生物蛋白胶封堵术治疗高位肛瘘的临床应用(附7例临床报告)

目的探讨生物蛋白胶封堵术治疗高位肛瘘的临床应用效果。方法回顾分析我科2006年2月至2007年9月，采用生物蛋白胶封堵术治疗高位肛瘘7例临床病例。结果术后随访半年，7例均无复发。结论生物蛋白胶封堵术治疗高位肛瘘有较好的效果，能缩短伤口愈合时间，减轻术后换药疼痛，为高位肛瘘的治疗开辟了一条新的途径。     

The Use of Fibrin Glue in the Treatment of Fistula-In-Ano: A Prospective Study

Purpose This prospective study was done to analyze the efficacy of commercial fibrin glue application in the healing of patients with fistulas-in-ano. Methods This clinical trial of 36 patients was performed during the period from November 2003 to May 2004. Thirty men and six women were treated for a fistula-in-ano with commercial fibrin glue application. None of the patients had undergone prior attempts to correct fistulas-in-ano surgically. All patients received preoperative mechanical bowel preparation and prophylactic intravenous antibiotics. In the operating room, the patients underwent an anorectal examination under spinal anesthesia. The external and internal fistula tract openings were then identified. The fistula tract was curetted. Fibrin glue was injected into the external fistula opening until fibrin glue could be seen coming from the internal opening. No dressing was applied over the external opening. Thereafter, the patient was discharged. A 1-week course of oral antibiotics was prescribed. The patients were followed up for 70 weeks with a mean of 54 weeks (range 40–70 weeks). Results The cause of the fistula-in-ano was cryptoglandular in all patients. The overall initial success rate was 77.8% (28/36). No complications were encountered related to the application. Two patients underwent a reapplication with fibrin glue and the fistulas of these patients were all closed. The overall success rate was 83.3% (30/36). Conclusion Fibrin glue application was thus found to be an easy, safe, effective, and useful alternative treatment in the management of fistulas-in-ano. However, our findings need substantiation by increasing the number of patients and prolonging the follow-up duration, as well as carrying out comparative studies.     

Use of Aerosolized Bovine-Prepared Fibrin Glue for Skin Fixation After Primary Open Rhinoplasty: A Prospective Randomized and Controlled Trial

Background Fibrin glue has been used in diverse areas of plastic surgery. To the authors’ knowledge, no clinical controlled trial studies have reported its use for open rhinoplasty. Methods A prospective, randomized, masked clinical trial was designed to demonstrate that aerosolized bovine-prepared fibrin glue used in open rhinoplasty controls skin fixation (flap movement), edema, hematomas, ecchymosis, bleeding, and cosmetic results 1 and 12 months postoperatively. The results were reviewed by two blinded plastic surgeons who assessed postoperative photographs using the Strasser score. Other items such as columella scar, pain, surgery/recovery time, and patient satisfaction also were evaluated. Results A computer system was used to randomize 22 consecutive open primary rhinoplasties. Cosmetic analysis did not differ significantly between the group redraped with fibrin glue and the control group. Patient satisfaction was the only outcome that significantly favored the active group. None of the other items or adverse events significantly differed between the two groups, including operative time and pain. Conclusions Fibrin glue is believed to reduce bleeding and to improve the adherence of tissues. The only statistical difference in this study favored the patient satisfaction cosmetic score of the group that received fibrin glue.     

Combined Use of Hair and Fibrin Glue for Soft Tissue Augmentation: Experimental Study

A vast variety of alloplastic materials together with autogenous grafts have been used for the correction of contour deformities related to aesthetic and reconstructive purposes. Despite a number of well-tolerated materials, the ideal has not yet been reached, although well-tolerated autogenous grafts have higher rates of resorption and distortion. The limited volume of autogenous grafts and concerns about donor-site morbidity may obligate the surgeon to use implantation materials. Covering almost every property of an ideal implantation material, hair, an organic autogenous nonvital tissue, was used for soft tissue augmentation in this experimental study. Hair pellets of 10 New Zealand rabbits were prepared and shaped as 1 × 1 × 1-cm cubes with the help of fibrin sealant, then inserted subcutaneously. The materials were evaluated 4 months later. No complications such as infection or extrusion were seen. The materials were intact, with no signs of resorption, but the shapes were distorted due to the pressure of the surrounding tissues. Histopathologic findings also demonstrated that the hair was well tolerated by the adjacent tissues. Different processes may enable hair to be used as a filler material in clinical practice. Well-tolerated, nonresorbable injectable materials or shaped implants may be obtained at low cost using hair.     

