Research progress of postoperative peritoneal adhesion_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 ZHANG Longlong ¹ ,  FAN Qiang ^1,2 , GU Yuelei ¹ ,  YANG Sunhu ¹

1. Department of General Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201999, P. R. China;
2. Bengbu Medical College, Bengbu, Anhui 233003, P. R. China;

Corresponding?author：

YANG Sunhu, Email: yangsh06@126.com

Keywords：

postoperative peritoneal adhesion; pathogenesis; abdominal cavity microenvironment; prevention; therapy

DOI：

10.7507/1007-9424.201707042

Video：

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Objective To understand etiology and available treatment of postoperative peritoneal adhesion. Method Domestic and overseas literatures in recent years about research progress of peritoneal adhesion were reviewed. Results As to the previous research, the operation was the main cause of peritoneal adhesion by the injury, inflammatory reaction, and hypoxia, which further affected the changes of the peritoneal microenvironment through the release of inflammatory cells, inflammatory mediators, cytokines, etc., then disturbed the balance of deposition and dissolution of fibrin and promoted the formation of extracellular matrix and microangiogenesis, resulted in peritoneal adhesion. The main treatment measures were optimizing surgical procedure and improving surgical technique, preventing fibrinolysis and promoting fiber protein degradation, some drug therapies involved molecules and genes, using biologic barrier treatment with drug barrier and mechanical barrier, and some other adjuvant therapies. Conclusions Pathogenesis of peritoneal adhesion is complex and poorly understood currently. There is no effective clinical treatment and intervention for this disease. Research on aspects of cell and molecular of abdominal cavity microenvironment will be beneficial to precise treatment of peritoneal adhesion, and combined medication of multiple targets and multiple links and related interventions are expected to apply for peritoneal adhesion in future.

Citation： ZHANG Longlong, FAN Qiang, GU Yuelei, YANG Sunhu. Research progress of postoperative peritoneal adhesion. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(2): 245-250. doi: 10.7507/1007-9424.201707042 Copy

