REPAIR-Lab, Institute of Pathology, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany.
J Biomed Mater Res A. 2011 Jul;98(1):143-56. doi: 10.1002/jbm.a.33083. Epub 2011 May 4.
Peritoneal adhesions remain a relevant clinical problem despite the currently available prophylactic barrier materials. So far, the physical separation of traumatized serosa areas using barriers represents the most important clinical strategy for adhesion prevention. However, the optimal material has not yet been found. Further optimization or pharmacological functionalization of these barriers could give an innovative input for peritoneal adhesion prevention. Therefore, a more complete understanding of pathogenesis is required. On the basis of the pathophysiology of adhesion formation the main barriers currently in clinical practice as well as new innovations are discussed in the present review. Physiologically, mesothelial cells play a decisive role in providing a frictionless gliding surface on the serosa. Adhesion formation results from a cascade of events and is regulated by a variety of cellular and humoral factors. The main clinically applied strategy for adhesion prevention is based on the use of liquid or solid adhesion barriers to separate physically any denuded tissue. Both animal and human trials have not yet been able to identify the optimal barrier to prevent adhesion formation in a sustainable way. Therefore, further developments are required for effective prevention of postoperative adhesion formation. To reach this goal the combination of structural modification and pharmacological functionalization of barrier materials should be addressed. Achieving this aim requires the interaction between basic research, materials science and clinical expertise.
尽管目前有预防粘连的屏障材料，但腹膜粘连仍然是一个相关的临床问题。到目前为止，使用屏障物将创伤的浆膜区域物理分离代表了预防粘连的最重要的临床策略。然而，还没有找到最佳的材料。这些屏障物的进一步优化或药理学功能化可能为预防腹膜粘连提供创新的思路。因此，需要更全面地了解发病机制。基于粘连形成的病理生理学，本文讨论了目前临床实践中的主要屏障物以及新的创新。在生理上，间皮细胞在浆膜上提供光滑滑动表面方面起着决定性的作用。粘连的形成是一系列事件的结果，并受到多种细胞和体液因素的调节。预防粘连的主要临床应用策略是使用液体或固体粘连屏障物将任何裸露的组织物理分离。动物和人体试验都尚未能够确定以可持续的方式预防粘连形成的最佳屏障物。因此，需要进一步开发有效的术后粘连形成预防措施。为了达到这个目标，应该解决屏障材料的结构改性和药理学功能化的结合。实现这一目标需要基础研究、材料科学和临床专业知识的相互作用。
