PDF(Pubmed)
Abstract：
Postsurgical adhesions are a common complication of surgical procedures that can lead to postoperative pain, bowel obstruction, infertility, as well as complications with future procedures. Several agents have been developed to prevent adhesion formation, such as barriers, anti-inflammatory and fibrinolytic agents. The Food and Drug Administration (FDA) has approved the use of physical barrier agents, but they have been associated with conflicting clinical studies and controversy in the clinical utilization of anti-adhesion barriers. In this review, we summarize the human anatomy of the peritoneum, the pathophysiology of adhesion formation, the current prevention agents, as well as the current research progress on adhesion prevention. The early cellular events starting with injured mesothelial cells and incorporating macrophage response have recently been found to be associated with adhesion formation. This may provide the key component for developing future adhesion prevention methods. The current use of physical barriers to separate tissues, such as Seprafilm®, composed of hyaluronic acid and carboxymethylcellulose, can only reduce the risk of adhesion formation at the end stage. Other anti-inflammatory or fibrinolytic agents for preventing adhesions have only been studied within the context of current research models, which is limited by the lack of in-vitro model systems as well as in-depth study of in-vivo models to evaluate the efficiency of anti-adhesion agents. In addition, we explore emerging therapies, such as gene therapy and stem cell-based approaches, that may offer new strategies for preventing adhesion formation. In conclusion, anti-adhesion agents represent a promising approach for reducing the burden of adhesion-related complications in surgical patients. Further research is needed to optimize their use and develop new therapies for this challenging clinical problem.
摘要：
术后粘连是外科手术的常见并发症，可导致术后疼痛，肠梗阻,不孕症,以及未来手术的并发症。已经开发了几种防止粘连形成的试剂，如障碍，抗炎药和纤维蛋白溶解药。美国食品和药物管理局（FDA）已批准使用物理屏障剂，但它们与相互矛盾的临床研究和抗粘连屏障临床应用的争议有关。在这次审查中,我们总结了人体腹膜的解剖结构,粘连形成的病理生理学，目前的预防措施，以及目前预防粘连的研究进展。最近发现，从损伤的间皮细胞开始并掺入巨噬细胞反应的早期细胞事件与粘附形成有关。这可以为开发未来的防粘连方法提供关键部分。目前使用物理屏障来分离组织，如Seprafilm®，由透明质酸和羧甲基纤维素组成，只能降低在最后阶段形成粘连的风险。其他用于预防粘连的抗炎或纤维蛋白溶解药物仅在当前研究模型的背景下进行了研究。这是由于缺乏体外模型系统以及对体内模型进行深入研究以评估抗粘连剂的有效性。此外,我们探索新兴的疗法，如基因治疗和基于干细胞的方法，这可能为防止粘连形成提供新的策略。总之,抗粘连剂是减少手术患者粘连相关并发症负担的一种有希望的方法.需要进一步的研究来优化它们的使用，并为这个具有挑战性的临床问题开发新的疗法。