1.	Makarchian HR, Kasraianfard A, Ghaderzadeh P, et al. The effectiveness of heparin, platelet-rich plasma (PRP), and silver nanoparticles on prevention of postoperative peritoneal adhesion formation in rats. Acta Cir Bras, 2017, 32(1): 22-27.
2.	Brochhausen C, Schmitt VH, Mamilos A, et al. Expression of CD68 positive macrophages in the use of different barrier materials to prevent peritoneal adhesions—an animal study. J Mater Sci Mater Med, 2017, 28(1): 15.
3.	Hamming JF, Bonsing BA. Adhesiolysis during abdominal surgery: substantial risks. Ned Tijdschr Geneeskd, 2013, 157(7): A5928.
4.	田易軍, 胡森. 腹腔粘連機制和防治研究進展. 感染、炎癥、修復, 2008, 9(2): 126-128.
5.	Arung W, Meurisse M, Detry O. Pathophysiology and prevention of postoperative peritoneal adhesions. World J Gastroenterol, 2011, 17(41): 4545-4553.
6.	Brüggmann D, Tchartchian G, Wallwiener M, et al. Intra-abdominal adhesions: definition, origin, significance in surgical practice, and treatment options. Dtsch Arztebl Int, 2010, 107(44): 769-775.
7.	劉賓, 彭創. 腹腔粘連的研究進展. 中國現代醫生, 2013, 51(5): 24-25.
8.	González-Quintero VH, Cruz-Pachano FE. Preventing adhesions in obstetric and gynecologic surgical procedures. Rev Obstet Gynecol, 2009, 2(1): 38-45.
9.	Atta HM. Prevention of peritoneal adhesions: a promising role for gene therapy. World J Gastroenterol, 2011, 17(46): 5049-5058.
10.	Alpay Z, Saed GM, Diamond MP. Postoperative adhesions: from formation to prevention. Semin Reprod Med, 2008, 26(4): 313-321.
11.	Vergnts J, Coosemans A, Corona R, et al. Intraperitoneal injection of cultured mesothelial cells decrease CO₂ pneumoperitoneum-enhanced adhesions in a laparoscopic mouse model. Gynecol Surg, 2011, 8(4): 409-414.
12.	Corona R, Verguts J, Koninckx R, et al. Intraperitoneal temperature and desiccation during endoscopic surgery. Intraoperative humidification and cooling of the peritoneal cavity can reduce adhesions. Am J Obstet Gynecol, 2011, 205(4): 392.e1-7.
13.	趙義江, 張國志, 王長友, 等. 腹腔粘連的研究現狀分析. 華北煤炭醫學院學報, 2011, 13(6): 777-779.
14.	Zhang Y, Liu Q, Yang N, et al. Hyaluronic acid and oxidized regenerated cellulose prevent adhesion reformation after adhesiolysis in rat models. Drug Des Devel Ther, 2016, 10: 3501-3507.
15.	Koca YS, Tarhan R, Kaya S, et al. Effects of saline lavage temperature on peritoneal fibrinolysis and adhesion formation. Ulus Travma Acil Cerrahi Derg, 2016, 22(1): 1-6.
16.	林思, 秦飛, 宋路瑤, 等. 丹參酮ⅡA 磺酸鈉通過增強腹膜纖溶系統活性降低大鼠術后腹膜粘連發生. 南方醫科大學學報, 2016, 36(2): 260-264.
17.	顏帥, 李文林, 曾莉. 腹腔微環境與腹腔粘連相關性的研究進展. 實用醫學雜志, 2014, 30(1): 155-157.
18.	Sapir L, Tzlil S. Talking over the extracellular matrix: How do cells communicate mechanically? Semin Cell Dev Biol, 2017 Jun 16. pii: S1084-9521(16)30310-X.
19.	Maciver AH, McCall M, James Shapiro AM. Intra-abdominal adhesions: cellular mechanisms and strategies for prevention. Int J Surg, 2011, 9(8): 589-594.
20.	Bayhan Z, Zeren S, Kocak FE, et al. Antiadhesive and anti-inflammatory effects of pirfenidone in postoperative intra-abdominal adhesion in an experimental rat model. J Surg Res, 2016, 201(2): 348-355.
21.	Yan S, Yang L, Yue YZ, et al. Effect of ligustrazine nanoparticles nano spray on transforming growth factor-β/Smad signal pathway of rat peritoneal mesothelial cells induced by tumor necrosis factor-α. Chin J Integr Med, 2016, 22(8): 629-634.
