HEALTH OF WOMAN.2015.3(99):42–46; doi 10.15574/HW.2015.99.42 
 

Спаечный процесс в гинекологии 
 

Медведев М. В.

ГУ «Днепропетровская медицинская академия МЗ Украины» 
 

Несмотря на распространение минимально инвазивных технологий, спаечный процесс в гинекологии является существенной причиной послеоперационной заболеваемости. Считается, что спайки могут развиваться в 90% случаев гинекологических операций. Среди методов профилактики спаек на первом месте остается четкая хирургическая техника, уменьшение травмы тканей, десикации. В последние годы активно внедряются противоспаечные средства, которые делятся на две большие группы – флотирующие и барьерные. Наибольшее распространение получила вторая группа. Получены впечатляющие результаты эффективности данных средств, в частности комбинации гиалуроновой кислоты с гидроскиэтилкрахмалом. 
 

Ключевые слова: спаечный процесс, профилактика, оперативная гинекология, противоспаечные средства. 
 

Литература: 

1. Robertson D, Lefebvre G. 2010. Adhesion Prevention in Gynaecological Surgery. SOGC CLINICAL PRACTICE GUIDELINE. JOGC 32;6:598–602. http://dx.doi.org/10.1016/j.ijgo.2010.07.002

2. Pathogenesis, consequences, and control of peritoneal adhesions in gynecologic surgery. Fertil Steril. 2008. 90; 5 Suppl: S144–9. http://dx.doi.org/10.1016/j.fertnstert.2008.08.060; PMid:19007613

3. Boland GM and Weigel RJ. 2006. Formation and prevention of postoperative abdominal adhesions. J Surg Res. 132;1:3–12. http://dx.doi.org/10.1016/j.jss.2005.12.002; PMid:16457846

4. Pouly JL, Darai E, Yazbeck C, Benifla JL, Dechaud H, Wattiez A, Crowe A and Audebert A. 2011. Postoperative abdominal adhesions and their prevention in gynaecological surgery: II. How can they be prevented? Gynecol Obstet Fertil.

5. Parker MC, Ellis H, Moran BJ, Thompson JN, Wilson MS, Menzies D, McGuire A, Lower AM, Hawthorn RJ, O’Briena F, Buchan S and Crowe AM. 2001. Postoperative adhesions: ten-year follow-up of 12,584 patients undergoing lower abdominal surgery. Dis Colon Rectum. 44;6:822–29; discussion 829–30. http://dx.doi.org/10.1007/BF02234701; PMid:11391142

6. Lower AM, Hawthorn RJ, Ellis H, O’Brien F, Buchan S and Crowe AM. 2000. The impact of adhesions on hospital readmissions over ten years after 8849 open gynaecological operations: an assessment from the Surgical and Clinical Adhesions Research Study. Bjog. 107;7:855–62. http://dx.doi.org/10.1111/j.1471-0528.2000.tb11083.x

7. Ellis H, Moran BJ, Thompson JN, Parker MC, Wilson MS, Menzies D, McGuire A, Lower AM, Hawthorn RJ, O’Brien F, Buchan S and Crowe AM. 1999. Adhesion-related hospital readmissions after abdominal and pelvic surgery: a retrospective cohort study. Lancet. 353;9163:1476–80. http://dx.doi.org/10.1016/S0140-6736(98)09337-4

8. diZerega GS and Campeau JD. 2001. Peritoneal repair and post-surgical adhesion formation. Hum Reprod Update. 7;6:547–55. http://dx.doi.org/10.1093/humupd/7.6.547

9. Volz J, Koster S, Weiss M, Schmidt R, Urbaschek R, Melchert F and Albrecht M. 1996. Pathophysiologic features of a pneumoperitoneum at laparoscopy: a swine model. Am J Obstet Gynecol. 174;1;1:132–40. http://dx.doi.org/10.1016/S0002-9378(96)70385-X

10. West MA, Hackam DJ, Baker J, Rodriguez JL, Bellingham J and Rotstein OD. 1997. Mechanism of decreased in vitro murine macrophage cytokine release after exposure to carbon dioxide: relevance to laparoscopic surgery. Ann Surg. 226;2:179–90. http://dx.doi.org/10.1097/00000658-199708000-00010

11. Binda MM and Koninckx PR. 2010. Hyperoxia and prevention of adhesion formation: a laparoscopic mouse model for open surgery. Bjog. 117;3:331–9. http://dx.doi.org/10.1111/j.1471-0528.2009.02370.x; PMid:19832833

