Спаечный процесс остается актуальной проблемой оперативной гинекологии. С каждым годом число женщин, страдающих от осложнений спаечного процесса, неуклонно растет, не говоря уже о рисках летальных исходов, связанных c данными осложнениями. Многофакторная полигенная этиология, низкая результативность лечения спаечного процесса определяют приоритетность поиска методов предотвращения процесса спайкообразования или по крайней мере уменьшения выраженности послеоперационной адгезии. В обзоре представлены современная парадигма патогенеза формирования послеоперационных спаек и возможности профилактики адгезивных нарушений у гинекологических больных.
The adhesive process is an urgent problem of operative gynecology. The number of women suffering from complications of the adhesive process is growing every year, not to mention the deaths associated with this problem. Polygenic etiology, low efficiency of treatment of the adhesion process determined the priority of searching for methods to prevent the process of adhesion formation or, at least, to reduce the severity of postoperative adhesion, at least a decrease in the severity of postoperative adhesion. The review presents the current paradigm of the pathogenesis of the formation of postoperative adhesions and the possibility of preventing adhesive disorders in gynecological patients.
Keywords: adhesions of the pelvis cavity, intrauterine adhesion, adhesive disease, Antiadgezin
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DOI:10.1016/s1072-7515(97)00127-0
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A retrospective cohort study. Taiwan J Obstet Gynecol. 2020;59:916-21. DOI:10.1016/j.tjog.2020.09.020
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21. Diegelmann RF, Evans MC. Wound healing: an overview of acute, fibrotic and delayed healing. Front Biosci. 2004;9(1):283-9. DOI:10.2741/1184
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23. Li J, Cen B, Chen S, He Y. MicroRNA-29b inhibits TGF-β1-induced fibrosis via regulation of the TGF-β1/Smad pathway in primary human endometrial stromal cells. Mol Med Rep. 2016;13(5):4229-37. DOI:10.3892/mmr.2016.5062
24. Van Beek JP, Kennedy L, Rockel JS, et al. The induction of CCN2 by TGFβ1 involves Ets-1. Arthritis Res Ther. 2006;8(2):R36. DOI:10.1186/ar1890
25. Evans J, Salamonsen LA, Winship A, et al. Fertile ground: Human endometrial programming and lessons in health and disease. Nat Rev Endocrinol. 2016;12:654-67. DOI:10.1038/nrendo.2016.116
26. Zhou Q, Shi X, Saravelos S, et al. Auto-cross-linked hyaluronic acid gel for prevention of intrauterine adhesions after hysteroscopic adhesiolysis:
A randomized controlled trial. J Minim Invasive Gynecol. 2021:28;307-13. DOI:10.1016/j.jmig.2020.06.030
27. Lin X, Wei M, Li TC, et al. A comparison of intrauterine balloon, intrauterine contraceptive device and hyaluronic acid gel in the prevention of adhesion reformation following hysteroscopic surgery for Asherman syndrome: A cohort study. Eur J Obstet Gynecol Reprod Biol. 2013;170:512-6. DOI:10.1016/j.ejogrb.2013.07.018
28. Zhu R, Duan H, Gan L, Wang S. Comparison of Intrauterine Suitable Balloon and Foley Balloon in the Prevention of Adhesion after Hysteroscopic Adhesiolysis. Biomed Res Int. 2018;2018:9494101. DOI:10.1155/2018/9494101
29. Lee WL, Lee FK, Wang PH. Application of hyaluronic acid in patients with interstitial cystitis. J Chin Med Assoc. 2021;84:341-3.