Fibrin glue obliteration is safe,effective and minimally invasive as first line treatment for pilonidal sinus disease in children

Background / PurposeSacrococcygeal pilonidal sinus disease (PSD) has an incidence of 1.2–2.5/1000 in children. Onset is around puberty. Symptoms of recurrent abscess and chronic suppuration may interfere with education and social integration. Treatments should cause minimal disruption while having good cure and recurrence rates. Curettage and Fibrin glue obliteration (FGO) show promising results in adults. We present our experience of its use in children.MethodsReview of all pediatric patients receiving FGO of pilonidal sinus performed by a single surgeon from September 2014 to February 2018.ResultsEighteen patients were identified. Median age was 16 (range 15–17), 55.6% were male. All procedures were completed as day cases. Median operative duration was 14 .1 (6–29) min. Twelve patients required only 1 procedure, 4 required 2 procedures, 1 required 5 procedures and 1 elected for formal excision after 2 FGO treatments. Median return to normal activities was 3 days, with 1 day school absence. Two patients developed minor surgical site infections. Median follow-up was 52 weeks (17–102), during which time there was 1 recurrence (5.6%).ConclusionThis study demonstrates FGO is a safe, effective procedure for pediatric PNS, with results comparable to off-midline flap techniques and without the need for extensive tissue excision and the associated morbidity.Level of evidenceIV     

新型复合纤维蛋白胶的磷酸钙骨水泥的生物安全性研究

目的 研究新型复合纤维蛋白胶的磷酸钙骨水泥的生物相容性和生物安全性,探讨其用于临床修复骨缺损的可行性。方法 制备新型复合纤维蛋白胶的磷酸钙骨水泥,获取材料浸提液。选择急性毒性试验、溶血试验、微核试验、细胞毒性试验,对新型复合人工骨材料进行生物相容性和安全性评价。结果 该磷酸钙骨水泥材料浸提液未引起小鼠急性毒性反应;各实验组肉眼下未见明显溶血反应,溶血率0.05);浸提液对小鼠MC3T3成骨细胞的生长分化无明显影响,细胞毒性分级为Ⅰ级。结论新型复合纤维蛋白胶的磷酸钙人工骨材料具有良好的生物相容性和生物安全性。     

Cartilage Tissue Engineering With Demineralized Bone Matrix Gelatin and Fibrin Glue Hybrid Scaffold: An In Vitro Study

To develop a cartilage‐like tissue with hybrid scaffolds of demineralized bone matrix gelatin (BMG) and fibrin, rabbit chondrocytes were cultured on hybrid fibrin/BMG scaffolds in vitro. BMG scaffolds were carefully soaked in a chondrocyte–fibrin suspension, which was polymerized by submerging the constructs into thrombin–calcium chloride solution. Engineered cartilage‐like tissue grown on the scaffolds was characterized by histology, immunolocalization, scanning electron microscopy, biochemical assays, and analysis of gene expression at different time points of the in vitro culture. The presence of proteoglycan in the fibrin/BMG hybrid constructs was confirmed by positive toluidine blue and alcian blue staining. Collagen type II exhibited intense immunopositivity at the pericellular matrices. Chondrogenic properties were further demonstrated by the expression of gene‐encoded cartilage‐specific markers, collagen type II, and aggrecan core protein. The glycosaminoglycan production and hydroxyproline content of tissue grown on the fibrin/BMG hybrid scaffolds were higher than that of the BMG group. In conclusion, the fibrin/BMG hybrid scaffolds may serve as a potential cell delivery vehicle and a structural basis for cartilage tissue engineering.     

生物蛋白胶预防鸡趾鞘管区屈肌腱粘连的实验研究

目的 研究生物蛋白胶预防鸡趾鞘管区屈肌腱粘连的作用。方法 种禽褐鸡60只，随机分为生物蛋白胶组（FG）和生理盐水组（NS），每组各30只动物。将第三、四趾趾深屈肌腱切断，作改良Kessler法缝合，不修复腱鞘，然后在腱鞘内肌腱周围及皮下按分组注入相应药物。术后第2、4、6周取材，分别进行大体观察、组织学检查、生物力学测定。结果 术后2、4、6周，组织学检查示两组动物肌腱吻合处的炎症细胞浸润情况及肌腱的愈合进程无明显差别。缝合处粘连半定量评分、将肌腱拉出鞘管所需最大力量、耗功，FG组与NS组相比，差异均无显性意义（P＞0．05）。结论 局部应用FG不能有效预防术后肌腱粘连，但不影响肌腱的愈合进程，也不引起额外的炎症反应。     

