University of Adelaide Discipline of Surgery, The Queen Elizabeth Hospital, Woodville, SA, Australia.
Dig Surg. 2010;27(5):347-58. doi: 10.1159/000314805. Epub 2010 Sep 16.
Adhesion formation remains an almost inevitable consequence of abdominal procedures, potentially resulting in significant morbidity and mortality. There is an ongoing need to evaluate current understanding of adhesion formation and products aimed at prevention. Failure to keep up to date with adhesion treatment may subject clinicians to a greater medico-legal risk.
Review of published studies exploring the problem of peritoneal adhesion formation. This encompasses the underlying processes of adhesion formation combined with general approaches to reduce formation. An overview of products trialled to prevent formation in both the animal model and clinical setting describes products of scientific interest and commercial success.
Advances in surgical technique, such as laparoscopic surgery, can help minimize the probability of adhesion formation. Currently barrier products, whilst reducing adhesion formation, have not been shown to reduce the risk of readmission with complications related to adhesions. Hybrid products may improve upon this situation.
No single approach has been wholly satisfactory in reducing adhesions. Research into the processes driving adhesion formation is providing exciting new targets for therapeutic agents. It would seem plausible that with many promising avenues of research a revolutionary agent to reduce the incidence of adhesional small bowel obstruction may result.
粘连的形成仍然是腹部手术几乎不可避免的后果,可能导致严重的发病率和死亡率。目前仍需要评估对粘连形成的现有认识以及旨在预防粘连的产品。未能及时了解粘连的治疗方法可能会使临床医生面临更大的法律风险。
回顾了探讨腹膜粘连形成问题的已发表研究。这包括粘连形成的潜在过程以及减少形成的一般方法。概述了在动物模型和临床环境中试验用于预防形成的产品,描述了具有科学和商业成功的产品。
手术技术的进步,如腹腔镜手术,可以帮助最大限度地减少粘连形成的可能性。目前,屏障产品虽然可以减少粘连的形成,但并没有显示出可以降低与粘连相关的并发症再次入院的风险。混合产品可能会改善这种情况。
没有一种单一的方法可以完全有效地减少粘连。对驱动粘连形成的过程的研究为治疗剂提供了令人兴奋的新目标。似乎有可能通过许多有前途的研究途径,开发出一种减少粘连性小肠梗阻发生率的革命性药物。