影片: 腹腔手術後粘黏產生的影響與負擔 播放
粘黏是內部疤痕組織的纖維束,可能導致正常情況下不應相連的組織與器官黏合在一起。1 粘黏是腹腔手術最常見、發生頻率最高的併發症,發生於逾 90% 的腹腔手術病人1,2

粘黏的風險及併發症


發生粘黏的病人會承受重大的長短期術後併發症之苦,對病人、外科醫師及醫療體系造成負擔,包括:

  • 小腸阻塞(SBO)3
  • 女性不孕3
  • 慢性腹部骨盆腔疼痛3
  • 再次手術以進行粘黏分離(以手術去除粘黏)3
  • 手術時間延長、併發症的相關風險提高3
  • 未來治療選擇受限3
  • 死亡風險提高4,5

儘管應當而且也能夠在手術期間盡全力預防粘黏形成,但是粘黏為組織癒合的自然過程,不一定能單純藉由手術技巧避免。3,6 雖然不是所有的粘黏都會造成問題,但許多粘黏確實會引起症狀、且並未被診斷為合併症的根本病因。3,4

粘黏的形成
單一帶狀粘黏導致的 SBO 需要再手術處理。

PubMed Abstracts


Adhesions and colorectal surgery - call for action

Parker MC, Wilson MS, van Goor H, et al. Colorectal Dis. 2007;9(suppl 2):66-72

Mounting evidence highlights that adhesions are now the most frequent complication of abdominopelvic surgery, yet many surgeons are still not aware of the extent of the problem and its serious consequences. VIEW ABSTRACT »

Practicalities and costs of adhesions

Wilson MS. Colorectal Dis. 2007; 9(suppl 2):60-5

In spite of postoperative adhesions being common there appears to be a reluctance to use anti-adhesion products routinely. This article compares the incidence of adhesions with other conditions in order to identify the level of risk. VIEW ABSTRACT »

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關於本網站


術後粘黏資料庫的設計宗旨,是幫助醫療專業人員(包含外科醫師、護士、醫師助理、醫院行政人員與採購人員)與醫療政策制定者更加了解術後粘黏形成的相關因素、以及會對病人造成的嚴重後果。在外科及醫療規劃者當中,對粘黏、與粘黏對病人治療結果所帶來之實質不良影響的認識未必完全。如有認知缺乏,會不利於全力預防粘黏或將其發生率降至最低。在本網站上,您可以查閱有關粘黏及相關併發症的專家審查文獻、簡報及影片等重要資料。請將本網頁加入書籤,並經常造訪查閱更新資訊。


醫療專業顧問揭露事項:從 2013 年 6 月起,Mike Parker 教授因參與以下企業相關活動而獲得報酬:座談會(Applied Medical、Covidien、Ethicon Endo Surgery、Sanofi)與臨床研究(Carpo Novum)。

References

  1. Sikirica V, Bapat B, Candrill SD, Davis KL, Wilson M, Johns A. The inpatient burden of abdominal and gynecological adhesiolysis in the US. BMC Surg. 2011;11:13.
  2. ten Broek RP, Issa Y, van Santbrink EJ, et al. Burden of adhesions in abdominal and pelvic surgery: systematic review and met-analysis. BMJ. 2013;347:f5588.
  3. Bruggmann D, Tchartchian G, Wallwiener M, Munstedt K, Tinneberg H-R, Hackethal A. Intra-abdominal adhesions. Dtsch Arztebl Int. 2010;107(44):769-775.
  4. DeWilde RL, Trew G; Expert Adhesions Working Party of the European Society of Gynaecological Endoscopy (ESGE). Postoperative abdominal adhesions and their prevention in gynaecological surgery. Expert consensus position. Gynecol Surg. 2007;4:161-168.
  5. van Goor H. Consequences and complications of peritoneal adhesions. J Assoc of Coloproctology of Great Britain and Ireland. 2007;9(suppl 2):25-34.
  6. DeWilde RL, Trew G; Expert Adhesions Working Party of the European Society of Gynaecological Endoscopy (ESGE). Postoperative abdominal adhesions and their prevention in gynaecological surgery. Expert consensus position. Part 2—steps to reduce adhesions. Gynecol Surg. 2007;4:243-253.