Techniques for navigating postsurgical adhesions: Insights into mechanisms and future directions.
Techniques for navigating postsurgical adhesions: Insights into mechanisms and future directions.
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DOI：
10.1002/btm2.10565
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发表时间：
2023-11
影响因子：
7.4
通讯作者：
中科院分区：
文献类型：
--
作者：
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、不孕以及未来手术的并发症。目前已经开发了几种预防粘连形成的药物，如屏障剂、抗炎剂和纤溶剂。美国食品和药物管理局（FDA）已经批准了物理屏障剂的使用，但它们与相互矛盾的临床研究和抗粘附屏障的临床应用存在争议。本文就腹膜粘连的人体解剖、粘连形成的病理生理、目前的预防药物以及目前粘连预防的研究进展作一综述。最近发现，从受伤的间皮细胞开始并结合巨噬细胞反应的早期细胞事件与粘连形成有关。这可能为开发未来的粘连预防方法提供关键成分。目前使用物理屏障来分离组织，例如由透明质酸和羧甲基纤维素组成的sepilfilm®，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溶药物仅在当前研究模型的背景下进行了研究，这受到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药物效率的限制。此外，我们还探索了新兴的治疗方法，如基因治疗和基于干细胞的方法，这些方法可能为防止粘连形成提供新的策略。总之，抗粘连剂是减轻外科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开发新的治疗方法来解决这一具有挑战性的临床问题。
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.
角质形成细胞生长因子与透明质酸钠凝胶相结合可抑制术后腹腔粘连。
影响因子：
5.6
作者：
Wei G;Zhou C;Wang G;Fan L;Wang K;Li X
通讯作者：
Li X