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中华结直肠疾病电子杂志 ›› 2023, Vol. 12 ›› Issue (02) : 112 -116. doi: 10.3877/cma.j.issn.2095-3224.2023.02.004

腹膜疾病专栏

腹膜粘连的病因、机制及诊治进展
白峻阁1, 王玲玲1(), 陈海鹏1,(), 刘正1,()   
  1. 1. 100021 北京,国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院结直肠外科
  • 收稿日期:2022-11-09 出版日期:2023-04-25
  • 通信作者: 王玲玲, 陈海鹏, 刘正
  • 基金资助:
    中国医学科学院医学与健康科技创新工程项目(2016-I2M-1-001); 北京市科技计划(D171100002617004); 北京金桥种子基金(ZZ19055)

The progress of occurrence, mechanism, diagnosis and treatment of peritoneal adhesions

Lingling Wang1, Haipeng Chen1,(), Zheng Liu1,()   

  1. 1. Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
  • Received:2022-11-09 Published:2023-04-25
  • Corresponding author: Haipeng Chen, Zheng Liu
引用本文:

白峻阁, 王玲玲, 陈海鹏, 刘正. 腹膜粘连的病因、机制及诊治进展[J]. 中华结直肠疾病电子杂志, 2023, 12(02): 112-116.

Lingling Wang, Haipeng Chen, Zheng Liu. The progress of occurrence, mechanism, diagnosis and treatment of peritoneal adhesions[J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2023, 12(02): 112-116.

腹膜粘连是临床上普遍存在又始终无法解决的问题,其发生机制与手术、放化疗等诸多因素相关,腹膜粘连伴随的并发症在不同程度上影响着患者的生活质量。本文结合文献对腹膜粘连的病因、机制及诊治等方面进行探讨,希望减少医源性腹膜粘连的发生,为临床医生提供合理、有效的诊疗策略。

Peritoneal adhesions are a common and unsolvable problem in clinical practice. Their occurrence is related to many factors such as surgery and radiotherapy. The complications associated with peritoneal adhesions affect the quality of life. This article combines the literature to discuss the etiology, mechanism, diagnosis and treatment of peritoneal adhesions, hoping to reduce the occurrence of iatrogenic peritoneal adhesions and provide clinicians with reasonable and effective diagnosis and treatment strategies.

