Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstrasse 30, Aachen, Germany.
Langenbecks Arch Surg. 2011 Mar;396(3):371-8. doi: 10.1007/s00423-011-0740-8. Epub 2011 Feb 1.
The inflammatory response to peritoneal injury is considered to be of particular importance in adhesion formation. The aim of this study was to investigate the dynamics of inflammatory mediators in peritoneal adhesions.
In 60 male rats, a peritoneal defect was performed using a standardized cecal abrasion model. On days 3, 5, 14, 30, 60, and 90, ten animals were sacrificed. The expression of five integral mediators for the cellular immune response (macrophages, T lymphocytes), inflammation (COX-2), cell differentiation, and proliferation (ß-catenin, c-myc) in visceral and parietal adhesions were analyzed.
A distinct infiltration of macrophages was observed in all animals up to the 90th postoperative day with a peak on day 3 for visceral adhesions (26.3 ± 5.6%) and on day 14 for parietal adhesions (5.1 ± 1.1%). Compared to parietal adhesions, macrophage levels were significantly higher on day 3 (p = 0.001) and 5 (p = 0.002) but significantly lower on days 30, 60, and 90 in visceral adhesions (p = 0.041; p = 0.001; p = 0.017). T lymphocytes were detected over time with the highest levels on day 3 (visceral 4.0 ± 0.7%; parietal 6.7 ± 2.9%). High levels of COX-2 expression could be detected for the whole observation period. Positive expression of both ß-catenin and c-myc was detected in persistent adhesions; however, no expression of c-myc was observed in parietal adhesions.
The inflammatory reaction in adhesions is not limited to the early postoperative phase. Macrophages may be fundamental in triggering adhesions, and the presence of T cells indicates an additional role of the adoptive immune system. Identification of chemokines and chemokine receptors that trigger the cellular immune response might be a potential option to minimize adhesion formation.
腹膜损伤的炎症反应被认为在粘连形成中尤为重要。本研究旨在探讨炎症介质在腹膜粘连中的动态变化。
在 60 只雄性大鼠中，使用标准化的盲肠磨损模型进行腹膜缺损。在第 3、5、14、30、60 和 90 天，10 只动物被处死。分析内脏和壁层粘连中 5 种细胞免疫反应（巨噬细胞、T 淋巴细胞）、炎症（COX-2）、细胞分化和增殖（β-连环蛋白、c-myc）的完整介质的表达。
所有动物在术后 90 天内均观察到明显的巨噬细胞浸润，内脏粘连的高峰在第 3 天（26.3±5.6%），壁层粘连的高峰在第 14 天（5.1±1.1%）。与壁层粘连相比，第 3 天（p=0.001）和第 5 天（p=0.002）巨噬细胞水平显著升高，但在第 30、60 和 90 天的内脏粘连中显著降低（p=0.041;p=0.001;p=0.017）。T 淋巴细胞随时间检测到，第 3 天水平最高（内脏 4.0±0.7%；壁层 6.7±2.9%）。整个观察期内 COX-2 表达水平较高。β-连环蛋白和 c-myc 的阳性表达在持续粘连中均有检测到，但壁层粘连中未检测到 c-myc 的表达。
粘连中的炎症反应不仅限于术后早期。巨噬细胞可能是触发粘连的基础，T 细胞的存在表明适应性免疫系统的额外作用。识别触发细胞免疫反应的趋化因子和趋化因子受体可能是减少粘连形成的潜在选择。
