DSouza Anisha A, Amiji Mansoor M
Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, Northeastern University, Boston, Massachusetts, USA.
Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA.
J Biomed Mater Res A. 2025 Jan;113(1):e37852. doi: 10.1002/jbm.a.37852.
Postsurgical adhesions are a common complication associated with surgical procedures; they not only impact the patient's well-being but also impose a financial burden due to medical expenses required for reoperative surgeries or adhesiolysis. Adhesions can range from a filmy, fibrinous, or fibrous vascular band to a cohesive attachment, and they can form in diverse anatomical locations such as the peritoneum, pericardium, endometrium, tendons, synovium, and epidural and pleural spaces. Numerous strategies have been explored to minimize the occurrence of postsurgical adhesions. These strategies include surgical approaches, adhesiolysis, antiadhesive agents, and mechanical barriers which have demonstrated the most promise in terms of efficacy and breadth of indications. In this review, we discuss the use of physical/mechanical barriers for adhesion prevention and outline the most commonly used, commercially available barriers. We then focus on a synthetic, dual-polymer gel composed of carboxymethyl cellulose (CMC) and poly(ethylene oxide) [PEO], which, unlike the more commonly used single-polymer hydrogels, has demonstrated higher efficacy across a greater range of indications and surgical procedures. We review the formulation, mechanical properties, and mechanisms of action of the CMC + PEO dual-polymer gel and summarize findings from clinical studies that have assessed the efficacy of CMC + PEO gels in multiple surgical settings in clinics across the world. In conclusion, the CMC + PEO dual-polymer gel represents an approach to preventing postsurgical adhesions that has been commonly used over the last 20 years and could therefore serve as a foundation for research into improving postsurgical outcomes as well as a drug delivery device to expand the use of gels in surgical settings.
术后粘连是外科手术常见的并发症；它们不仅影响患者的健康，还因再次手术或粘连松解所需的医疗费用而带来经济负担。粘连的范围可从薄膜状、纤维蛋白性或纤维血管带至紧密附着，且可在不同的解剖位置形成，如腹膜、心包、子宫内膜、肌腱、滑膜以及硬膜外和胸膜腔。人们已探索了多种策略以尽量减少术后粘连的发生。这些策略包括手术方法、粘连松解、抗粘连剂和机械屏障，其中机械屏障在疗效和适应证广度方面显示出了最大的前景。在本综述中，我们讨论了物理/机械屏障在预防粘连方面的应用，并概述了最常用的市售屏障。然后，我们重点介绍一种由羧甲基纤维素（CMC）和聚环氧乙烷（PEO）组成的合成双聚合物凝胶，与更常用的单聚合物水凝胶不同，它在更广泛的适应证和手术操作中显示出更高的疗效。我们回顾了CMC + PEO双聚合物凝胶的配方、力学性能和作用机制，并总结了在世界各地诊所评估CMC + PEO凝胶在多种手术环境中疗效的临床研究结果。总之，CMC + PEO双聚合物凝胶是过去20年来常用的一种预防术后粘连的方法，因此可作为改善术后结局研究的基础以及一种药物递送装置，以扩大凝胶在手术环境中的应用。
