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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Abstract Full text Figures/Tables Video References Cited by

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.	田易军, 胡森. 腹腔粘连机制和防治研究进展. 感染、炎症、修复, 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.	刘宾, 彭创. 腹腔粘连的研究进展. 中国现代医生, 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.	赵义江, 张国志, 王长友, 等. 腹腔粘连的研究现状分析. 华北煤炭医学院学报, 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, 秦飞, 宋路瑶, 等. 丹参酮ⅡA 磺酸钠通过增强腹膜纤溶系统活性降低大鼠术后腹膜粘连发生. 南方医科大学学报, 2016, 36(2): 260-264.
17.	颜帅, 李文林, 曾莉. 腹腔微环境与腹腔粘连相关性的研究进展. 实用医学杂志, 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.	陈志新. 腹腔粘连的形成及术后预防. 中国普外基础与临床杂志, 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.	兰义兵, 周坚红. 妇科手术后粘连发生机制及防治研究进展. 国际妇产科学杂志, 2010, 37(3): 179-182.
27.	刘博, 葛春林, 宋茂民. 奥曲肽预防术后腹腔粘连的实验研究. 中国现代普通外科进展, 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.	翁永强, 涂彦渊, 肖立, 等. 转化生长因子-β 多克隆抗体预防腹腔粘连的实验研究. 中国普通外科杂志, 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.	郑振华, 张桦, 潘玉先, 等.应用 VEGF 抗体预防术后腹腔粘连的实验研究.世界华人杂志, 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, 颜帅, 李文林. 国外抗腹腔粘连材料的研究进展. 医学研究生学报, 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. 田易军, 胡森. 腹腔粘连机制和防治研究进展. 感染、炎症、修复, 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. 刘宾, 彭创. 腹腔粘连的研究进展. 中国现代医生, 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. 赵义江, 张国志, 王长友, 等. 腹腔粘连的研究现状分析. 华北煤炭医学院学报, 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, 秦飞, 宋路瑶, 等. 丹参酮ⅡA 磺酸钠通过增强腹膜纤溶系统活性降低大鼠术后腹膜粘连发生. 南方医科大学学报, 2016, 36(2): 260-264.
17. 颜帅, 李文林, 曾莉. 腹腔微环境与腹腔粘连相关性的研究进展. 实用医学杂志, 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. 陈志新. 腹腔粘连的形成及术后预防. 中国普外基础与临床杂志, 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. 兰义兵, 周坚红. 妇科手术后粘连发生机制及防治研究进展. 国际妇产科学杂志, 2010, 37(3): 179-182.
27. 刘博, 葛春林, 宋茂民. 奥曲肽预防术后腹腔粘连的实验研究. 中国现代普通外科进展, 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. 翁永强, 涂彦渊, 肖立, 等. 转化生长因子-β 多克隆抗体预防腹腔粘连的实验研究. 中国普通外科杂志, 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. 郑振华, 张桦, 潘玉先, 等.应用 VEGF 抗体预防术后腹腔粘连的实验研究.世界华人杂志, 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, 颜帅, 李文林. 国外抗腹腔粘连材料的研究进展. 医学研究生学报, 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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