所有开展腹部手术的外科科室。
因粘连性小肠梗阻入院或接受手术治疗的患者数量、预防粘连形成所采用的方法以及腹部手术中粘连相关并发症的费用。
每年至少有4700例患者因粘连性小肠梗阻症状入院。其中，2200例接受手术以缓解梗阻。在减少粘连形成方面，没有一致采用的方法。回复的84个科室中，有49个科室在手术前不清洗手术手套，且其中只有12个科室始终使用无粉手套，这使得在所有手术中有70%-82%的可能性发生淀粉污染。只有13个（16%）科室始终避免单独缝合腹膜。每年至少有1500例剖腹手术因先前形成的粘连而出现并发症。粘连性小肠梗阻的年度医疗费用超过600万美元。
术后粘连形成给外科科室带来了严重的发病率和工作量。必须采取措施减少粘连的形成。为启动这一进程，临床实践中可省略腹膜缝合和使用有粉手套的操作。
