Binda M M, Koninckx P R
Department of Obstetrics and Gynaecology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium.
Hum Reprod. 2009 Jun;24(6):1473-9. doi: 10.1093/humrep/dep053. Epub 2009 Mar 3.
Adhesion formation results from a series of local events at the trauma site. This process can be enhanced by factors derived from the peritoneal cavity such as mesothelial cell hypoxia (pneumoperitoneum with pure CO(2)), reactive oxygen species (pneumoperitoneum with more than 4% oxygen), desiccation and mesothelial trauma produced through manipulation. Adhesion prevention, therefore, should combine local treatment while minimizing adverse peritoneal factors through conditioning of the pneumoperitoneum.
In a laparoscopic mouse model, adhesion induction comprised a mechanical lesion together with a humidified pneumoperitoneum for 60 min with pure CO(2) at 37 degrees C. Adhesion prevention consisted of a combination of treatments known to reduce adhesions, i.e. pneumoperitoneum with CO(2) with the addition of 3-4% O(2), reduction of body temperature (BT) to 32 degrees C and application of antiadhesion products such as anti-inflammatory drugs (dexamethasone, nimesulide), calcium-channel blockers (diltiem), surfactants (phospholipids), barriers (Hyalobarrier gel), reactive oxygen species scavengers (superoxide dismutase and ascorbic acid) and recombinant plasminogen activator.
The addition of 3% O(2) to the pneumoperitoneum or a lower BT decreased adhesions by 32% or 48%, respectively (P < 0.05, Wilcoxon), but were without additional effects when combined. In addition, if dexamethasone or Hyalobarrier((R)) gel were administrated, the total reduction was 76% (P = 0.04) or 85% (P < 0.02), respectively.
Combining pneumoperitoneum conditioning together with dexamethasone or a barrier resulted in significant adhesion reduction in a laparoscopic mouse model.
粘连形成是由创伤部位的一系列局部事件引起的。该过程可因来自腹膜腔的因素而增强，如间皮细胞缺氧（纯二氧化碳气腹）、活性氧（氧气含量超过4%的气腹）、干燥以及操作产生的间皮损伤。因此，粘连预防应结合局部治疗，同时通过调节气腹来尽量减少不利的腹膜因素。
在腹腔镜小鼠模型中，粘连诱导包括机械损伤以及在37℃下用纯二氧化碳进行60分钟的湿化气腹。粘连预防包括已知可减少粘连的多种治疗方法的组合，即添加3 - 4%氧气的二氧化碳气腹、将体温降至32℃以及应用抗粘连产品，如抗炎药物（地塞米松、尼美舒利）、钙通道阻滞剂（地尔硫䓬）、表面活性剂（磷脂）、屏障（透明质酸屏障凝胶）、活性氧清除剂（超氧化物歧化酶和抗坏血酸）以及重组纤溶酶原激活剂。
气腹中添加3%氧气或降低体温分别使粘连减少32%或48%（P < 0.05，Wilcoxon检验），但联合使用时无额外效果。此外，如果给予地塞米松或透明质酸屏障凝胶，粘连减少总量分别为76%（P = 0.04）或85%（P < 0.02）。
在腹腔镜小鼠模型中，将气腹调节与地塞米松或屏障联合使用可显著减少粘连。