22.	陳志新. 腹腔粘連的形成及術后預防. 中國普外基礎與臨床雜志, 2003, 10(5): 509-510.
23.	Braun KM, Diamond MP. The biology of adhesion formation in the peritoneal cavity. Semin Pediatr Surg, 2014, 23(6): 336-343.
24.	Koninckx PR, Gomel V, Ussia A, et al. Role of the peritoneal cavity in the prevention of postoperative adhesions, pain, and fatigue. Fertil Steril, 2016, 106(5): 998-1010.
25.	Xiao L, Sun L, Liu FY, et al. Connective tissue growth factor knockdown attenuated matrix protein production and vascular endothelial growth factor expression induced by transforming growth factor-beta1 in cultured human peritoneal mesothelial cells. Ther Apher Dial, 2010, 14(1): 27-34.
26.	蘭義兵, 周堅紅. 婦科手術后粘連發生機制及防治研究進展. 國際婦產科學雜志, 2010, 37(3): 179-182.
27.	劉博, 葛春林, 宋茂民. 奧曲肽預防術后腹腔粘連的實驗研究. 中國現代普通外科進展, 2004, 7(5): 294.
28.	Nappi C, Di Spiezio Sardo A, Greco E, et al. Prevention of adhesions in gynaecological endoscopy. Hum Reprod Update, 2007, 13(4): 379-394.
29.	Topal E, Ozturk E, Sen G, et al. A comparison of three fibrinolytic agents in prevention of intra-abdominal adhesions. Acta Chir Belg, 2010, 110(1): 71-75.
30.	翁永強, 涂彥淵, 肖立, 等. 轉化生長因子-β 多克隆抗體預防腹腔粘連的實驗研究. 中國普通外科雜志, 2002, 11(12): 741-745.
31.	Zhang Z, Garron TM, Li XJ, et al. Recombinant human decorin inhibits TGF-beta1-induced contraction of collagen lattice by hypertrophic scar fibroblasts. Burns 2009; 35: 527-537.
32.	鄭振華, 張樺, 潘玉先, 等.應用 VEGF 抗體預防術后腹腔粘連的實驗研究.世界華人雜志, 1999, 7:227.
33.	Ignjatovic D, Aasland K, Pettersen M, et al. Intra-abdominal administration of bevacizumab diminishes intra-peritoneal adhesions. Am J Surg, 2010; 200(2): 270-275.
34.	Hellebrekers BW, Trimbos-Kemper TC, Boesten L, et al. Preoperative predictors of postsurgical adhesion formation and the prevention of adhesions with plasminogen activator (PAPA-study): results of a clinical pilot study. Fertil Steril, 2009, 91(4): 1204-1214.
35.	Atta HM, Al-Hendy A, El-Rehany MA, et al. Adenovirus-mediated overexpression of human tissue plasminogen activator prevents peritoneal adhesion formation/reformation in rats. Surgery, 2009, 146(1): 12-17.
36.	曾莉, 顏帥, 李文林. 國外抗腹腔粘連材料的研究進展. 醫學研究生學報, 2014, 27(12): 1315-1317.
37.	Yang B, Gong C, Zhao X, et al. Preventing postoperative abdominal adhesions in a rat model with PEG-PCL-PEG hydrogel. Int J Nanomedicine, 2012, 7: 547-557.
38.	Gong CY, Wu QJ, Liao JF, et al. Prevention of postsurgical cauterization-induced peritoneal adhesions by biodegradable and thermosensitive micelles. J Biomed Nanotechnol, 2013, 9(12): 1984-1995.
39.	Pan G, Liu S, Zhao X, et al. Full-course inhibition of biodegradation-induced inflammation in fibrous scaffold by loading enzyme-sensitive prodrug. Biomaterials, 2015, 53: 202-210.
40.	Cheng L, Sun X, Zhao X, et al. Surface biofunctional drug-loaded electrospun fibrous scaffolds for comprehensive repairing hypertrophic scars. Biomaterials, 2016, 83: 169-181.
41.	Jiang S, Zhao X, Chen S, et al. Down-regulating ERK1/2 and SMAD2/3 phosphorylation by physical barrier of celecoxib-loaded electrospun fibrous membranes prevents tendon adhesions. Biomaterials, 2014, 35(37): 9920-9929.

