腹腔粘连的评估及其临床指导意义  

Evaluation of abdominal adhesions and its clinical significance

作　　者：李思澄 任华建 任建安 LI Si-cheng;REN Hua-jian;REN Jian-an(Affiliated Jinling Hospital,Medical School of Nanjing University,Nanjing 210002,China)

机构地区：[1]南京大学医学院附属金陵医院,中国人民解放军普通外科研究所,江苏南京210002

出　　处：《中国实用外科杂志》2025年第3期346-350,共5页Chinese Journal of Practical Surgery

基　　金：国家自然科学基金面上项目(No.82270595);江苏省重点研发计划项目(No.BE2023810);江苏省卓越博士后计划项目(No.2024ZB307)。

摘　　要：腹腔粘连是腹部手术后最常见的并发症,发生率可高达90%,尤其在肠瘘等复杂腹部疾病中更易形成广泛而致密的粘连。精准评估腹腔粘连对优化治疗和降低并发症风险至关重要。当前腹腔粘连评估方法包括临床评估、影像学评估、生物标记物检测及手术探查。临床评估通过病史采集和体格检查提供粘连线索,但难以准确判断粘连部位和严重程度。影像学评估中,超声可显示腹腔内器官运动状态及内脏滑动征,但对深部粘连显示效果较差;常规计算机断层扫描(CT)仅能间接提示粘连存在;动态磁共振成像(Cine MRI)通过捕捉器官动态活动,评估准确率可达90%。生物标记物如C反应蛋白(CRP)和白细胞介素-6(IL-6)与粘连严重程度相关,但特异性不足。手术探查虽为"金标准",但因其侵入性不适合常规诊断。腹腔粘连评分系统包括美国生殖医学学会粘连分级、Nair评分系统和临床粘连评分(CLAS),其中,CLAS结合了粘连相关并发症和再手术难度等多维参数,其观察者间可靠性高达0.95。精准评估腹腔粘连可指导手术入路选择、预测术后并发症风险及指导抗粘连策略应用。未来研究方向包括:多组学联合分析探索特异性分子网络;建立多模态数据综合评估体系;开发风险分层的评估体系;研发新型抗粘连材料和药物。尽管腹腔粘连评估取得一定进展,但仍面临敏感度低、特异性不足、缺乏统一标准等挑战。开发精准、无创或微创的评估方法,建立风险预测模型,并推动临床转化研究,是改善病人临床结局的关键。Abdominal adhesions are the most common complications following abdominal surgery,with an incidence rate of up to 90%,especially in complex abdominal diseases such as intestinal fistula,where extensive and dense adhesions are more likely to form.Precise assessment of abdominal adhesions is crucial for optimizing treatment and reducing the risk of complications.Current methods for evaluating abdominal adhesions include clinical assessment,imaging evaluation,laboratory marker detection,and surgical exploration.Clinical assessment provides clues about adhesions through medical history collection and physical examination but struggles to accurately determine the location and severity of adhesions.Among imaging evaluations,ultrasound can display the movement of intra-abdominal organs and visceral sliding signs but performs poorly in visualizing deep adhesions;conventional computed tomography(CT)can only indirectly suggest the presence of adhesions;dynamic magnetic resonance imaging(Cine MRI)can achieve an accuracy rate of up to 90%by capturing dynamic organ activities.Laboratory markers such as Creactive protein(CRP)and interleukin-6(IL-6)correlate with adhesion severity but lack specificity.Although surgical exploration is the“gold standard”,it is not suitable for routine diagnosis due to its invasiveness.Abdominal adhesion scoring systems include the American Society for Reproductive Medicine adhesion classification,the Nair scoring system,and the Clinical Adhesion Score(CLAS).The latter integrates multidimensional parameters such as adhesion-related complications and reoperation difficulty,with an interobserver reliability of up to 0.95.Precise assessment of abdominal adhesions can guide surgical approach selection,predict the risk of postoperative complications,and direct antiadhesion strategy application.Future research directions include integrating multi-omics analysis to explore specific molecular networks,establishing comprehensive multi-modal data evaluation systems,developing risk-stratified assessment

关 键 词：腹腔粘连 精准评估 临床决策 

分 类 号：R6[医药卫生—外科学]