DOI:10.1097/JCMA.0000000000000489
30. Friedman JA, Wong JMK, Chaudhari A, et al. Hysteroscopic myomectomy: A comparison of techniques and review of current evidence in the management of abnormal uterine bleeding. Curr Opin Obstet Gynecol. 2018;30:243-51. DOI:10.1097/GCO.0000000000000475
31. Annes JP, Munger JS, Rifkin DB. Making sense of latent TGFb activation. J Cell Sci. 2003;116(2):217-24. DOI:10.1242/jcs.00229
32. Kim T, Ahn KH, Choi DS, et al. A randomized, multi-center, clinical trial to assess the efficacy and safety of alginate carboxymethylcellulose hyaluronic acid compared to carboxymethylcellulose hyaluronic acid to prevent postoperative intrauterine adhesion. J Minim Invasive Gynecol. 2012;19:731-6. DOI:10.1016/j.jmig.2012.08.003
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1. Okabayashi K, Ashrafian H, Zacharakis E, et al. Adhesions after abdominal surgery: a systematic review of the incidence, distribution and severity. Surg Today. 2014;44:405-20. DOI:10.1007/s00595-013-0591-8
2. Coccolini F, Ansaloni L, Manfredi R, et al. Peritoneal adhesion index (PAI): proposal of a score for the “gnored iceberg” of medicine and surgery. World J Emerg Surg. 2013;8(1):6. DOI:10.1186/1749-7922-8-6
3. De Wilde RL, Brölmann H, Koninckx PR, et al. Prevention of adhesions in gynaecological surgery: the 2012 European field guideline. Gynecol Surg. 2012;9(4):365-8. DOI:10.1007/s10397-012-0764-2
4. Ray NF, Denton WG, Thamer M, et al. Abdominal adhesiolysis: inpatient care and expenditures in the United States in 1994. J Am Coll Surg. 1998;186(1):1-9.
DOI:10.1016/s1072-7515(97)00127-0
5. Lutsevich OE, Akimov VP, Shirinsky VG, Bichev AA. Adhesive disease of the peritoneum: a modern view of pathogenesis and treatment. Khirurgiia (Mosk). 2017;10:100-8. DOI:10.17116/hirurgia201710100-108
6. Kovacs EJ, DiPietro LA. Fibrogenic cytokines and connective tissue production. FASEB J. 1994;8(11):854-61. DOI:10.1096/fasebj.8.11.7520879
7. Zeyneloglu HB, Senturk LM, Seli E, et al. The role of monocyte chemotactic protein-1 in intraperitoneal adhesion formation. Hum Reprod. 1998;13(5):1194-9. DOI:10.1093/humrep/13.5.1194
8. Kovacs EJ. Fibrogenic cytokines: the role of immune mediators in the development of scar tissue. Immunol Today. 1991;12(1):17-23. DOI:10.1016/0167-5699(91)90107-5
9. Fernandez H, Benifla JL, Fritel X, et al. Post-curettage and aspiration synechiae: is there value in an anti-adhesion agent? J Gynecol Obstet Biol Reprod (Paris). 2012;41(2):8-12. DOI:10.1016/S0368-2315(12)70004-2
10. Snimshchikova IA, Medvedev AI, Khalilov MA, et al. Teoreticheskie i klinicheskie aspekty izbytochnogo adgeziogeneza. Vestnik RGMU. 2008;4:99-102 (in Russian).
11. Oosterlynck DJ, Lacquet FA, Waer M, Koninckx PR. Lymphokinactivated killer activity in women with endometriosis. Gynecol Obstet Invest. 1994;37(3):185-90. DOI:10.1159/000292556
12. Burlev VA, Dubinskaia ED, Gasparov AS, Il'iasova NA. Antiangiogenic therapy and a commissural process in the small pelvis: prospects for prevention and treatment. Russian Bulletin of Obstetrician-Gynecologist. 2010;10(4):25-31 (in Russian).
13. Tabibian N, Swehli E, Boyd A, et al. Abdominal adhesions: A practical review of an often overlooked entity. Ann Med Surg (Lond). 2017;15:9-13. DOI:10.1016/j.amsu.2017.01.021
14. Sabry D, Mostafa A, Mekawey D, et al. An experimental model: intrauterine adhesion versus subendometrial fibrosis. Biomedical Research. 2018;29(17):3311-8. DOI:10.4066/biomedicalresearch.29-18-849
