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目的观察采用透明质酸钠凝胶(HA)术前内皮黏膜覆盖及术后创面隔离法在预防妇产科手术后盆腹腔粘连的临床效果。方法回顾性分析行妇产科手术的患者7 000例,根据术中是否应用HA分为实验组(3 652例)和对照组(3 348例)。实验组于术中病灶切除前,在病灶区域的内皮黏膜上及对应区域的腹膜上充分涂抹HA;病灶切除后再于创面涂抹HA。对照组患者按常规行手术,术中不应用HA。观察比较两组患者术后盆腹腔粘连发生情况。结果术后1周、3个月、6个月,实验组患者盆腹腔粘连发生率均低于对照组(均P<0.05)。组间比较,无论是初次手术还是再次手术、微创手术还是开腹手术,实验组患者术后盆腹腔粘连发生率均低于对照组(均P<0.05);组内比较,实验组和对照组初次手术患者术后盆腹腔粘连发生率均低于再次手术患者(均P<0.05),微创手术患者术后盆腹腔粘连发生率均低于开腹手术患者(均P<0.05)。结论 HA作为屏障制剂,在术前和术后分别于手术区域涂抹,能够有效预防妇产科手术后盆腹腔粘连的形成,值得临床推广使用。
Objective To observe the clinical effect of hyaluronic acid sodium gel (HA) preoperative endothelial mucosa covering and postoperative wound isolation in preventing pelvic adhesions after obstetrics and gynecology. Methods A retrospective analysis of 7 000 cases of obstetrics and gynecology surgery patients were divided into experimental group (3 652 cases) and control group (3 348 cases) according to whether HA was applied or not. In the experimental group, HA was applied to the peritoneum on the endothelium mucosa in the lesion area and the corresponding area before the excision of the intraoperative lesion; HA was smeared on the wound after excision of the lesion. Patients in the control group underwent routine surgery without intraoperative HA. Observe and compare the occurrence of pelvic adhesions in both groups after operation. Results The incidence of pelvic adhesions in experimental group was lower than that in control group at 1 week, 3 months and 6 months after operation (all P <0.05). The incidence of pelvic adhesions in the experimental group was significantly lower than that in the control group (both P <0.05). No significant difference was found between the experimental group and the control group The incidence of postoperative pelvic adhesions in patients undergoing primary surgery was lower than that in patients undergoing reoperation (all P <0.05). The incidence of pelvic adhesions in patients after minimally invasive surgery was significantly lower than that in patients undergoing open surgery (all P <0.05). Conclusion As a barrier preparation, HA is applied to the operation area before and after operation, which can effectively prevent the formation of abdominal adhesions after obstetrics and gynecology. It is worth to be used clinically.