腹膜粘连的最新研究进展

腹膜粘连是腹盆腔手术后常见的并发症之一，发生率90％，许多因素与术后腹膜粘连的形成有关，如手术损伤、异物残留、组织缺血等。这些因素引起腹膜组织损伤、炎症反应，而浸润的炎症细胞释放细胞因子，被认为是导致腹膜粘连形成的触发机制。腹腔粘连是引起慢性腹痛、女性不育、机械性肠梗阻的主要原因。近年来，对腹膜粘连的大量研究仍未取得突破性进展，     

间皮细胞及其在腹膜粘连中的研究进展

腹膜粘连仍是腹部手术后常见的并发症。腹膜内纤维性粘连可以引起严重的机械性肠梗阻、女性不育及慢性盆腔痛。其原因包括手术损伤、炎症反应、异物残留、组织缺血等。目前预防纤维性粘连的方法有抗炎症反应、应用抗生素、物理和化学性屏障。但临床上尚无广泛应用的好方法。对粘连形成的病理生理学过程进行细胞和分子机制的探讨,可以为预防粘连提出更有效的方法。近年来研究认为,间皮细胞在腹膜创伤修复及粘连形成过程中发挥重要的作用。现综述如下。     

WNT2B基因高表达成纤维细胞诱导克罗恩病肠道损伤的机制研究

目的探讨WNT2B基因高表达成纤维细胞通过激活巨噬细胞促进克罗恩病肠道组织损伤的机制。方法生物信息分析、病理组织研究及细胞实验研究。生物信息分析方面, 收集课题组前期炎症性肠病(IBD)患儿结肠组织细胞生物信息研究数据, 再次进行单细胞测序分析。病理组织研究方面, 以2022年7至9月于广州市妇女儿童医疗中心消化科住院行结肠镜检查确诊为克罗恩病的10例患儿为研究对象, 每例患儿均分别取结肠炎症明显或溃疡部位组织及邻旁炎症轻微或正常部位组织, 根据结肠镜下外观显示炎症明显或溃疡部位组织为炎症组, 炎症轻且无溃疡部位组织为非炎症组。结肠组织行HE染色观察其病理情况, 组织免疫荧光检测巨噬细胞浸润和CXCL12的表达情况。细胞实验研究方面, 转染了WNT2B质粒或空载质粒的成纤维细胞分别与有或无经盐霉素处理的巨噬细胞共培养, 蛋白质印迹法检测Wnt经典通路蛋白表达情况;使用SKL2001处理的巨噬细胞作为实验组, 磷酸盐缓冲液处理的巨噬细胞为对照组, 采用实时荧光定量PCR(qPCR)反应、酶联免疫吸附试验检测巨噬细胞CXCL12的表达及分泌情况。组间比较采用t检验或秩和检验。结果单细胞测序...     

两种手术方法下化脓性腹膜炎患儿血清t-PA、PAI的变化研究

目的通过比较开腹手术及腹腔镜手术下化脓性腹膜炎患儿血清t-PA、PAI的动态变化,探讨其与腹膜粘连的关系以及腹腔镜手术对化脓性腹膜炎术后腹膜粘连的保护作用。方法采用开腹手术及腹腔镜手术治疗化脓性腹膜炎,取血检测血浆中t-PA、PAI两种粘连因子的变化及粘连发生情况,并比较两组病人临床恢复情况。结果经腹腔镜治疗的患儿术后24-48ht-PA、PAI值即开始发生变化,而开腹手术治疗的患儿术后96h才出现变化,腹腔镜治疗的患儿术后肠鸣音恢复时间、肛门排气、排便时间、术后白细胞恢复正常时间均短于开腹手术组。结论腹腔镜手术可以有效清除腹腔内炎症渗出,使术后粘连形成过程中,体内t-PA、PAI值出现变化,起到减轻粘连的作用。     

