PDF(Pubmed)
Abstract：
OBJECTIVE: The formation of adhesions after gynecological surgery not only has detrimental impacts on those affected, including pain, obstruction, and infertility, but also imposes a high economic burden on healthcare systems worldwide.
OBJECTIVE: The aim of this review was to evaluate the adhesion prevention potential of all currently available adhesion barriers for gynecological surgery.
METHODS: We systematically searched MEDLINE and CENTRAL databases for randomized controlled trials (RCTs) on the use of adhesion barriers as compared with peritoneal irrigation or no treatment in gynecological surgery. Only RCTs with second-look surgery to evaluate adhesions in the pelvic/abdominal (but not intrauterine) cavity were included.
RESULTS: We included 45 RCTs with a total of 4,120 patients examining a total of 10 unique types of barriers in second-look gynecological surgery. While RCTs on oxidized regenerated cellulose (significant improvement in 6 of 14 trials), polyethylene glycol with/without other agents (4/10), hyaluronic acid and hyaluronate + carboxymethylcellulose (7/10), icodextrin (1/3), dextran (0/3), fibrin-containing agents (1/2), expanded polytetrafluoroethylene (1/1), N,O-carboxymethylchitosan (0/1), and modified starch (1/1) overall showed inconsistent findings, results for expanded polytetrafluoroethylene, hyaluronic acid, and modified starch yielded the greatest improvements regarding adhesion reduction at 75%, 0-67%, and 85%, respectively.
CONCLUSIONS: Best results for adhesion prevention were reported after applying Gore-Tex Surgical Membrane, hyaluronic acid, and 4DryField®. As Gore-Tex Surgical Membrane is nonabsorbable, it is associated with a greater risk of new adhesion formation due to second-look surgery to remove the product. 4DryField® yielded the greatest improvement in adhesion score compared to all other barrier agents (85%). For better comparability, future studies should use standardized scores and put more emphasis on patient-reported outcome measures, such as pain and infertility.
OBJECTIVE: The aim of this review was to evaluate the adhesion prevention potential of all currently available adhesion barriers for gynecological surgery.
METHODS: We systematically searched MEDLINE and CENTRAL databases for randomized controlled trials (RCTs) on the use of adhesion barriers as compared with peritoneal irrigation or no treatment in gynecological surgery. Only RCTs with second-look surgery to evaluate adhesions in the pelvic/abdominal (but not intrauterine) cavity were included.
RESULTS: We included 45 RCTs with a total of 4,120 patients examining a total of 10 unique types of barriers in second-look gynecological surgery. While RCTs on oxidized regenerated cellulose (significant improvement in 6 of 14 trials), polyethylene glycol with/without other agents (4/10), hyaluronic acid and hyaluronate + carboxymethylcellulose (7/10), icodextrin (1/3), dextran (0/3), fibrin-containing agents (1/2), expanded polytetrafluoroethylene (1/1), N,O-carboxymethylchitosan (0/1), and modified starch (1/1) overall showed inconsistent findings, results for expanded polytetrafluoroethylene, hyaluronic acid, and modified starch yielded the greatest improvements regarding adhesion reduction at 75%, 0-67%, and 85%, respectively.
CONCLUSIONS: Best results for adhesion prevention were reported after applying Gore-Tex Surgical Membrane, hyaluronic acid, and 4DryField®. As Gore-Tex Surgical Membrane is nonabsorbable, it is associated with a greater risk of new adhesion formation due to second-look surgery to remove the product. 4DryField® yielded the greatest improvement in adhesion score compared to all other barrier agents (85%). For better comparability, future studies should use standardized scores and put more emphasis on patient-reported outcome measures, such as pain and infertility.
摘要：
目的：妇科手术后粘连的形成不仅对患者有不利影响，包括疼痛,阻塞,和不孕症，但也给全球医疗保健系统带来了沉重的经济负担。
目的：本综述的目的是评估目前所有可用于妇科手术的粘连屏障的粘连预防潜力。
方法：我们系统地检索了MEDLINE和CENTRAL数据库中关于在妇科手术中使用粘连屏障与腹膜冲洗或不治疗相比的随机对照试验（RCT）。仅包括进行二次手术以评估盆腔/腹腔（但不包括子宫内）粘连的RCT。
结果：我们纳入了45个随机对照试验，共有4,120名患者在妇科二次手术中检查了10种独特类型的障碍。虽然RCT对氧化再生纤维素(14项试验中有6项显著改善)，聚乙二醇有/无其他试剂（4/10），透明质酸和透明质酸盐+羧甲基纤维素（7/10），艾考糊精（1/3），葡聚糖（0/3），含纤维蛋白的药物（1/2），膨体聚四氟乙烯(1/1),N,O-羧甲基壳聚糖（0/1），和改性淀粉(1/1)总体上表现出不一致的发现，膨胀聚四氟乙烯的结果，透明质酸，和改性淀粉在75%的粘附性降低方面产生了最大的改进，0-67%,85%,分别。
结论：应用Gore-Tex外科膜后，报告了预防粘连的最佳结果，透明质酸，和4DryField®。因为Gore-Tex手术膜是不可吸收的,由于二次手术切除产品，它与新粘连形成的风险更大。与所有其他阻隔剂(85%)相比,4DryField®在粘附分数方面产生了最大的改善。为了更好的可比性，未来的研究应该使用标准化的评分，并更加强调患者报告的结局指标，如疼痛和不孕症。
目的：本综述的目的是评估目前所有可用于妇科手术的粘连屏障的粘连预防潜力。
方法：我们系统地检索了MEDLINE和CENTRAL数据库中关于在妇科手术中使用粘连屏障与腹膜冲洗或不治疗相比的随机对照试验（RCT）。仅包括进行二次手术以评估盆腔/腹腔（但不包括子宫内）粘连的RCT。
结果：我们纳入了45个随机对照试验，共有4,120名患者在妇科二次手术中检查了10种独特类型的障碍。虽然RCT对氧化再生纤维素(14项试验中有6项显著改善)，聚乙二醇有/无其他试剂（4/10），透明质酸和透明质酸盐+羧甲基纤维素（7/10），艾考糊精（1/3），葡聚糖（0/3），含纤维蛋白的药物（1/2），膨体聚四氟乙烯(1/1),N,O-羧甲基壳聚糖（0/1），和改性淀粉(1/1)总体上表现出不一致的发现，膨胀聚四氟乙烯的结果，透明质酸，和改性淀粉在75%的粘附性降低方面产生了最大的改进，0-67%,85%,分别。
结论：应用Gore-Tex外科膜后，报告了预防粘连的最佳结果，透明质酸，和4DryField®。因为Gore-Tex手术膜是不可吸收的,由于二次手术切除产品，它与新粘连形成的风险更大。与所有其他阻隔剂(85%)相比,4DryField®在粘附分数方面产生了最大的改善。为了更好的可比性，未来的研究应该使用标准化的评分，并更加强调患者报告的结局指标，如疼痛和不孕症。