15. Fritsch H. Ein Fall von volligen Schwund der Gebaumutterhohle nach Auskratzung. Zentralbl Gynaekol. 1894;18:1337-42.
16. Asherman JG. Traumatic intra-uterine adhesions. J Obstet Gynaecol Br Emp. 1948;57(6):892-6. DOI:10.1111/j.1471-0528.1950.tb06053.x
17. Yu D, Wong YM, Cheong Y, et al. Asherman syndrome – one century later. Fertil Steril. 2008;89:759-79. DOI:10.1016/j.fertnstert.2008.02.096
18. Lin S, Xie X, Guo Y, et al. Clinical characteristics and pregnancy outcomes of infertile patients with endometriosis and endometrial polyps:
A retrospective cohort study. Taiwan J Obstet Gynecol. 2020;59:916-21. DOI:10.1016/j.tjog.2020.09.020
19. Owusu-Akyaw A, Krishnamoorthy K, Goldsmith LT, Morelli SS. The role of mesenchymal-epithelial transition in endometrial function. Hum Reprod Update. 2019;25:114-33. DOI:10.1093/humupd/dmy035
20. March CM. Asherman's syndrome. Semin Reprod Med. 2011;29(2):83-94. DOI:10.1055/s-0031-1272470
21. Diegelmann RF, Evans MC. Wound healing: an overview of acute, fibrotic and delayed healing. Front Biosci. 2004;9(1):283-9. DOI:10.2741/1184
22. Chen JX, Yi XJ, Gu PL, Gao SX. The role of KDR in intrauterine adhesions may involve the TGF-β1/Smads signaling pathway. Braz J Med Biol Res. 2019;52(10):e8324. DOI:10.1590/1414-431X20198324
23. Li J, Cen B, Chen S, He Y. MicroRNA-29b inhibits TGF-β1-induced fibrosis via regulation of the TGF-β1/Smad pathway in primary human endometrial stromal cells. Mol Med Rep. 2016;13(5):4229-37. DOI:10.3892/mmr.2016.5062
24. Van Beek JP, Kennedy L, Rockel JS, et al. The induction of CCN2 by TGFβ1 involves Ets-1. Arthritis Res Ther. 2006;8(2):R36. DOI:10.1186/ar1890
25. Evans J, Salamonsen LA, Winship A, et al. Fertile ground: Human endometrial programming and lessons in health and disease. Nat Rev Endocrinol. 2016;12:654-67. DOI:10.1038/nrendo.2016.116
26. Zhou Q, Shi X, Saravelos S, et al. Auto-cross-linked hyaluronic acid gel for prevention of intrauterine adhesions after hysteroscopic adhesiolysis:
A randomized controlled trial. J Minim Invasive Gynecol. 2021:28;307-13. DOI:10.1016/j.jmig.2020.06.030
27. Lin X, Wei M, Li TC, et al. A comparison of intrauterine balloon, intrauterine contraceptive device and hyaluronic acid gel in the prevention of adhesion reformation following hysteroscopic surgery for Asherman syndrome: A cohort study. Eur J Obstet Gynecol Reprod Biol. 2013;170:512-6. DOI:10.1016/j.ejogrb.2013.07.018
28. Zhu R, Duan H, Gan L, Wang S. Comparison of Intrauterine Suitable Balloon and Foley Balloon in the Prevention of Adhesion after Hysteroscopic Adhesiolysis. Biomed Res Int. 2018;2018:9494101. DOI:10.1155/2018/9494101
29. Lee WL, Lee FK, Wang PH. Application of hyaluronic acid in patients with interstitial cystitis. J Chin Med Assoc. 2021;84:341-3.
DOI:10.1097/JCMA.0000000000000489
30. Friedman JA, Wong JMK, Chaudhari A, et al. Hysteroscopic myomectomy: A comparison of techniques and review of current evidence in the management of abnormal uterine bleeding. Curr Opin Obstet Gynecol. 2018;30:243-51. DOI:10.1097/GCO.0000000000000475
31. Annes JP, Munger JS, Rifkin DB. Making sense of latent TGFb activation. J Cell Sci. 2003;116(2):217-24. DOI:10.1242/jcs.00229
32. Kim T, Ahn KH, Choi DS, et al. A randomized, multi-center, clinical trial to assess the efficacy and safety of alginate carboxymethylcellulose hyaluronic acid compared to carboxymethylcellulose hyaluronic acid to prevent postoperative intrauterine adhesion. J Minim Invasive Gynecol. 2012;19:731-6. DOI:10.1016/j.jmig.2012.08.003
1 ФГАОУ ВО «Российский университет дружбы народов», Москва, Россия;
2 ФГБНУ «Научно-исследовательский институт морфологии человека им. акад. А.П. Авцына», Москва, Россия
*omekan@mail.ru
________________________________________________
Mekan R. Orazov*1, Viktor E. Radzinsky1, Marina B. Khamoshina1, Liudmila M. Mikhaleva2, Sevinc Ya. Ismailzade1
1 People’s Friendship University of Russia (RUDN University), Moscow, Russia;
2 Avtsyn Research Institute of Human Morphology, Moscow, Russia
*omekan@mail.ru