Herrick S E, Mutsaers S E, Ozua P, Sulaiman H, Omer A, Boulos P, Foster M L, Laurent G J
Department of Medicine, University College London Medical School, University College London, London WC1E 6JJ, UK.
J Pathol. 2000 Sep;192(1):67-72. doi: 10.1002/1096-9896(2000)9999:9999<::AID-PATH678>3.0.CO;2-E.
Peritoneal adhesions are a major complication of healing following surgery or infection and can lead to conditions such as intestinal obstruction, infertility, and chronic pain. Mature adhesions are the result of aberrant peritoneal healing and historically have been thought to consist of non-functional scar tissue. The aim of the present study was to analyse the cellular composition, vascularity, and extracellular matrix distribution of human peritoneal adhesions, to determine whether adhesions represent redundant scar tissue or are dynamic regenerating structures. Furthermore, the histological appearance of each adhesion was correlated with the clinical history of the patient, to determine whether maturity or intraperitoneal pathology influences adhesion structure. Human peritoneal adhesions were collected from 29 patients undergoing laparotomy for various conditions and were prepared for histology, immunocytochemistry, and transmission electron microscopy. All adhesions were highly vascularized, containing well-developed arterioles, venules, and capillaries. Nerve fibres, with both myelinated and non-myelinated axons, were present in adhesions from nearly two-thirds of the patients, with increased incidence in those with a malignancy. Approximately one-third of the adhesions contained conspicuous smooth muscle cell clusters lined by collagen fibres of heterogeneous size. Adipose tissue was a consistent feature of all the adhesions, with some areas displaying fibrosis. There appeared to be no correlation between the estimated maturity or site of each adhesion and its histological appearance. However, intraperitoneal pathology at the time of surgery did influence the incidence of some histological features, such as the presence of nerve fibres, clusters of smooth muscle cells, and inflammation. This study challenges previous concepts that adhesions represent non-functional scar tissue and clearly demonstrates that established adhesions are highly cellular, vascularized, and innervated, features more consistent with dynamic, regenerating structures.
腹膜粘连是手术或感染后愈合过程中的主要并发症，可导致肠梗阻、不孕和慢性疼痛等病症。成熟的粘连是腹膜异常愈合的结果，历来被认为由无功能的瘢痕组织构成。本研究的目的是分析人腹膜粘连的细胞组成、血管分布和细胞外基质分布，以确定粘连是多余的瘢痕组织还是动态的再生结构。此外，将每个粘连的组织学表现与患者的临床病史相关联，以确定成熟度或腹腔内病理状况是否会影响粘连结构。从29例因各种病症接受剖腹手术的患者中收集人腹膜粘连组织，并制备用于组织学、免疫细胞化学和透射电子显微镜检查的样本。所有粘连均有丰富的血管，包含发育良好的小动脉、小静脉和毛细血管。近三分之二患者的粘连中存在神经纤维，包括有髓和无髓轴突，恶性肿瘤患者中神经纤维的发生率更高。约三分之一的粘连含有明显的平滑肌细胞簇，周围衬有大小不一的胶原纤维。脂肪组织是所有粘连的一个恒定特征，有些区域有纤维化表现。每个粘连的估计成熟度或部位与其组织学表现之间似乎没有相关性。然而，手术时的腹腔内病理状况确实会影响一些组织学特征的发生率，如神经纤维的存在、平滑肌细胞簇和炎症。本研究挑战了以往认为粘连代表无功能瘢痕组织的观念，并清楚地表明，已形成的粘连具有高度的细胞性、血管化和神经支配，这些特征更符合动态的再生结构。