腹膜炎大鼠肺泡巨噬细胞分泌IL-1、TNF的变化及大黄牡丹皮汤的调节作用

目的观察肺泡巨噬细胞在急性腹膜炎时分泌IL-1、TNF的变化,以及应用大黄牡丹皮汤进行治疗的调节作用。方法取健康Wistar大鼠40只,将其分成感染组、中药治疗组、抗生素组及正常对照组,通过腹腔内注入菌液的方法,造成大鼠腹膜炎模型。采用单纯应用抗生素、抗生素配合大黄牡丹皮汤不同方法进行治疗。分离和培养肺泡巨噬细胞,收集培养上清液,采用MTT法测定细胞因子活性。结果模型组巨噬细胞分泌IL-1、TNF的水平显著升高(P<0.01),中药治疗组虽明显高于对照组,但明显低于模型组(P<0.05),抗生素与造模组差异无统计学意义(P>0.05)。结论大黄牡丹皮汤能抑制腹膜炎时炎性细胞因子的过度分泌,对大鼠巨噬细胞功能有明显的调整作用”     

细胞因子与SIRS/MODS的概念及在儿科临床的意义

近年来由于科学技术的发展，检测手段的先进，从分子生物学的角度进行研究的课题越来越多越深入，认识到一些危重疾病的病理生理过程与炎症介质有关，炎症介质包括细胞因子、内皮素、自由基、活化的中性粒细胞、活化补体C3。、组织胺、环氧化酶等。细胞因子（CK）是细胞自身分泌产生的一种肽类介质，在各组织细胞和网状内皮细胞之间起介导的作用，起到细胞之间、介质和靶细胞受体之间的信息交通和协调作用。当机体受到损伤或感染后，受累的组织和网状内皮系统则产生大量的CK，引起全身炎症反应综合征，进一步发展则形成MODS或MSOF，在…     

SIRS ALI/ARDS的临床相互关系与治疗

目前已认识到一些危重症的病理生理过程 ,与炎性介质的参与有关。炎性介质包括细胞因子、内皮素、自由基、活化的中性粒细胞、活化的补体Ｃ5ａ、组织胺、环氧化酶等。细胞因子是细胞自身分泌产生的一种肽类物质 ,当机体受到感染或损伤后 ,受累的组织和网状内皮系统则产生大量的细胞因子 ,如肿瘤坏死因子 (ＴＮＦ α)、白细胞介素 (ＩＬ)、血小板激活因子 (ＰＡＦ)等 ,引起全身炎症反应综合征(ＳＩＲＳ)。ＴＮＦ α具有广泛的生物活性 ,是机体炎症反应中最重要的炎性介质 ,能诱发多种细胞因子释放 ,引起全身炎症反应。白细胞介素有多种 ,如白…     

辅助T细胞17经中性粒细胞介导气道重建的研究进展

最近研究发现了一种独特的不同于辅助T细胞(Th)1、2的CD4+T细胞新亚型--Th17,它在支气管哮喘(哮喘)的气道重建中起着关键作用.Th17分泌的主要细胞因子IL-17可以通过诱导CXC趋化因子、白细胞介素(IL)-6、IL-8、巨噬细胞炎症蛋白-2、粒-巨噬细胞集落刺激因子、粒细胞集落刺激因子和转化生长因子-β等细胞因子释放,促进气道中性粒细胞募集和活化,产生弹性蛋白酶、髓样过氧化物酶和蛋白水解酶-3等介质,与哮喘的气道炎症损伤和重建密切相关.IL-17有可能成为降低哮喘严重程度及控制哮喘病理进程的新靶点.     

