Biology of the peritoneum in normal homeostasis and after surgical trauma
Biology of the peritoneum in normal homeostasis and after surgical trauma
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DOI：
10.1111/j.1463-1318.2007.01345.x
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发表时间：
2007-10-01
影响因子：
3.4
通讯作者：
Jeekel, J.
中科院分区：
文献类型：
--
作者：
van der Wal, J. B. C.;Jeekel, J.
腹膜是一层浆膜，对腹腔内容物有保护作用。它通过允许分子交换和腹腔液的产生来维持动态平衡，从而提供一个腹内器官能够正常运作的环境。当受到创伤时，无论是通过手术还是由于炎症过程，一系列的反应都会启动，以再生受损的腹膜部分。炎症反应会导致炎症细胞的涌入，但也会激活常驻的间皮细胞，最终导致纤维蛋白渗出。根据创伤的严重程度，这种渗出物是由于纤维蛋白溶解而暂时的，或者由于成纤维细胞的持续存在而变得更加致密，从而导致纤维蛋白粘连。纤溶酶及其促进剂和抑制物起着关键作用，主要是组织型纤溶酶原激活剂/纤溶酶原激活剂抑制物的比值，它决定了纤溶的速度，从而决定了黏附的形成速度。损伤的速度决定了对损伤的炎症反应的速度和程度；反过来，炎症反应又决定了粘连形成的程度。在进行腹内手术时，人们应该意识到这一点，这实际上是在腹膜器官内进行手术。
The peritoneum is a serous membrane, which has a protective function for the contents of the abdominal cavity. It maintains homeostasis by allowing exchange of molecules and production of peritoneal fluid, thus providing an environment in which intra-abdominal organs can function properly. When traumatized, whether by surgery or due to inflammatory processes, a series of responses come into action to regenerate the injured part of the peritoneum. The inflammatory reaction causes influx of inflammatory cells but also activates resident mesothelial cells, ultimately leading to a fibrinous exudate. Depending on the severity of the trauma this exudate is transient due to fibrinolysis, or becomes more dense as a result of fibroblasts persisting, leading to fibrinous adhesions. A pivotal role is taken by the enzyme plasmin and its promotors and inhibitors; it is mainly the tissue-type plasminogen activator/plasminogen activator inhibitor ratio which determines the rate of fibrinolysis and therefore the rate of adhesion formation. The rate of injury determines the rate and extent of the inflammatory response to that injury; in its turn the inflammatory reaction determines the extent of adhesion formation. One should realize this when performing intra-abdominal surgery, which is in fact operating inside the peritoneal organ.