腹腔镜手术后粘连形成减少。

Adhesion formation is reduced after laparoscopic surgery.

作者信息

Garrard C L, Clements R H, Nanney L, Davidson J M, Richards W O

机构信息

Department of Surgery, MCN-D5203 Vanderbilt University Medical Center, Nashville, TN 37232, USA.

出版信息

Surg Endosc. 1999 Jan;13(1):10-3. doi: 10.1007/s004649900887.

DOI:10.1007/s004649900887

PMID:9869679

Abstract

BACKGROUND

Adhesion formation after abdominal operations causes significant morbidity.

METHODS

Adhesion formation in pigs was compared after placement of prosthetic mesh during celiotomy (group 1), laparoscopy with large incision (group 2), and laparoscopy (group 3). After peritoneum was excised, polypropylene mesh was fixed to the abdominal wall, then to the opposite abdominal wall in the preperitoneal space followed by peritoneal closure. Adhesion area, grade, and vascularity were measured.

RESULTS

More adhesions (p < 0.02) covered intraperitoneal mesh (7.57 +/- 1.89 cm2) than covered reperitonealized mesh (2.16 +/- 1.13 cm2), and adhesion grade was significantly greater (p < 0.02). Adhesion areas were significantly greater in groups 1 and 2 than in group 3 (p = 0.001 and 0.03, respectively). Adhesion grade was significantly greater in groups 1 and 2 than in group 3 (p = 0.02 and p = 0.04, respectively). Groups 1 and 2 had more vascular adhesions than group 3 (p < 0.01 and p = 0.02, respectively)

CONCLUSIONS

A foreign body within the peritoneum stimulates more numerous and denser adhesions. Tissue trauma distant from the site of adhesions increases their formation. A major advantage of laparoscopic surgery is decreased adhesion formation.

摘要

背景

腹部手术后粘连形成会导致显著的发病率。

方法

比较猪在剖腹术期间放置人工补片后（第1组）、大切口腹腔镜检查后（第2组）和腹腔镜检查后（第3组）的粘连形成情况。切除腹膜后，将聚丙烯补片固定于腹壁，然后在腹膜前间隙固定于对侧腹壁，随后关闭腹膜。测量粘连面积、分级和血管分布情况。

结果

腹膜内补片覆盖的粘连（7.57±1.89平方厘米）多于再腹膜化补片覆盖的粘连（2.16±1.13平方厘米）（p<0.02），且粘连分级显著更高（p<0.02）。第1组和第2组的粘连面积显著大于第3组（分别为p=0.001和0.03）。第1组和第2组的粘连分级显著高于第3组（分别为p=0.02和p=0.04）。第1组和第2组的血管性粘连多于第3组（分别为p<0.01和p=0.02）。