术后腹腔粘连的研究进展

Research progress of postoperative peritoneal adhesion

目的了解术后腹腔粘连的病因及有效防治措施。方法查阅近年来国内外有关术后腹腔粘连研究的相关文献并进行分析总结。结果就目前的研究初步认为,手术主要通过直接损伤、炎症反应及缺氧环节导致腹腔粘连的发生,进一步通过炎症细胞、炎症介质、细胞因子等的释放作用于腹腔微环境,破坏腹腔微环境原有的平衡,引起相关作用分子的改变,促进腹腔粘连的形成。主要防治措施体现在优化手术方案及提高手术技巧,采用预防纤维蛋白渗出、促进纤维蛋白降解及针对相关作用分子和基因的药物治疗以及采用药物屏障和机械屏障的生物屏障治疗以及其他一些辅助治疗。结论术后腹腔粘连的发病机制复杂,目前仍不十分明确,临床上仍缺乏有效的针对病因的治疗和干预措施。从腹腔微环境中的细胞及分子水平上对粘连机制的进一步研究有助于将来的精准治疗,多靶点、多环节发挥作用的联合用药及相关干预有望在不久的将来得到应用。

Objective To understand etiology and available treatment of postoperative peritoneal adhesion. Method Domestic and overseas literatures in recent years about research progress of peritoneal adhesion were reviewed. Results As to the previous research, the operation was the main cause of peritoneal adhesion by the injury, inflammatory reaction, and hypoxia, which further affected the changes of the peritoneal microenvironment through the release of inflammatory cells, inflammatory mediators, cytokines, etc., then disturbed the balance of deposition and dissolution of fibrin and promoted the formation of extracellular matrix and microangiogenesis, resulted in peritoneal adhesion. The main treatment measures were optimizing surgical procedure and improving surgical technique, preventing fibrinolysis and promoting fiber protein degradation, some drug therapies involved molecules and genes, using biologic barrier treatment with drug barrier and mechanical barrier, and some other adjuvant therapies. Conclusions Pathogenesis of peritoneal adhesion is complex and poorly understood currently. There is no effective clinical treatment and intervention for this disease. Research on aspects of cell and molecular of abdominal cavity microenvironment will be beneficial to precise treatment of peritoneal adhesion, and combined medication of multiple targets and multiple links and related interventions are expected to apply for peritoneal adhesion in future.