术后腹腔粘连形成及预防研究进展

尽管现代外科手术技术已有很大的发展和进步，但术后腹腔粘连仍然是腹部手术后常见的并发症，发生率高达９０％〔１〕。腹腔粘连可引起腹部很多并发症。有的要接受再次开腹手术甚至多次手术〔２〕。近年来，人们对术后腹腔粘连进行了大量的实验和临床研究，有了一些新的认...     

腹腔粘连形成机制及治疗研究进展

腹腔及盆腔术后粘连是外科常见而棘手的问题.虽然粘连的确切机制尚不完全清楚,但近年来无论在机制研究或临床防治方面均取得了长足进步,现将近年来的一些进展综述如下.     

细胞因子在宫腔粘连发病机制中的作用

宫腔粘连(IUA)是指由于子宫内膜损伤导致子宫腔部分或全部闭塞,可引起月经及妊娠异常等表现。IUA的发病机制尚不明确,近年来研究发现许多细胞因子通过直接或者间接的方式参与IUA的发生。这些细胞因子的异常表达,可导致子宫内膜纤维化,促进IUA的形成。本文对细胞因子在IUA形成中的作用进行综述,为进一步探讨IUA的发病机制及临床治疗新手段提供参考。     

腹腔粘连机制和防治研究进展

腹腔粘连为腹部外科手术后的常见并发症,发生率高达90%,可导致肠梗阻、女性不孕不育等严重并发症,需再次入院手术治疗。目前,腹腔粘连发生机制尚未完全阐明,临床防治仍有不足之处,故一直是腹部外科的研究热点。现将国内外腹腔粘连的研究进展情况综述如下。     

右旋糖酐预防腹腔粘连实验观察

腹腔粘连是腹部手术后常见并发症，目前尚无一致公认的安全有效的特异性预防方法〔１〕。本实验采用不同分子量右旋糖酐灌注腹腔以观察术后预防腹腔粘连的作用。１材料与方法１．１动物和分组当地杂种犬３６只，１９～２４月龄，体重９～１２ｋｇ，随机分为对照组、低分子...     

腹腔粘连的形成及术后预防

腹部手术后腹腔粘连是一种常见的临床现象 ,可导致严重的并发症 ,如肠梗阻、腹腔和盆腔疼痛、不孕和不育等。严重的腹腔粘连常给再次手术造成极大困难 ,由于粘连形成过程复杂 ,治疗效果又十分不理想 ,所以探索其形成机理及预防措施成为当今外科领域的重点内容之一 ,本文就此分述如下。1　腹腔粘连的形成机理腹腔粘连的原因除极少数为腹腔内先天性因素外 ,主要是后天因素造成的 ,常见原因有腹腔炎症、损伤、出血、缺血、腹腔内异物、腹腔内注射化学药物和腹部放射治疗等。有人报道腹部外科手术后粘连率约占 90 %。腹腔粘连的发生机理尚不完全…     

腹部手术后腹腔粘连形成的病理生理及预防

腹部手术后腹腔粘连的防治在外科中仍是一难题,本文着重对细胞因子和纤维蛋白溶解酶原激活物的作用与粘连形成的关系进行了讨论,并提出全身使用成纤维细胞和免疫活性细胞调节剂,纤维蛋白溶解剂以及应用屏障物质的效果和可能性。     

腹壁切口感染对腹腔粘连形成的影响

目的　探讨腹壁切口感染对腹腔粘连形成的影响。方法　将 12 0只Wistar大鼠分为低、中、高浓度组和对照组 ,每组各 3 0只 ,前 3组动物分别按 1× 10 2 cfu/ml、1× 10 5 cfu/ml、1× 10 8cfu/ml的浓度将大肠埃希氏菌、金黄色葡萄球菌和铜绿假单胞菌的定量混合液 0 .2ml分别注入切口皮下 ,对照组注入等量生理盐水 ,建立腹部切口感染的动物模型。术后第 8天处死动物 ,观察和比较 4组动物的切口粘连情况。结果　低、中、高浓度组和对照组的切口感染率分别为 81.48%、86.67%、90 .0 0 %和 50 .0 0 % ;粘连率分别为 53 .3 3 %、60 .0 0 %、70 .0 0 %和 2 6.67% ,经 χ2 检验 ,低浓度组与对照组腹腔粘连发生率的差异有显著性意义 (P<0 .0 5) ,中、高浓度组和对照组比较差异有高度显著性意义 (P均 <0 .0 1) ;而低、中、高浓度组之间的腹腔粘连率比较差异则无显著性意义 (P>0 .0 5)。结论　腹壁切口感染可使腹膜粘连的发生率增高 ,而与细菌的数量没有明显的关系。提示腹部手术切口感染也是形成腹腔粘连的一个原因     