1. Makarchian HR, Kasraianfard A, Ghaderzadeh P, et al. The effectiveness of heparin, platelet-rich plasma (PRP), and silver nanoparticles on prevention of postoperative peritoneal adhesion formation in rats. Acta Cir Bras, 2017, 32(1): 22-27.
2. Brochhausen C, Schmitt VH, Mamilos A, et al. Expression of CD68 positive macrophages in the use of different barrier materials to prevent peritoneal adhesions—an animal study. J Mater Sci Mater Med, 2017, 28(1): 15.
3. Hamming JF, Bonsing BA. Adhesiolysis during abdominal surgery: substantial risks. Ned Tijdschr Geneeskd, 2013, 157(7): A5928.
4. 田易軍, 胡森. 腹腔粘連機制和防治研究進展. 感染、炎癥、修復, 2008, 9(2): 126-128.
5. Arung W, Meurisse M, Detry O. Pathophysiology and prevention of postoperative peritoneal adhesions. World J Gastroenterol, 2011, 17(41): 4545-4553.
6. Brüggmann D, Tchartchian G, Wallwiener M, et al. Intra-abdominal adhesions: definition, origin, significance in surgical practice, and treatment options. Dtsch Arztebl Int, 2010, 107(44): 769-775.
7. 劉賓, 彭創. 腹腔粘連的研究進展. 中國現代醫生, 2013, 51(5): 24-25.
8. González-Quintero VH, Cruz-Pachano FE. Preventing adhesions in obstetric and gynecologic surgical procedures. Rev Obstet Gynecol, 2009, 2(1): 38-45.
9. Atta HM. Prevention of peritoneal adhesions: a promising role for gene therapy. World J Gastroenterol, 2011, 17(46): 5049-5058.
10. Alpay Z, Saed GM, Diamond MP. Postoperative adhesions: from formation to prevention. Semin Reprod Med, 2008, 26(4): 313-321.
11. Vergnts J, Coosemans A, Corona R, et al. Intraperitoneal injection of cultured mesothelial cells decrease CO₂ pneumoperitoneum-enhanced adhesions in a laparoscopic mouse model. Gynecol Surg, 2011, 8(4): 409-414.
12. Corona R, Verguts J, Koninckx R, et al. Intraperitoneal temperature and desiccation during endoscopic surgery. Intraoperative humidification and cooling of the peritoneal cavity can reduce adhesions. Am J Obstet Gynecol, 2011, 205(4): 392.e1-7.
13. 趙義江, 張國志, 王長友, 等. 腹腔粘連的研究現狀分析. 華北煤炭醫學院學報, 2011, 13(6): 777-779.
14. Zhang Y, Liu Q, Yang N, et al. Hyaluronic acid and oxidized regenerated cellulose prevent adhesion reformation after adhesiolysis in rat models. Drug Des Devel Ther, 2016, 10: 3501-3507.
15. Koca YS, Tarhan R, Kaya S, et al. Effects of saline lavage temperature on peritoneal fibrinolysis and adhesion formation. Ulus Travma Acil Cerrahi Derg, 2016, 22(1): 1-6.
16. 林思, 秦飛, 宋路瑤, 等. 丹參酮ⅡA 磺酸鈉通過增強腹膜纖溶系統活性降低大鼠術后腹膜粘連發生. 南方醫科大學學報, 2016, 36(2): 260-264.
17. 顏帥, 李文林, 曾莉. 腹腔微環境與腹腔粘連相關性的研究進展. 實用醫學雜志, 2014, 30(1): 155-157.
18. Sapir L, Tzlil S. Talking over the extracellular matrix: How do cells communicate mechanically? Semin Cell Dev Biol, 2017 Jun 16. pii: S1084-9521(16)30310-X.
19. Maciver AH, McCall M, James Shapiro AM. Intra-abdominal adhesions: cellular mechanisms and strategies for prevention. Int J Surg, 2011, 9(8): 589-594.
20. Bayhan Z, Zeren S, Kocak FE, et al. Antiadhesive and anti-inflammatory effects of pirfenidone in postoperative intra-abdominal adhesion in an experimental rat model. J Surg Res, 2016, 201(2): 348-355.
21. Yan S, Yang L, Yue YZ, et al. Effect of ligustrazine nanoparticles nano spray on transforming growth factor-β/Smad signal pathway of rat peritoneal mesothelial cells induced by tumor necrosis factor-α. Chin J Integr Med, 2016, 22(8): 629-634.
