摘要
目的探讨应用医用几丁糖对阴式全子宫切除术后预防肠粘连及盆腔粘连的临床应用价值。方法将2009年1月～2011年12月在本院收治的180例阴式全子宫切除术(VTH)患者随机分为对照组与实验组,每组各90例。对照组予以常规护理,包括术前常规检查、术中麻醉及手术配合、术后生命体征的观察等,阴式手术后不采取任何预防粘连的措施。实验组在常规护理的基础上提高术前、术后护理质量和预防措施,术中将医用几丁糖凝胶涂于手术创面表面及周围腹腔脏器,观察术后肠粘连和盆腔粘连的发生情况。结果实验组90例患者术后随访6个月,无1例发生粘连性肠梗阻,术后腰骶部疼痛、下腹痛、腹胀等症状明显低于对照组(均P<0.05),差异有统计学意义。结论在妇科阴式全子宫切除术通过提高术前、术后护理质量和预防措施,术中应用医用几丁糖凝胶预防阴式全子宫切除术后肠粘连及盆腔粘连并发症,能有效避免或减少术后肠粘连及腹腔粘连并发症的发生,促进患者的康复,值得在阴式手术中推广应用。
Objective To investigate the clinical value of chitosan on the prevention of intestinal adhesions and pelvic adhesions after vaginal hysterectomy.Methods In our hospital from January 2009 to December 2011, 180 cases of vaginal hysterectomy （VTH） patients were randomly divided into control group and experimental group,with 90 cases in each group. Control group used usual care, including routine examination in the preoperative, intraoperative anesthesia and surgery with postoperative observation of vital signs, but without taking any measures to prevent adhesions; while experimental group added care to improve the preoperative, postoperative quality of care and preventive measures, postoperative medical chitosan applied to the surgical wound surface and surrounding abdominal organs, then observing postoperative intestinal adhesion and pelvic adhesions in both groups. Results 90 patients in the experi mental group patients were followed up for 6 months, no case of adhesive intestinal obstruction, postoperative lumbosacral pain, ab dominal pain, bloating and other symptoms appearing and decreasing significantly（P〈0.05）.Conclusion Prevention of vaginal hysterec tomy complications of postoperative intestinal adhesion and pelvic adhesions in gynecological vaginal hysterectomy by improving preop erative, postoperative quality of care and preventive measures, intraoperative application of medical chitosan can effectively reduce the occurrence of complications of postoperative intestinal adhesion and peritoneal adhesions, to promote the rehabilitation of patients, and it is worthy to promote the use of vaginal surgery.