腹腔内粘连和脓肿形成的病理生理学及透明质酸对其的作用(编译)

复习腹腔内粘连和脓肿形成的病理生理学 ,以透明质酸为基础的制剂能减少术后肠粘连和腹腔内脓肿的形成 ,后两者的发生机制涉及凝血和纤溶平衡的紊乱及纤维蛋白降解的减少。透明质酸溶液则起机械性分离伤口接触面、改善腹膜愈合 ,调控炎症反应和促进纤溶。     

The effect of Kombucha on post-operative intra-abdominal adhesion formation in rats

Background  

Peritoneal adhesions are fibrous bands of tissues formed between organs that are normally separated and/or between organs and the internal body wall after peritoneal injury. The aim of the study was to investigate the effect of intra-peritoneal administration of Kombucha on intra-peritoneal adhesions.     

In vivo expression of thrombospondin-1 suppresses the formation of peritoneal adhesion in rats

BACKGROUND Formation of intraperitoneal adhesions is one of the major complications after abdominal surgery, which may lead to bowel obstruction. Thrombospondin 1(TSP-1) is an extracellular matrix modulating glycoprotein during tissue regeneration and collagen deposition.AIM To evaluated the therapeutic potential of overexpressed TSP-1 in suppressing pelvic adhesion formations in rat models.METHODS Pelvic adhesion was induced in anesthetized rats by laparotomy cecal abrasion.The animals were randomly assigned to treatment of local application with Seprafilm(an antiadhesive bioresorbable membrane) or adenoviral vectors encoding mouse TSP-1(AdTSP-1) on the surfaces of the injured cecum. The severity of the peritoneal adhesions was evaluated by blinded observers 14 d later.RESULTS Compared with control(no treatment) group, the application of Sperafilm significantly reduced the formation of adhesion band, and local administration of AdTSP-1 on the injured cecum the also attenuated the severity of peritoneal adhesion score. However, systemic delivery of AdTSP-1 did not affect the formation of adhesion.CONCLUSION We conclude that therapeutic approaches in inducing regional overexpression of TSP-1 may serve as alternative treatment strategies for preventing postoperative peritoneal adhesion.     

Role of mast cells and myofibroblasts in human peritoneal adhesion formation

OBJECTIVE: To study fibroblasts and mast cells in human peritoneal adhesions and to evaluate whether their interaction plays a role in adhesion development. SUMMARY BACKGROUND DATA: Myofibroblasts play a critical role in wound repair/fibrosis. Mast cells influence the formation of peritoneal adhesions in a rat model, and they are modulators of fibroblast functions. METHODS: Peritoneal adhesion biopsies were processed for either histology (H&E, toluidine blue) or immunohistochemistry (tryptase, laminin, collagen type IV and VIII, and alpha-SMA) or grown as explants for obtention of fibroblasts. The effects of mast cell (HMC-1) sonicate and selected mast cell mediators and cytokines on fibroblast proliferation ([ (3)H]thymidine) and collagen synthesis ([ (3)H]proline) and on fibroblast contractile activity (tridimensional collagen lattice) were evaluated. Mast cell mediators influencing fibroblast proliferation were partially characterized by enzymatic susceptibility and FPLC gel filtration column chromatography. RESULTS: Most of the fibroblasts in peritoneal adhesions were identified as alpha-SMA-positive myofibroblasts. Mast cell hyperplasia was observed and more than one third of the mast cells were degranulated. Few mast cells showed a faint staining for laminin or collagen type IV and VIII. Mast cell sonicate increased fibroblast proliferation and contractile activity while decreasing collagen synthesis. Mast cell sonicate proliferating activities were found to be proteinase-sensitive with a molecular weight of more than 158 kd, of approximately 40 kd, and of less than 10 kd. TGF-beta and tryptase enhanced collagen synthesis; TNF-alpha and chymase decreased it. None of the selected mediators increased fibroblast proliferation. CONCLUSIONS: Myofibroblasts are the main connective tissue cells present in human peritoneal adhesions, and mast cells play a direct role in peritoneal adhesion formation.     