22. 陳志新. 腹腔粘連的形成及術后預防. 中國普外基礎與臨床雜志, 2003, 10(5): 509-510.
23. Braun KM, Diamond MP. The biology of adhesion formation in the peritoneal cavity. Semin Pediatr Surg, 2014, 23(6): 336-343.
24. Koninckx PR, Gomel V, Ussia A, et al. Role of the peritoneal cavity in the prevention of postoperative adhesions, pain, and fatigue. Fertil Steril, 2016, 106(5): 998-1010.
25. Xiao L, Sun L, Liu FY, et al. Connective tissue growth factor knockdown attenuated matrix protein production and vascular endothelial growth factor expression induced by transforming growth factor-beta1 in cultured human peritoneal mesothelial cells. Ther Apher Dial, 2010, 14(1): 27-34.
26. 蘭義兵, 周堅紅. 婦科手術后粘連發生機制及防治研究進展. 國際婦產科學雜志, 2010, 37(3): 179-182.
27. 劉博, 葛春林, 宋茂民. 奧曲肽預防術后腹腔粘連的實驗研究. 中國現代普通外科進展, 2004, 7(5): 294.
28. Nappi C, Di Spiezio Sardo A, Greco E, et al. Prevention of adhesions in gynaecological endoscopy. Hum Reprod Update, 2007, 13(4): 379-394.
29. Topal E, Ozturk E, Sen G, et al. A comparison of three fibrinolytic agents in prevention of intra-abdominal adhesions. Acta Chir Belg, 2010, 110(1): 71-75.
30. 翁永強, 涂彥淵, 肖立, 等. 轉化生長因子-β 多克隆抗體預防腹腔粘連的實驗研究. 中國普通外科雜志, 2002, 11(12): 741-745.
31. Zhang Z, Garron TM, Li XJ, et al. Recombinant human decorin inhibits TGF-beta1-induced contraction of collagen lattice by hypertrophic scar fibroblasts. Burns 2009; 35: 527-537.
32. 鄭振華, 張樺, 潘玉先, 等.應用 VEGF 抗體預防術后腹腔粘連的實驗研究.世界華人雜志, 1999, 7:227.
33. Ignjatovic D, Aasland K, Pettersen M, et al. Intra-abdominal administration of bevacizumab diminishes intra-peritoneal adhesions. Am J Surg, 2010; 200(2): 270-275.
34. Hellebrekers BW, Trimbos-Kemper TC, Boesten L, et al. Preoperative predictors of postsurgical adhesion formation and the prevention of adhesions with plasminogen activator (PAPA-study): results of a clinical pilot study. Fertil Steril, 2009, 91(4): 1204-1214.
35. Atta HM, Al-Hendy A, El-Rehany MA, et al. Adenovirus-mediated overexpression of human tissue plasminogen activator prevents peritoneal adhesion formation/reformation in rats. Surgery, 2009, 146(1): 12-17.
36. 曾莉, 顏帥, 李文林. 國外抗腹腔粘連材料的研究進展. 醫學研究生學報, 2014, 27(12): 1315-1317.
37. Yang B, Gong C, Zhao X, et al. Preventing postoperative abdominal adhesions in a rat model with PEG-PCL-PEG hydrogel. Int J Nanomedicine, 2012, 7: 547-557.
38. Gong CY, Wu QJ, Liao JF, et al. Prevention of postsurgical cauterization-induced peritoneal adhesions by biodegradable and thermosensitive micelles. J Biomed Nanotechnol, 2013, 9(12): 1984-1995.
39. Pan G, Liu S, Zhao X, et al. Full-course inhibition of biodegradation-induced inflammation in fibrous scaffold by loading enzyme-sensitive prodrug. Biomaterials, 2015, 53: 202-210.
40. Cheng L, Sun X, Zhao X, et al. Surface biofunctional drug-loaded electrospun fibrous scaffolds for comprehensive repairing hypertrophic scars. Biomaterials, 2016, 83: 169-181.
41. Jiang S, Zhao X, Chen S, et al. Down-regulating ERK1/2 and SMAD2/3 phosphorylation by physical barrier of celecoxib-loaded electrospun fibrous membranes prevents tendon adhesions. Biomaterials, 2014, 35(37): 9920-9929.

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Research progress of postoperative peritoneal adhesion

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