12. Taskin O, Buhur A, Birincioglu M, Burak F, Atmaca R, Yilmaz I and Wheeler JM. 1998. The effects of duration of CO2 insufflation and irrigation on peritoneal microcirculation assessed by free radical scavengers and total glutathion levels during operative laparoscopy. J Am Assoc Gynecol Laparosc. 5;2:129–33. http://dx.doi.org/10.1016/S1074-3804(98)80078-9

13. Taskin O, Sadik S, Onoglu A, Gokdeniz R, Yilmaz I, Burak F and Wheeler JM. 1999. Adhesion formation after microlaparoscopic and laparoscopic ovarian coagulation for polycystic ovary disease. J Am Assoc Gynecol Laparosc. 6;2:159–63. http://dx.doi.org/10.1016/S1074-3804(99)80095-4

14. Yesildaglar N, Demirbag S, Pekcan M and Erogul O. 2003. Reduction of CO2-pneumoperitoneum-induced metabolic hypoxaemia by the addition of small amounts of O2 to the CO2 in a rabbit ventilated model. A preliminary study. Hum Reprod. 18;4:890; author reply 891.

15. Agdi M, Valenti D and Tulandi T. 2008. Intraabdominal adhesions after uterine artery embolization. Am J Obstet Gynecol. 199;5:482 e1-3.

16. Payne JF and Haney AF. 2003. Serious complications of uterine artery embolization for conservative treatment of fibroids. Fertil Steril. 79;1:128–31. http://dx.doi.org/10.1016/S0015-0282(02)04398-4

17. Goldfarb HA. 2000. Myoma coagulation (myolysis). Obstet Gynecol Clin North Am. 27;2:421–30. http://dx.doi.org/10.1016/S0889-8545(00)80032-7

18. Mais V, Angioli R, Coccia E, Fagotti A, Landi S, Melis GB, Pellicano M, Scambia G, Zupi E, Angioni S, Arena S, Corona R, Fanfani F and Nappi C. 2011. Prevention of postoperative abdominal adhesions in gynecological surgery. Consensus paper of an Italian gynecologists’ task force on adhesions. Minerva Ginecol. 63;1:47–70. PMid:21311420

19. Audebert A, Darai E, Benifla JL, Yazbeck C, Dechaud H, Wattiez A, Crowe A and Pouly JL. 2011. Postoperative abdominal adhesions and their prevention in gynaecological surgery: I. What should you know? Gynecol Obstet Fertil.

20. diZerega GS. 1994. Contemporary adhesion prevention. Fertil Steril. 61;2:219–35. PMid:8299773

21. Metwally M, Watson A, Lilford R and Vandekerckhove P. 2006. Fluid and pharmacological agents for adhesion prevention after gynaecological surgery. Cochrane Database Syst Rev. 2:CD001298. http://dx.doi.org/10.1002/14651858.cd001298.pub3

22. El-Mowafi DM and Diamond MP. 2003. Are pelvic adhesions preventable? Surg Technol Int. 11:222–35. PMid:12931305

23. Risberg B. 1997. Adhesions: preventive strategies. Eur J Surg Suppl. 577:32–9. PMid:9076450

24. Saed GM, Jiang Z, Fletcher NM and Diamond MP. 2008. Modulation of the BCL-2/BAX ratio by interferon-gamma and hypoxia in human peritoneal and adhesion fibroblasts. Fertil Steril. 90;5:1925–30. http://dx.doi.org/10.1016/j.fertnstert.2007.06.091; PMid:17905238

25. Hague BA, Honnas CM, Berridge BR and Easter JL. 1998. Evaluation of postoperative peritoneal lavage in standing horses for prevention of experimentally induced abdominal adhesions. Vet Surg. 27;2:122–6. http://dx.doi.org/10.1111/j.1532-950X.1998.tb00107.x

26. Duffy DM and diZerega GS. 1996. Adhesion controversies: pelvic pain as a cause of adhesions, crystalloids in preventing them. J Reprod Med. 41,1:19–26. PMid:8855072

27. Yaacobi Y, Goldberg EP and Habal MB. 1991. Effect of Ringer’s lactate irrigation on the formation of postoperative abdominal adhesions. J Invest Surg. 4;1:31–6. http://dx.doi.org/10.3109/08941939109140759