Resistance to adhesion formation: A comparative study of treated and untreated mesh products placed in the abdominal cavity

Background: New materials have been devised to prevent postoperative adhesions when placing a prosthesis in contact with abdominal contents. Methods: Eighty rats underwent laparotomy and denudation of the serosa of the cecum and peritoneal covering of the abdominal wall. Five treated mesh products (Parietex Composite, Parietene Composite, Bard Composix E/X, Sepramesh, and Gore-Tex Dual Mesh) and one untreated mesh product (untreated Parietene) were randomly placed between the cecum and abdominal wall. A group without mesh was used as control. The animals were sacrificed at 21 days following surgery and analyzed for the presence of adhesions.Results: The incidence of adhesion formation, mean adhesion area, maximum adhesion length, and strength of adhesion separation were similar between Parietex Composite, Parietene Composite, and Bard Composix E/X, and they were significantly less than with Sepramesh, untreated Parietene, and the control group. Gore-Tex Dual Mesh resulted in less adhesions, adhesion area, mean strength of separation, and work of separation than the untreated Parietene group and the control group. Sepramesh resulted in less strength and work of separation compared to the control group. Conclusions: The incidence of adhesions and work and strength of adhesion separation are reduced when using a treated mesh, compared to the untreated mesh and the control group without mesh. Parietex Composite, Parietene Composite, Bard Composix E/X, and Gore-Tex Dual Mesh were superior to Sepramesh, untreated Parietene, and the control group in the prevention of adhesion formation.Disclosure statement: This study was sponsored by: Sofradim, Trévoux, France     

The neurokinin 1 receptor regulates peritoneal fibrinolytic activity and postoperative adhesion formation

Background

Intra-abdominal adhesions are a common source of postoperative morbidity. Previous studies in our laboratory have shown that a neurokinin 1 receptor antagonist (NK-1RA) reduces abdominal adhesion formation and increases peritoneal fibrinolytic activity. However, the cellular pathway by which the antagonist exerts its effects is unclear, as cultured peritoneal mesothelial cells exposed to the NK-1RA show increases in fibrinolytic activity despite having very low expression of neurokinin 1 receptor (NK-1R) messenger RNA and protein. Our aim was to determine whether the NK-1R plays an essential role in the adhesion-reducing effects of the NK-1RA, or if the NK-1RA is acting independently of the receptor.

Methods

Homozygous NK-1R knockout mice and age matched wild-type mice underwent laparotomy with cecal cautery to induce adhesions. At the time of surgery, mice received a single intraperitoneal dose of either NK-1RA (25 mg/kg) or saline alone. Adhesion severity at the site of cecal cautery was assessed on postoperative day 7. In a separate experiment, peritoneal fluid was collected from wild type and NK-1R knockout mice 24 h after laparotomy with cecal cautery and administration of either NK-1RA or saline. Tissue plasminogen activator levels, representative of total fibrinolytic activity, were then measured in peritoneal fluid.

Results

In wild-type mice, NK-1RA administration significantly decreased adhesion formation compared with saline controls. Among the NK-1R knockout mice, there was no significant reduction in adhesion formation by the NK-1RA. Fibrinolytic activity increased 244% in wild-type mice administered NK-1RA compared with saline controls; however, the NK-1RA did not raise fibrinolytic activity above saline controls in NK-1R knockout mice.

Conclusions

These data indicate that the NK-1R mediates the adhesion-reducing effects of the NK-1RA, in part, by the upregulation of peritoneal fibrinolysis, and suggest that the NK-1R is a promising therapeutic target for adhesion prevention.     

