术后腹膜粘连的发生机制与预防

Postoperative Peritoneal Adhesions: Mechanisms and Prevention

摘要: 术后腹膜粘连(Postoperative Peritoneal Adhesions, PPAs)是腹部及盆腔手术后的主要临床挑战，可导致肠梗阻、慢性疼痛及不孕症等严重并发症。尽管近年来外科手术技术持续改进，但其高发生率与复发率仍需开发更有效的预防策略。目前认为，PPAs的病理过程始于腹膜损伤，继而触发炎症级联反应与纤溶系统失衡，最终导致成纤维细胞过度活化及胶原异常沉积。针对腹膜粘连的预防，需要将精细的外科操作与个体化风险评估相结合。临床上可采用多模式综合方案，包括通过微创手术减轻组织损伤、合理应用抗炎与促纤溶类药物，以及在手术创面局部放置可降解防粘连材料等。虽然生物材料相关研究已取得一定进展，但未来仍需深入探索其关键分子机制。并通过高质量临床试验，将具有潜在应用价值的干预手段转化为安全、规范的临床治疗策略，从而进一步改善患者的长期预后。

Abstract: Postoperative peritoneal adhesions (PPAs) are a major clinical challenge after abdominal and pelvic surgery, leading to serious complications such as intestinal obstruction, chronic pain, and infertility. Although surgical techniques have continued to improve in recent years, their high incidence and recurrence rate still require the development of more effective prevention strategies. It is currently believed that the pathological process of PPAs begins with peritoneal injury, which triggers the inflammatory cascade, imbalance of the fibrinolytic system, overactivation of fibroblasts, and abnormal collagen deposition. Prevention of peritoneal adhesions requires a combination of delicate surgical procedures and individualized risk assessment. In clinical practice, a multimodal comprehensive scheme can be adopted, including minimally invasive surgery to reduce tissue damage, rational application of anti-inflammatory and fibrinolytic drugs, and local placement of degradable anti-adhesion materials on the surgical wound. Although some progress has been made in biomaterials-related research, their key molecular mechanisms still need to be explored in depth in the future. And through high-quality clinical trials, interventions with potential application value will be transformed into safe and standardized clinical treatment strategies, so as to further improve the long-term prognosis of patients.