过敏性紫癜患儿止血分子标志物的测定意义

目的　研究儿童过敏性紫癜 (HSP)止血分子标志物的变化 ,探讨其在HSP发病中的作用及临床意义。方法　采用发色底物法测定组织型纤溶酶原激活物 (t PA)、组织型纤溶酶原激活物抑制物 (PAI 1)活性 ;采用ELISA双抗体夹心法测定血浆血管性假血友病因子 (vWF)、颗粒膜蛋白 14 0 (GMP 14 0 )及蛋白C(PC)含量。结果　发病初期血浆PAI 1、vWF、GMP 14 0水平均较正常对照组显著升高 ,血浆t PA、PC水平下降。肾炎组改变尤为明显 ;恢复期非肾炎组各观察指标恢复正常 ,但肾炎组部分患儿在病程后期血浆PAI 1、vWF水平仍高于正常对照组 ,而t PA水平稍低于对照组。结论　HSP患儿存在血管内皮损伤、血小板活化及血栓前状态 ,这些分子标志物变化以肾炎组尤为明显 ,表明止血异常在HSP ,尤其紫癜性肾炎 (HSPN)发生、发展中起重要作用     

腹腔粘连的研究进展

腹腔感染或腹部手术后易出现腹腔粘连,危害人类健康。腹腔粘连的发生机制及其如何减少腹腔粘连的研究一直没有间断,现就其情况综述如下。1发生机制1.1腹腔粘连形成的病理因素腹腔粘连形成原因可分为先天性和获得性两大类。先天性因素多为发育异常和胎粪性腹膜炎;后天性因素为手术、感染、缺血、出血、创伤、异物存留、化学药物刺激等。1.2粘连的构成典型的纤维粘连是高度分化的,其表面有一层与正常腹膜表面相同的间皮细胞,内部是由大量胶原纤维及部分弹性纤维组成的结缔组织,其间分布着纤维母细胞及少量吞噬细胞;并有毛细血管长入其中,能提…     

小儿急性阑尾炎手术中腹腔冲洗的必要性探讨

目的通过对比各型小儿阑尾炎术中行腹腔冲洗与未行腹腔冲洗的疗效,探讨术中行腹腔冲洗的必要性。方法收集本院近3年内收治的急性阑尾炎病例共350例,其中A组为单纯性阑尾炎,行腹腔镜阑尾切除术;B、C组为化脓性阑尾炎未穿孔,B组行腹腔镜阑尾切除+腹腔引流术,C组行腹腔镜阑尾切除+腹腔冲洗+腹腔引流术;D、E组为坏疽穿孔性阑尾炎,D组行腹腔镜阑尾切除+腹腔引流术,E组行腹腔镜阑尾切除+腹腔冲洗+腹腔引流术。术后对患者资料进行详细统计和相应分析。结果急性单纯性阑尾炎行腹腔镜阑尾切除术后患儿预后良好。急性化脓性阑尾炎组术中行腹腔冲洗后,术后患儿肛门排气排便时间、直肠刺激症状、间断腹痛情况明显增加,且术后腹腔脓肿的发生率明显增多,术后5 d血常规白细胞稍高,1例并发右侧膈下脓肿,平均住院时间较未冲洗组明显延长;相反,急性坏疽穿孔性阑尾炎组,术中行腹腔冲洗后,患儿术后舡门排气排便时间缩短,术后腹腔残余感染、直肠刺激症状、间断腹痛情况降低,术后腹腔脓肿等并发症的发生率降低,术后5 d血白细胞较未冲洗组稍低。术后患儿恢复相对较快,住院时间短。结论小儿急性阑尾炎术中冲洗治疗应根据具体情况选择合适的方法,术中调节体位,充分显露脓腔,引流彻底,引流管位置适宜;急性化脓性阑尾炎未穿孔者不需行腹腔冲洗,而急性坏疽穿孔性阑尾炎则需术中行腹腔冲洗。     

Anatomy and physiology of the peritoneum

The peritoneum is commonly encountered in abdominal surgery. The development and rotation of the primitive gut tube lead to the normal adult arrangement of the peritoneal cavity, which forms bloodless planes allowing the retroperitoneal portions of the bowel to be safely mobilised. The arrangement of the peritoneum also forms spaces in which infected fluid or pus can collect. The microcirculation of peritoneal fluid is now well understood, and the large absorptive surface of the peritoneum can be exploited in peritoneal dialysis. The absorption of gas by the peritoneum following abdominal surgery is faster in neonates than in older children, and understanding this process contributes to the interpretation of post-operative radiographs.     

