Tissue markers as predictors of postoperative adhesions

British Journal of Surgery - Tập 85 Số 11 - Trang 1549-1554 - 1998
Marie‐Louise Ivarsson1, Maria Bergström1, E. Eriksson1, Bo Risberg1, I Holmdahl1
1Department of Surgery, Sahlgrenska University Hospital/Östra, Göteborg University , S-41685 Göteborg,

Tóm tắt

Abstract Background Postoperative adhesion formation has been associated with a decreased capacity to degrade intra-abdominally deposited fibrin. Adhesions, once lysed, have a high propensity for reformation. This study tested the hypothesis that patients with a high propensity for adhesion formation as well as adhesion tissue had a reduced fibrinolytic capacity. Methods Peritoneal biopsies were taken during abdominal surgery from 21 patients who had previously undergone operation; previously formed adhesion tissue was sampled from ten of these patients. Adhesion formation was scored. The fibrinolytic capacity of peritoneum was determined in tissue extracts. Results At the time of opening of the abdominal cavity, levels of plasminogen activator inhibitor (PAI) type 1 (P = 0·009) and tissue-type plasminogen activator (tPA)/PAI complex (P = 0·008) were increased in peritoneal samples from patients with severe adhesions compared with those in samples from patients with less severe adhesions. Adhesion tissue similarly had reduced fibrinolytic capacity as judged by a decrease in tPA activity (P = 0·005) and an increase in PAI-1 level (P = 0·01), reflected in an increased level of tPA/PAI complex (P = 0·008) compared with unaffected peritoneum. Conclusion These observations demonstrate reduced fibrinolytic capacity in peritoneal tissue in patients with a greater propensity for development of adhesions and likewise in adhesion tissue. This suggests that components of the fibrinolytic system may be used as markers of an increased risk of adhesion development.

Từ khóa


Tài liệu tham khảo

Menzies, 1990, Intestinal obstruction from adhesions – how big is the problem?, Ann R Coll Surg Engl, 72, 60

Luijendijk, 1996, Foreign material in postoperative adhesions, Ann Surg, 223, 242, 10.1097/00000658-199603000-00003

Wilkins, 1986, Incidence of postoperative adhesion obstruction following neonatal laparotomy, Br J Surg, 73, 762, 10.1002/bjs.1800730929

Monk, 1994, Adhesions after extensive gynecologic surgery: clinical significance, etiology, and prevention, Am J Obstet Gynecol, 170, 1396, 10.1016/S0002-9378(13)90479-8

Zbar, 1993, The postoperative incidence of small bowel obstruction following standard, open appendectomy and cholecystectomy: a six-year retrospective cohort study at Yale-New Haven Hospital, Conn Med, 57, 123

Montz, 1994, Small bowel obstruction following radical hysterectomy: risk factors, incidence, and operative findings, Gynecol Oncol, 53, 114, 10.1006/gyno.1994.1097

Ivarsson, 1997, Cost of bowel obstruction resulting from adhesions, Eur J Surg, 163, 679

Räf, 1969, Causes of small intestinal obstruction. A study covering the Stockholm area, Acta Chirurgica Scandinavica, 135, 67

Raftery, 1981, Effect of peritoneal trauma on peritoneal fibrinolytic activity and intraperitoneal adhesion formation. An experimental study in the rat, Eur Surg Res, 13, 397, 10.1159/000128208

Ellis, 1962, The aetiology of post-operative abdominal adhesions: an experimental study, Br J Surg, 50, 10, 10.1002/bjs.18005021904

Holmdahl, 1994, The role of fibrinolysis in the formation of postoperative adhesions, Wound Repair and Regeneration, 7, 171, 10.1046/j.1524-475X.1994.20306.x

Holmdahl, 1996, Fibrinolysis in human peritoneum during operation, Surgery, 119, 701, 10.1016/S0039-6060(96)80196-6

Vipond, 1990, Peritoneal fibrinolytic activity and intra-abdominal adhesions, Lancet, 335, 1120, 10.1016/0140-6736(90)91125-T

Diamond, 1987, Adhesion reformation and de novo adhesion formation after reproductive pelvic surgery, Fertil Steril, 47, 864, 10.1016/S0015-0282(16)59181-X

R˚anby, 1989, Blood collection in strong acidic citrate anticoagulant used in a study of dietary influence on basal tPA activity, Thromb Haemost, 62, 917, 10.1055/s-0038-1651028

Eriksson, 1989, Doctoral Dissertation

Holmdahl, 1997, Measurement of fibrinolytic components in human tissue, Scand J Clin Lab Invest, 57, 445, 10.3109/00365519709084593

Operative Laparoscopy Study Group, 1992, Postoperative adhesion development after operative laparoscopy: evaluation at early second-look procedures, Fertil Steril, 55, 700

Thompson, 1989, Reduced human peritoneal plasminogen activating activity: possible mechanism of adhesion formation, Br J Surg, 76, 382, 10.1002/bjs.1800760422

Idell, 1992, Mechanisms of fibrin formation and lysis by human lung fibroblasts: influence of TGF-beta and TNF-alpha, Am J Physiol, 263, 487

Holmdahl, 1997, Plasminogen activator and inhibitors in peritoneal tissue, APMIS, 105, 25, 10.1111/j.1699-0463.1997.tb00535.x

Vassalli, 1994, Tumour biology. Membrane proteases in focus, Nature, 370, 14, 10.1038/370014a0

Rånby, 1982, Studies on the kinetics of plasminogen activation by tissue plasminogen activator, Biochim Biophys Acta, 704, 461, 10.1016/0167-4838(82)90068-1

Thông tin
Thông tin xuất bản

British Journal of Surgery

Tập 85 Số 11

1549-1554

Thông tin tác giả