Morgan Ryan B, Shogan Benjamin D
Department of Surgery, University of Chicago Medicine, Chicago, IL.
Semin Colon Rectal Surg. 2022 Jun;33(2). doi: 10.1016/j.scrs.2022.100879. Epub 2022 Mar 8.
Intestinal anastomotic tissue follows a similar pattern of healing that is seen in all tissues with characteristic inflammatory, proliferative, and remodeling phases. Several aspects of intestinal healing are distinct from other tissues, however, including its time course and interaction with the environment of the gastrointestinal tract. As the anastomosis progresses through each stage, initial inflammatory cells are replaced by collagen-producing fibroblasts that generate the anastomosis' strength. A complex network of cell-to-cell signaling mediates this process through the release of cytokines and growth factors including platelet-derived growth factor (PDGF), transforming growth factor-β (TGF-β), and vascular endothelial growth factor (VEGF). Interventions based on these signaling pathways have been shown to improve anastomotic strength in animals, though methods for improving anastomotic healing in human patients remain unclear. Given the risks associated with anastomotic failure in patients, there is value in monitoring inflammatory markers and cytokines that can indicate the presence of a leak.
肠吻合组织的愈合模式与所有组织相似，具有典型的炎症、增殖和重塑阶段。然而，肠愈合的几个方面与其他组织不同，包括其时间进程以及与胃肠道环境的相互作用。随着吻合口经历每个阶段，最初的炎症细胞被产生胶原蛋白的成纤维细胞取代，这些成纤维细胞产生吻合口的强度。细胞间信号传导的复杂网络通过释放细胞因子和生长因子来介导这一过程，这些细胞因子和生长因子包括血小板衍生生长因子（PDGF）、转化生长因子-β（TGF-β）和血管内皮生长因子（VEGF）。基于这些信号通路的干预措施已被证明可提高动物的吻合口强度，尽管改善人类患者吻合口愈合的方法仍不明确。鉴于患者吻合口失败的风险，监测可指示渗漏存在的炎症标志物和细胞因子具有重要意义。