表1 Zühlke腹膜粘连分类33
[1]
Ten Broek RP, Issa Y, van Santbrink EJ, et al. Burden of adhesions in abdominal and pelvic surgery: systematic review and met-analysis[J]. BMJ, 2013, 347: f5588.
[2]
van Baal JO, Van de Vijver KK, Nieuwland R, et al. The histophysiology and pathophysiology of the peritoneum[J]. Tissue Cell, 2017, 49(1): 95-105.
[3]
Torres-De La Roche LA, Campo R, Devassy R, et al. Adhesions and anti-adhesion systems highlights[J]. Facts Views Vis Obgyn, 2019, 11(2): 137-149.
[4]
Moris D, Chakedis J, Rahnemai-Azar AA, et al. Postoperative abdominal adhesions: clinical significance and advances in prevention and management[J]. J Gastrointest Surg, 2017, 21(10): 1713-1722.
[5]
Parker MC, Wilson MS, Menzies D, et al. The SCAR-3 study: 5-year adhesion-related readmission risk following lower abdominal surgical procedures[J]. Colorectal Dis, 2005, 7(6): 551-558.
[6]
Ellis H, Moran BJ, Thompson JN, et al. Adhesion-related hospital readmissions after abdominal and pelvic surgery: a retrospective cohort study[J]. Lancet, 1999, 353(9163): 1476-1480.
[7]
Parker MC, Ellis H, Moran BJ, et al. Postoperative adhesions: ten-year follow-up of 12,584 patients undergoing lower abdominal surgery[J]. Dis Colon Rectum, 2001, 44(6): 822-830.
[8]
Krielen P, Stommel MWJ, Pargmae P, et al. Adhesion-related readmissions after open and laparoscopic surgery: a retrospective cohort study (SCAR update) [J]. Lancet, 2020, 395(10217): 33-41.
[9]
Stommel MWJ, Ten Broek RPG, Strik C, et al. Multicenter observational study of adhesion formation after open-and laparoscopic surgery for colorectal cancer[J]. Ann Surg, 2018, 267(4): 743-748.
[10]
Binda MM. Humidification during laparoscopic surgery: overview of the clinical benefits of using humidified gas during laparoscopic surgery[J]. Arch Gynecol Obstet, 2015, 292(5): 955-971.
[11]
Welle NJ, Sajjad H, Adkins A, et al. Bowel Adhesions. 2022 May 4. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan.
[12]
Baxter NN, Hartman LK, Tepper JE, et al. Postoperative irradiation for rectal cancer increases the risk of small bowel obstruction after surgery[J]. Ann Surg, 2007, 245(4): 553-559.
[13]
Tiefenbacher U, Wenz F. Präoperative radiotherapie vor totaler mesorektaler Exzision (TME) bei Rektumkarzinomen [Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer]. Strahlenther Onkol, 2001, 177(12): 682-684.
[14]
Peeters KC, van de Velde CJ, Leer JW, et al. Late side effects of short-course preoperative radiotherapy combined with total mesorectal excision for rectal cancer: increased bowel dysfunction in irradiated patients-a Dutch colorectal cancer group study[J]. J Clin Oncol, 2005, 23(25): 6199-6206.
[15]
Sauer R, Becker H, Hohenberger W, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer[J]. N Engl J Med, 2004, 351(17): 1731-1740.
[16]
Birgisson H, Påhlman L, Gunnarsson U, et al. Adverse effects of preoperative radiation therapy for rectal cancer: long-term follow-up of the Swedish Rectal Cancer Trial[J]. J Clin Oncol, 2005, 23(34): 8697-8705.
[17]
Holm T, Singnomklao T, Rutqvist LE, et al. Adjuvant preoperative radiotherapy in patients with rectal carcinoma. Adverse effects during long term follow-up of two randomized trials[J]. Cancer, 1996, 78(5): 968-976.
[18]
Cubukçu A, Alponat A, Gönüllü NN, et al. An experimental study evaluating the effect of Mitomycin C on the prevention of postoperative intraabdominal adhesions[J]. J Surg Res, 2001, 96(2): 163-166.
[19]
Pestieau SR, Marchettini P, Stuart OA, et al. Prevention of intraperitoneal adhesions by intraperitoneal lavage and intraperitoneal 5-fluorouracil: experimental studies[J]. Int Surg, 2002, 87(3): 195-200.
[20]
Acun G, Ozdemir H, Sunamak O, et al. The effect of single-dose intraperitoneal Bevacizumab on peritoneal adhesion formation[J]. Rev Invest Clin, 2018, 70(6): 279-284.
[21]