28. Catena F, Ansaloni L, Di Saverio S and Pinna AD. 2012. P.O.P.A. Study: Prevention of Postoperative Abdominal Adhesions by Icodextrin 4% Solution After Laparotomy for Adhesive Small Bowel Obstruction. A Prospective Randomized Controlled Trial. J Gastrointest Surg. 16;2:382–388. http://dx.doi.org/10.1007/s11605-011-1736-y; PMid:22052104

29. Catena F, Ansaloni L, Lauro A, Ercolani G, D’Alessandro L and Pinna A. 2008. Prospective controlled randomized trial on prevention of postoperative abdominal adhesions by Icodextrin 4% solution after laparotomic operation for small bowel obstruction caused by adherences POPA study: Prevention of Postoperative Adhesions on behalf of the World Society of Emergency Surgery. Trials. 9:74. http://dx.doi.org/10.1186/1745-6215-9-74; PMid:19094225 PMCid:PMC2631497

30. Harris ES, Morgan RF and Rodeheaver GT. 1995. Analysis of the kinetics of peritoneal adhesion formation in the rat and evaluation of potential antiadhesive agents. Surgery 117;6:663–9. http://dx.doi.org/10.1016/S0039-6060(95)80010-7

31. Saravelos H and Li TC. 1996. Post-operative adhesions after laparoscopic electrosurgical treatment for polycystic ovarian syndrome with the application of Interceed to one ovary: a prospective randomized controlled study. Hum Reprod. 11;5:992–7. http://dx.doi.org/10.1093/oxfordjournals.humrep.a019337

32. Pados G, Camus M, De Munck L and Devroey P. 1992. Laparoscopic application of interceed (TC7). Hum Reprod. 7,8:1141–3. PMid:1400939

33. Sawada T, Nishizawa H, Nishio E and Kadowaki M. 2000. Postoperative adhesion prevention with an oxidized regenerated cellulose adhesion barrier in infertile women. J Reprod Med. 45;5:387–9. PMid:10845171

34. Rajab TK, Wallwiener M, Planck C, Brochhausen C, Kraemer B and Wallwiener CW. 2010. A direct comparison of seprafilm, adept, intercoat, and spraygel for adhesion prophylaxis. J Surg Res. 161;2:246–9. http://dx.doi.org/10.1016/j.jss.2008.11.839; PMid:19375716

35. Schonman R, Corona R, Bastidas A, De Cicco C, Mailova K and Koninckx PR. 2009. Intercoat gel (oxiplex): efficacy, safety, and tissue response in a laparoscopic mouse model. J Minim Invasive Gynecol. 16;2:188–94. http://dx.doi.org/10.1016/j.jmig.2008.12.014; PMid:19249707

36. Farquhar C, Vandekerckhove P, Watson A, Vail A and Wiseman D. 2000. Barrier agents for preventing adhesions after surgery for subfertility. Cochrane Database Syst Rev. 2:CD000475. PMid:10796548

37. Haney AF, Hesla J, Hurst BS, Kettel LM, Murphy AA, Rock JA, Rowe G and Schlaff WD. Expanded polytetrafluoroethylene (Gore-Tex Surgical Membrane) is superior to oxidized regenerated cellulose (Interceed TC7+) in preventing adhesions. Fertil Steril. 1995. 63;5:1021–6. PMid:7720911

38. Mettler L, Audebert A, Lehmann-Willenbrock E, Schive K and Jacobs VR. 2003. Prospective clinical trial of SprayGel as a barrier to adhesion formation: an interim analysis. J Am Assoc Gynecol Laparosc. 10;3:339–44. http://dx.doi.org/10.1016/S1074-3804(05)60258-7

39. Ustun C, Kocak I and Akpolat I. 2000. Effects of Seprafilm (sodium hyaluranate-based bioresorbable), Sepracoat (0.4% hyaluronic acid), and Ringer’s lactate on the prevention of postsurgical adhesion formation in rat models. J Obstet Gynaecol. 20;1:78–80. http://dx.doi.org/10.1080/01443610063543; PMid:15512475

40. Park JK, Yeom J, Hahn SK. 2010. Anti-Coagulating Hydroxyethyl Starch Blended with Hyaluronic Acid as A Novel Post-surgical Adhesion Barrier. Macromolecular Research. 18;11:1076–1080. http://dx.doi.org/10.1007/s13233-010-1103-y