Reduction of peritoneal adhesions by sustained and local administration of epidermal growth factor

Previous studies have shown epidermal growth factor (EGF) facilitate peritoneal membrane healing by augmenting cell adhesion and migration. The objective of this study was to show the effect of sustained and local administration of EGF on peritoneal adhesion. Fourty-two rats were divided into six groups: control 7 and 14, gelatin 7 and 14, and EGF 7 and 14. Adhesions were created by scraping the cecum with mesh gause followed by application of absolute alcohol and placement of silk suture in the parietal peritoneum. The anterior walls of the intestines were covered with 5 × 5 cm unloaded, and EGF loaded gelatin films in the gelatin and EGF groups, respectively. The rats were killed on days 7 and 14 to assess the adhesion occurring, and for biochemical examination. The mean adhesion grades of EGF groups were significantly lower than in the other groups (P < 0.008). The mean adenosine deaminase (ADA) measurements of EGF 7 group were lower than in the gelatin 7 and control 7 groups but the difference was not significant (P > 0.008). The mean ADA measurements in the 14 days groups were as follows: control 14 < EGF 14 < gelatin 14 groups. The mean ADA measurements between 14 days groups did not significantly differ from each other (P > 0.008). The mean hydroxyproline measurements did not differ among the groups (P > 0.008). EGF decreased intestinal adhesion in our study. EGF has important roles in DNA synthesis and cell proliferation. Further studies are required to determine the exact mechanism by which EGF lowers the efficiency of intestinal adhesion.     

Hemodynamic effects of peritoneal dialysis in three children following open heart surgery

Summary We studied the hemodynamic responses of peritoneal dialysis (PD) in three children following open heart surgery. Hemodynamic measurements were made prior to a dialysis run, following the instillation of dialysis solution (20 ml/kg), and immediately prior to and 5 min after drainage of the peritoneal cavity. The same protocol was repeated 48 h later. There was a significant increase in right atrial pressure (RAP) and mean pulmonary artery pressure upon instillation of the dialysate into the peritoneal cavity (p<0.01). However, cardiac index, mean arterial blood pressure (MAP), systemic (SVRI) and pulmonary vascular resistances (PVRI), left atrial pressure (LAP), and oxygen saturation did not change significantly. There were no significant differences between responses in the initial study and that performed 48 h later. PD is associated with modest right-sided hemodynamic changes which, in this small group of patients, did not compromise patient care.     

用气管导管作腹膜透析管治疗儿童急性肾衰竭

目的腹膜透析(peritonealdialysis,PD)是治疗儿童急性肾功能衰竭(acuterenalfailure,ARF)的有效方法,本研究拟寻找一种合适的PD管代用品,简化置管方法,降低腹膜炎的发生率。方法不同年龄阶段的ARF患儿分别选用2.5、3.0、3.5号的气管导管,经刺侧孔、消毒等处理后代替PD管,用深静脉置管装置,参考Seldinger穿刺法行床边置管,PD液分别从二个不同的通路持续或间断流入、流出腹腔。结果经此法治疗的26例ARF患儿虽有7例死于DIC或MODF,但无一例发生腹膜炎和腹壁渗漏,水肿均逐渐消退,大部分尿量增加。结论在没有合适的商用PD管的情况下,以气管导管代替PD管,床边插管,有一定疗效,值得进一步探讨和推广。     

Pleural macrophages are the dominant cell population in the thoracic cavity with an inflammatory cytokine profile similar to peritoneal macrophages

