Оценка эффективности комплексного подхода к профилактике послеоперационного спаечного процесса в малом тазу

Abstract

Aim: to assess the efficacy of complex prevention of postoperative pelvic adhesions. Patients and Methods: this open-label comparative prospective study involved 222 women of reproductive age with gynecological diseases, tuboperitoneal infertility, and pelvic adhesions stage 1–2 diagnosed laparoscopically (according to the R-AFS classification). In the study group (n=112), the prevention of postoperative adhesions was performed using the authors’ algorithm that included separation of adhesions using HARMONIC ultrasonic energy, intra-abdominal injection of anti-adhesive agent based on a natural polymer of carboxymethyl cellulose, and IM sodium deoxyribonucleate from post-op day 1 with a 24-hour interval for 10 days. In the comparison group (n=110), separation of adhesions was performed using bipolar energy, and standard preventive measures were applied. The rate and severity of postoperative adhesions (via second-look laparoscopy), the recovery of reproductive function (by the fact of intrauterine pregnancy), and the quality of life (using MOS SF-36 and WHQ questionnaires) were evaluated. The levels of CD20+, CD4+, CD8+, and CD56+ lymphocytes cells were measured preoperatively and on postoperative days 3 and 14. Follow-up was 12 months. Results: authors’ preventive algorithm activates immunoregulatory mechanisms of cellular humoral immunity, reduces the rate (by 4.5 times, p<0.001) and severity of adhesions (p = 0.047), increases the rate of pregnancy by 1.6 times, and provides maximum physical and psychological quality of life. Conclusions: authors’ algorithm of the prevention of postoperative pelvic adhesions in women with gynecological diseases and tuboperitoneal infertility is characterized by reliable clinical efficacy as demonstrated by the improvement of both early and long-term surgical outcomes. KEYWORDS: postoperative pelvic adhesions, small pelvis, prevention, cellular humoral immunity, infertility, reproductive function, quality of life. FOR CITATION: Sulima A.N., Puchkina G.A. Efficacy of complex preventive approach to postoperative pelvic adhesions. Russian Journal of Woman and Child Health. 2021;4(2):130–136. DOI: 10.32364/2618-8430-2021-4-2-130-136.