腹部手术后盆腹腔粘连发生及相关因素分析

目的:分析前次腹部手术后盆腹腔粘连的发生及相关因素。方法:2002年1月至2005年4月就诊于北京协和医院、有腹部手术史及因各种妇科疾病需行腹腔镜手术的患者170例。记录既往的手术相关情况以及腹腔镜手术中盆腹腔的粘连情况,对粘连进行分级并分析其相关因素。结果:腹壁切口下方粘连总的发生率为40.6%(69/170)。腹腔镜切口粘连发生率为8.7%(2/23)较横切口的46.4%(13/28)、纵切口的42%(34/81)、其他类型切口的52.6%(20/38)相比较低,其差异有显著性(P=0.003,P=0.003,P<0.001)。多次手术是切口下粘连的危险因素(χ2=8.699,P=0.013)。手术野粘连率为77%(131/170)。有不孕史、PID史以及子宫内膜异位症(EM)史者粘连的发生率分别为96.3%,100%及94.4%。与无上述病史的手术者比较,手术野严重粘连的发生率显著增高(P<0.001,P=0.008,P<0.001)。结论:有腹部手术史的患者,切口下方及手术野粘连发生率较高。切口下方粘连与手术方式及手术次数相关。腹腔镜手术切口下方的粘连发生率最低。多次手术史切口下方的粘连尤其是肠粘连发生率较高。手术野粘连与腹壁切口种类无关,与手术种类有关,其中EM、不孕及PID手术史是手术野粘连的危险因素。

The incidence and the associated factors of intra-abdominal and pelvic adhesion after previous abdominal surgery

Objective:To analyze the incidence and the risk factors of intra-abdominal postoperative adhesion.Methods:Adhesion in one hundred and seventy patients with previous abdominal surgery between January 2002 and April 2005 were evaluated.The information concerning previous surgeries,the adhesions both in the incision site and the operative site,as well as the adhesion degree were assessed.The associated factors of adhesions were also analyzed.Results: The incidence of adhesion in the incision site was 40.6%(69/70).The rate of adhesion in laparoscopic incision of 40.6% is lower than that in transverse incision(46.4%,P=0.003) or longitudinal incision(42%,P=0.003)and the other incision(52.6%,P=<0.001).Patients who had multiple previous operations had a higher risk of anterior abdominal wall adhesion,especially adhesion involved by bowel.The incidence of operative field adhesion with the higher adhesion incidence of 96.3%,100% and 94.4% was observed in patients with history of infertility,PID or endometriosis compared with that in other patients(P<0.001,0.008,<0.001 respectively).Conclusion: Adhesions in abdominal incision or the operative site are the common consequence of previous surgery.The incidence of incision site is associated with incision type,with the lowest in laparoscopic incision.Multiple previous operations are associated with higher and more severe incision site adhesions.The incidence of operative adhesion is associated with previous operative type,operative adhesion is often observed in patients with previous operation dealing with endometriosis,PID,or infertility.