术前内皮覆盖、术后病灶隔离法对妇产科腹盆腔手术术后粘连的预防作用

The preventive effect of preoperative endothelial coverage and postoperative lesion isolation on postoperative adhesions in the obstetric and gynecologic surgery

目的探讨对妇产科腹盆腔手术术后粘连的预防过程中运用透明质酸钠进行术前内皮覆盖、术后病灶隔离法的应用效果。方法选取2014年11月至2016年11月江苏大学附属澳洋医院70例行妇产科腹盆腔手术的患者的病历资料进行回顾性分析。将采用透明质酸钠进行术前内皮覆盖、术后病灶隔离预防术后粘连的35例患者设为观察组,术后使用透明质酸钠凝胶预防肠粘连的35例患者设为对照组。比较两组患者术后总粘连率以及重度粘连率,同时检测两组患者手术前后CRP、TNF-α、IL-6和IL-10水平,并对两组患者相关血液流变学指标进行比较。结果观察组第一次手术粘连率为20.00%,重度粘连率为8.57%,均显著低于对照组(45.71%、22.86%),观察组第二次手术粘连率为22.86%,重度粘连率为11.43%,均显著低于对照组(51.43%、28.57%),差异具有统计学意义(P<0.05);两组患者手术前后CRP、TNF-α、IL-6和IL-10水平差异显著,同时手术后观察组与对照组也具有显著性差异,有统计学意义(P<0.05);术后观察组全血黏度高、低切值、血浆黏度、血细胞比容与对照组差异显著,有统计学意义(P<0.05)。结论对妇产科腹盆腔手术术后粘连的预防过程中运用透明质酸钠进行术前内皮覆盖、术后病灶隔离法能够显著降低术后粘连率以及重度粘连率,同时能够降低血液黏度,改善相关炎性因子水平,更利于患者的预后。

Objective Investigate the application effect of preoperative endothelial coverage and postoperative lesion isolation with sodium hyaluronate in the prevention of postoperative adhesions in the obstetric and gynecologic surgery.Methods Given the retrospective analysis of the medical records of 70 cases of patients in the obstetric and gynecologic surgery in our hospital from November 2014 to November 2016.Using sodium hyaluronate for preoperative endothelial coverage,postoperative lesion isolation,prevention of postoperative adhesions in 35 patients as observation group,35 patients who were treated with sodium hyaluronate gel for prevention of intestinal adhesions were set up as control group.Compared the total adhesion rate and severe adhesion rate of the patients in two groups after the surgery.Meanwhile,Detected the level of CRP,TNF-α,IL-6 and IL-10 of the patients in two groups before and after the surgery,and compared the related hemorheology indexes of the patients in two groups.Results The first adhesion rate of the operation and the severe adhesion rate in the observation group were 20.00%and 8.57%respectively,which were significant lower than that in the control group(45.71%,22.86%).The second adhesion rate of the operation and the severe adhesion rate in the observation group were 22.86%and 11.43%respectively,which were significant lower than that in the control group(51.43%,28.57%),the differences in two groups were statistical significance(P<0.05).There were significant differences in the level of CRP,TNF-α,IL-6 and IL-10 of the patients in two groups before and after the surgery,the differences in two groups were statistical significance(P<0.05).There were significant differences in the whole blood viscosity(high and low shearing),plasma viscosity and HCT after the surgery in two groups,the differences in two groups were statistical significance(P<0.05).Conclusions Preoperative endothelial coverage and postoperative lesion isolation with sodium hyaluronate in the prevention of postoperative adhesions in the obstetric and gynecologic surgery can decrease the postoperative adhesion rate and severe adhesion rate significantly.Meanwhile,it can reduce blood viscosity and improve the level of related inflammatory factor,which is conducive to the prognosis of patients.