Numerous human macrophage (mϕ) subpopulations with different behavior have been identified in adults. It is well known that peritoneal mϕ are activated by abdominal surgery and subsequently contribute to a systemic inflammatory response that leads to immune suppression, increased morbidity and mortality. Information on the role of pleural mϕ in adults is scarce and information on their role in children is lacking. We investigated the behavior of pleural versus peritoneal mϕ in children and adolescents. As a first step, we compared the cellular composition of the pleural and peritoneal surface in children and adolescents. Pleural and peritoneal lavages were performed in 21 patients undergoing non-contaminated laparoscopic and thoracoscopic surgical procedures. We observed a significantly higher percentage of mϕ in the pleural compared to the peritoneal cavity with less lymphocytes, a small amount of polymorphonuclear cells (PMNs) and other cells. To further study the mϕ inflammatory response, we measured the spontaneous and LPS triggered cytokine release of isolated pleural versus peritoneal mϕ (IL-1β, IL-6, and IL-10). The pattern of cytokine release was similar in both, pleural and peritoneal mϕ. Directly after lavage, they showed a strong activation, with no difference between stimulated and non-stimulated cells. After 24 h resting, mϕ of both compartments reacted to LPS with a similar significant increase in the cytokine release. In conclusion, our results demonstrate that pleural mϕ represent the dominant cell population in the pleural cavity of the young. They show a similar inflammatory response as peritoneal mϕ and should be considered to play a major role in the local inflammatory response to thoracic surgery.     

腹膜透析治疗小儿肾功能衰竭临床分析

目的 探讨腹膜透析对儿童肾功能衰竭治疗的效果.方法 对2003年6月至2008年4月应用腹膜透析治疗的11例急慢性肾功能衰竭患儿临床资料及随访结果 进行分析.结果 11例患儿无一例死亡,急性肾功能衰竭平均在院透析时间15.5 d,慢性肾功能衰竭平均在院透析时间22.8 d.治疗前后血尿素氮、肌酐分别由(34.03±8.44) mmol/L和(710.09±167.54) μmol/L降至(15.94±4.93) mmol/L和(233.87±92.71) μmol/L,差异有非常显著性(P＜0.01).血钠由(130.91±9.15) mmol/L升至(139.46±3.98) mmol/L,差异有显著性(P＜0.05).血碳酸氢根由(14.56±2.07) mmol/L升至(22.47±3.29) mmol/L,差异有非常显著性(P＜0.01).随访时间1个月至5年不等.5例急性肾功能衰竭患儿肾功能和尿常规均正常.1例慢性肾功能衰竭患儿规律透析后行肾移植,3例仍于院外透析中.结论 经济、实用、有效的腹膜透析辅以综合治疗可成为儿童急慢性肾功能衰竭较好替代治疗方法 .     

Peritoneal dialysis following open heart surgery in children

Summary Over the course of the last 5 years, we have instituted peritoneal dialysis on 26 (7.7%) of 338 complex postoperative cardiac bypass cases.The mean age of dialysis patients was 0.64±0.75 years with a range of 0.1–2.5 years. The indications for the start of dialysis were oliguria (15 cases), fluid overload (three cases), hyperkalemia (one case), and anuria (seven cases). There were no complications as the result of dialysis, although two of the dialysis catheters had to be replaced. Dialysis successfully treated the starting indication in all cases. Dialysis was instituted at 47±50 (12–240) h after bypass, and lasted 111±134 (18–552) h; early institution of dialysis had no effect on mortality.Low cardiac output was a significant predictor of death in dialysis patients (p=0.015). Age was a significant determinant of death (p=0.0001) and the need for dialysis (p=0.0043) in the total bypass population; the younger the patient, the greater was the likelihood of death or the need for dialysis. Age, however, was not a predictor of mortality in the peritoneal dialysis group.     

32例小儿腹部结核的外科治疗

３２例小儿腹部结核经外科治疗，２１例治愈，１１例好转。术后无腹腔内并发症。对于有并发症的小儿腹部结核应行手术治疗，对于小儿腹部包块与肿瘤难以鉴别者，应行剖腹探查术。手术治疗原则是清除结核病灶，解除粘连梗阻，切除结核病变重建胃肠道及有效的抗结核治疗。