The role of oral fluvastatin on postoperative peritoneal adhesion formation in an experimental rat model

Background: Postoperative peritoneal adhesions are a momentousness complication after abdominal surgery. Although varied means have been used to prevent and treat adhesions, the effects have not been satisfactory. Fluvastatin, a HMG-CoA reductase inhibitors, exhibits a variety of pharmacological effects. Aim of this study was to evaluate the effect of fluvastatin on postoperative peritoneal adhesion formation.

Methods: Seventy-five male Wistar rats weighting 220–250g were randomly assigned equally to three groups. Group A was given sham operation without treatment, Group B was the model group in which postoperative peritoneal adhesion model was created without medication, and Group C was given oral fluvastatin treatment after postoperative peritoneal adhesion model created. After laparotomy on day 7, macroscopic and pathological assessment were evaluated, IL-1β and t-PA in plasma were performed to measure, and tissue samples were taken to measure MMP-9 protein.

Results: There were significant differences between the groups on adhesion grade (p?p?Conclusion: Oral fluvastatin application could reduce formation of intra-abdominal adhesion by promoting expression of MMP-9 level, lowering the levels of IL-1β and increasing the activity of t-PA after abdominal surgery.     

An evaluation of normal saline and taurolidine on intra-abdominal adhesion formation and peritoneal fibrinolysis

BACKGROUND: Intraoperative lavage with normal saline or taurolidine solutions is commonly used in abdominal surgery. For this purpose, normal saline and taurolidine, which may modify the intrinsic fibrinolytic activity of the peritoneum by breaking the peritoneal adhesions, are frequently used. We aimed to evaluate how normal saline and taurolidine affect peritoneal fibrinolysis and adhesion formation. METHODS: A rat model of peritoneal adhesion was used. Control animals received no medication, while normal saline or taurolidine solutions were administered intraperitoneally to the remaining two groups (n = 20 for each group). At postoperative day 10 adhesions were graded, and cardinal parameters of peritoneal fibrinolysis (activities and concentrations of tissue plasminogen activator [tPA], plasminogen activator inhibitor type 1 [PAI-1], and tPA/PAI-1 complex), and hydroxyproline contents were determined in peritoneal tissue samples. RESULTS: Total adhesion scores were decreased in both of the treated groups. Median tissue levels of tPA and tPA activity were higher in the treated groups versus controls. The PAI-1 levels were similar among the three groups. tPA/PAI-1 complex levels were higher in animals that received normal saline and in those treated with taurolidine solution compared with control animals. Peritoneal hydroxyproline levels were similar across the three groups. CONCLUSIONS: Our results suggest that normal saline and taurolidine solution administrations might reduce peritoneal adhesion formation, probably by altering peritoneal fibrinolytic activity.     

Role of a hyaluronate-based membrane in the prevention of peritonitis-induced adhesions

Adhesions remain a significant postoperative complication of abdominal surgery; however, recent evidence suggests that physical barriers may reduce their incidence. Although these adhesion prevention barriers are efficacious when used under aseptic conditions, little is known about their use in the presence of peritonitis, which is associated with an increased incidence of abdominal adhesions. A sodium hyaluronate and carboxymethylcellulose bioresorbable membrane (HA membrane) has been shown recently to reduce postoperative adhesions in several animal models and in two clinical trials. To investigate the efficacy of HA membrane in the presence of peritonitis, generalized peritonitis was induced in rats by either cecal ligation and puncture (CLP) or cecal ligation (CL) alone. The ceca were resected after 12 hours, and animals were randomly assigned to receive or not receive HA membrane applied to the cecum. At day 7, abdominal adhesions and abscesses were scored. In the presence of peritonitis, HA membrane did not significantly reduce the number or tenacity of adhesions. A trend toward increased abscess formarion was associated with HA membrane in the CL group. Although HA membrane has been shown to reduce the incidence and severity of abdominal adhesions under aseptic conditions, this study demonstrates that it is not efficacious in preventing abdominal adhesions in the presence of peritonitis. The association between HA membrane and abscess formation in the presence of experimental peritonitis requires further investigation. Supported by the Genzyme Corporation, Cambridge, Mass. Presented at the Fortieth Annual Meeting of The Society for Surgery of the Alimentary Tract, Orlando, Fla., May 16–19, 1999.