Meydanli MM, Celik H, Hanay F, et al. Effect of intraoperative irrigation with alteplase on adhesion formation associated with intraperitoneal chemotherapy (experimental study) [J]. Eur J Gynaecol Oncol, 2008, 29(4): 386-389.
[22]
Adachi W, Koike S, Rafique M, et al. Preoperative intraperitoneal chemotherapy for gastric cancer, with special reference to delayed peritoneal complications[J]. Surg Today, 1995, 25(5): 396-403.
[23]
Lotti M, Giulii Capponi M, Campanati L, et al. The onset of intra-abdominal adhesions during closed-abdomen hyperthermic intraperitoneal chemotherapy[J]. J Laparoendosc Adv Surg Tech A, 2016, 26(12): 997-1002.
[24]
Klaver CEL, Wisselink DD, Punt CJA, et al. Adjuvant hyperthermic intraperitoneal chemotherapy in patients with locally advanced colon cancer (COLOPEC): a multicentre, open-label, randomised trial[J]. Lancet Gastroenterol Hepatol, 2019, 4(10): 761-770.
[25]
Ryan MD, Wattchow D, Walker M, et al. Adhesional small bowel obstruction after colorectal surgery[J]. ANZ J Surg, 2004, 74(11): 1010-1012.
[26]
Stewart RM, Page CP, Brender J, et al. The incidence and risk of early postoperative small bowel obstruction. A cohort study[J]. Am J Surg, 1987, 154(6): 643-647.
[27]
Menzies D, Ellis H. Intestinal obstruction from adhesions--how big is the problem? [J]. Ann R Coll Surg Engl, 1990, 72(1): 60-63.
[28]
Maetani S, Tobe T, Kashiwara S. Neglected role of torsion and constriction in pathogenesis of simple adhesive bowel obstruction[J]. Br J Surg, 1984, 71(2): 127-130.
[29]
Andersen P, Jensen KK, Erichsen R, et al. Nationwide population-based cohort study to assess risk of surgery for adhesive small bowel obstruction following open or laparoscopic rectal cancer resection[J]. BJS Open, 2017, 1(2): 30-38.
[30]
Nakajima J, Sasaki A, Otsuka K, et al. Risk factors for early postoperative small bowel obstruction after colectomy for colorectal cancer[J]. World J Surg, 2010, 34(5): 1086-1090.
[31]
Pirotte B, Inaba K, Schellenberg M, et al. Intraoperative consultations to acute care surgery at a level I trauma center[J]. Am Surg, 2019, 85(1): 82-85.
[32]
Behman R, Nathens AB, Mason S, et al. Association of surgical intervention for adhesive small-bowel obstruction with the risk of recurrence[J]. JAMA Surg, 2019, 154(5): 413-420.
[33]
Zühlke HV, Lorenz EM, Straub EM, et al. Pathophysiology and classification of adhesions[J]. Langenbecks Arch Chir Suppl II Verh Dtsch Ges Chir, 1990: 1009-1016.
[34]
Coccolini F, Ansaloni L, Manfredi R, et al. Peritoneal adhesion index (PAI): proposal of a score for the "ignored iceberg" of medicine and surgery[J]. World J Emerg Surg, 2013, 8(1):6.
[35]
Long B, Robertson J, Koyfman A. Emergency medicine evaluation and management of small bowel obstruction: evidence-based recommendations[J]. J Emerg Med, 2019, 56(2): 166-176.
[36]
Quah GS, Eslick GD, Cox MR. Laparoscopic versus open surgery for adhesional small bowel obstruction: a systematic review and meta-analysis of case-control studies[J]. Surg Endosc, 2019, 33(10): 3209-3217.
[37]
Meissner K. Late radiogenic small bowel damage: guidelines for the general surgeon[J]. Dig Surg, 1999, 16(3): 169-174.
[38]
朱小林, 吕铁升.腹腔镜肠粘连松解术治疗粘连性肠梗阻的临床疗效及并发症观察[J].贵州医药, 2022, 46(07): 1093-1094.
[39]
Gómez D, Cabrera LF, Pedraza M, et al. Minimal invasive surgery for multiple adhesive small bowel obstruction: Results of a comparative multicenter study[J]. Cir Cir, 2021, 89(6): 710-717.
[40]
陈永兵, 黄晓远.腹腔镜手术治疗顽固性粘连性肠梗阻的临床疗效及预后分析[J].世界复合医学, 2022, 8(8): 125-128.
[41]
裴绍栋.生长抑素联合肠梗阻导管治疗黏连性肠梗阻的临床效果分析[J].黑龙江科学, 2022, 13(8): 114-115.
[42]
Xie Y, Zheng C, Tan X, et al. Clinical efficacy of acupuncture in patients with adhesive intestinal obstruction: A meta-analysis[J]. Medicine (Baltimore), 2022, 101(40): e30257.
[43]
王永礼, 潘峰, 台小东.芒朴通下方灌肠联合隔药灸治疗术后粘连性肠梗阻42例[J].环球中医药, 2022, 15(9): 1693-1696.
[44]
李玉山, 孙建明, 王永平.加味承气汤加减结合针刺足三里治疗粘连性肠梗阻的临床疗效观察[J].中国处方药, 2022, 20(8): 162-164.
[45]
杨丹丹, 何永恒.承气汤类方加减治疗顽固性粘连性肠梗阻验案1则[J].湖南中医杂志, 2020, 36(7): 83-84.
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