防治手术后腹腔粘连屏障材料:生物特性及优势与不足

Barrier materials for postoperative abdonimal adhesion: biological characteristics, merits and demerits

背景:术后腹腔粘连是亟待解决的外科问题之一,针对复杂的术后粘连病理机制及众多危险因素,手术技巧及屏障材料日趋成为术后预防粘连研究的关注点。目的:概述术后粘连病理机制及危险因素,综述不同制剂类型屏障材料的来源、生物特性、研究现状及潜在不足等。方法:通过计算机检索PubMed、CNKI数据库、万方数据库和维普数据库入库至2018年1月的相关文章,设定"术后腹腔粘连、病因病机、相关因素、防治措施、屏障材料"和"postoperative abdominal adhesion、pathological mechanism、risk factors、preventive measures、barrier materials"为检索词,最后纳入54篇文献进行分析讨论。结果与结论:防粘连材料能够通过物理屏障在粘连形成的早期阶段隔离受创区域和外周组织,防止腹腔粘连形成。目前防粘连屏障材料主要存在溶液剂、凝胶剂及膜剂3种剂型,每种材料均有自身的优势与不足,因此针对目前不足深入研究术后腹腔粘连病理过程,预测术后粘连的危险因素,术中提高手术技巧,根据实际情况选择合适的防粘连屏障材料,有望减少术后腹腔粘连的形成。关键词:

BACKGROUND:Postoperative abdominal adhesion is one of the most urgent surgical problems.In view of the complicated pathological mechanisms and various risk factors of postoperative adhesion,surgical techniques and barrier materials have increasingly become the focus of postoperative prevention of adhesion.OBJECTIVE:To summarize the pathological mechanisms and risk factors of postoperative abdominal adhesions and to review the material source,biological characteristics,current research status,and potential deficiencies of different types of barrier materials.METHODS:We retrieved PubMed,CNKI,WanFang and VIP databases from their inception dates to January 2018,and“postoperative abdominal adhesion,etiology and pathogenesis,risk factors,preventive measures,barrier materials”were used as the keywords in English and Chinese,respectively.Fifty-four articles were included in final analysis.RESULTS AND CONCLUSION:Anti-adhesion materials can isolate the injured area and peripheral tissues through physical barriers in the early stage of adhesion formation,and thus prevent the formation of abdominal adhesion.There are three types of anti-adhesion barrier material at present,including solution,gel and membrane agents.Each kind of material has its own advantages and disadvantages.Therefore,we explore the pathological process of postoperative abdominal adhesions,predict the risk factors of postoperative adhesions,improve surgical skills and select appropriate anti-adhesion barrier materials according to actual conditions,which are expected to reduce the formation of postoperative abdominal adhesions.