壳聚糖防粘连膜预防剖宫产术后组织粘连的初步临床观察

Adhesion prevention after Cesarean section by short-term biological barrier of modified chitosan

目的观察使用壳聚糖防粘连隔离膜作短期生物性屏障预防剖宫产术后盆腔组织粘连的临床效果。方法选择2011年1月至2012年6月在浙江萧山医院行首次剖宫产术孕妇250例，随机分为两组，研究组130例，术中使用改性壳聚糖防粘连隔离膜行短期生物性屏障；对照组120例，术中不给予任何预防组织粘连的治疗措施。对术后排气回复时间、术后感染情况及术后随访盆腔粘连发生情况等几方面作为指标评价临床疗效。结果研究组排气时间（25±7）h，产褥感染3例（2．3％），术后随访异常2例（1．5％）。对照组排气时间（34±11）h，产褥感染5例（4．2％），术后随访异常5例（4．2％）。两组排气时间、产褥感染、术后随访异常率差异有统计学意义（P〈0．05）。结论改性壳聚糖防粘连膜短期生物性屏障可减少剖宫产术后感染及盆腔组织粘连。

Objective To evaluate the efficacies of modified chitosan, an adhesive prevention substance, as a biological barrier for preventing adhesion after Cesarean section. Methods A total of 250 cases undergoing primary Cesarean section from January 2011 to June 2012 at our hospital were recruited. They were randomly divided into experiment （n = 130） and control （n = 120） groups. The experiment group received modified chitosan during Cesarean section while no adhesive prevention substance was offered for the control group. Postoperative flatus time, postoperative infection and pelvic adhesion were used to evaluate the clinical efficacies. Results For the experiment group, the average postoperative flatus time was （25 ：i： 7 ） hours. Three cases had postoperative infections with a postoperative infection rate of 2. 3%. There were 2 cases of pelvic adhesion （pelvic adhesion rate： l. 5% ） during the postoperative follow-up period. For the control group, the average postoperative flatus time was （ 34 ± 11 ） hours. Five cases had postoperative infections with a postoperative infection rate of 4. 2%. There were 5 cases of pelvic adhesion （ pelvic adhesion rate： 4. 2% ） during the postoperative follow-up period. There were significant inter-group differences in postoperative flatus time, postoperative infection and pelvic adhesion （ P 〈 0.05 ）. Conclusion Modified chitosan can prevent pelvic adhesion after Cesarean section.