纤维蛋白凝胶复合骨形态发生蛋白和庆大霉素缓释药物治疗感染性骨缺损的实验研究

目的 探讨将纤维蛋白凝胶(FG)作为骨形态发生蛋白(BMP)及庆大霉素的共同载体,一期治疗感染性骨缺损。方法 48只青紫兰兔,制作慢性骨髓炎模型,清创后造成胫骨干骺端内侧1.5 cm长半环形骨缺损,采用三种方法进行处理:A组,植入FG、BMP和庆大霉素复合物;B组植入FG/BMP复合物;C组作为空白对照。术后观察动物一般情况,作骨细菌培养及其计数,X线摄片及组织学检查。结果 A组感染控制及骨修复均良好,感染控制率、再生骨量明显优于B组;B、C两组在感染控制率上无显著差异;C组动物骨修复差。结论 FG、BMP及庆大霉素复合物具有抗感染及促进成骨的双重作用,可用于感染性骨缺损的治疗,也可用于污染严重的开放性损伤造成的骨缺损的治疗,方法简便、易行。     

Efficacy of a Pedicled Pericardial Fat Pad Fixed with Fibrin Glue on Postoperative Alveolar Air Leakage

The purpose of this randomized trail was to investigate the effect of using a pedicled pericardial fat pad fixed with fibrin glue on postoperative alveolar air leakage. Thirty consecutive patients with lung cancer, who had moderate alveolar air leaks after pulmonary resection, were randomized into two groups: in group A fibrin glue was applied onto the surface of the leaking raw lung and in group B, after applying fibrin glue in the same manner as in group A, a pedicled pericardial fat pad was immediately fixed to the leaking lung surface with fibrin glue. The duration of the postoperative air leakage and chest tube drainage was recorded. In 6 of 15 patients in group B the air leakage ceased within the first 24 h after pulmonary resection, while in group A only 1 of 15 patients showed a cessation of the air leakage, and a significant difference was noticed between the two groups (P = 0.0309). The duration of the postoperative air leakage was 4.8 ± 4.6 days in group A and 3.6 ± 3.4 days in group B. The pedicled pericardial fat pad fixed onto the surface of the leaking raw lung using fibrin glue was found to reduce alveolar air leakage after pulmonary resection. Received: January 11, 2001 / Accepted: September 11, 2001     

前脂肪细胞凝胶植入预防腰椎术后硬膜外腔瘢痕粘连的实验研究

目的：探讨自体前脂肪细胞凝胶植入法预防腰椎术后硬膜外腔瘢痕粘连的效果。方法：将60只SD大鼠随机分为A组(前脂肪细胞凝胶植入组)、B组(自体脂肪颗粒植入组)、C组(空白对照组)，将A组动物先进行前脂肪细胞培养，待其脂肪细胞培养传代至适量后，制备各组大鼠的椎板缺损模型，A组取培养的单层脂肪细胞与生物蛋白胶制成混合物，B组取自体脂肪颗粒分别植入椎板缺损区，C组不植入任何物质，于术后8周行大体、光镜、电镜及MRI检查。结果：A组预防硬膜外腔瘢痕粘连效果良好，优于B组。结论：自体前脂肪细胞与生物蛋白胶制成的混合物植入预防硬膜外腔瘢痕的形成与粘连有良好的效果，是一种预防椎板切除术后硬膜外腔瘢痕形成与粘连的新方法。     

Histomorphologic and Volumetric Analysis of Implanted Autologous Preadipocyte Cultures Suspended in Fibrin Glue: A Potential New Source for Tissue Augmentation

Previous efforts to use adipocyte transplants for tissue augmentation have been limited by high and unpredictable resorption rates. Preadipocytes are precursor cells that are capable of replication and differentiation into mature adipocytes. Furthermore, they are more resilient to ischemia, making them a desirable transplant media. Utilizing fibrin glue as a transport vehicle and a prefabricated intramuscular capsule pouch as the recipient site, we have demonstrated the successful transplantation of cultured preadipocytes without the previously presented resorption sequelae. Histological analysis at 2 weeks has demonstrated establishment of vascular supply and the complete resorption of fibrin glue. Most importantly, using planimetric analysis, volume retention has been demonstrated in implanted areas up to 1 year following implantation. Finally, BrdU labeling has been utilized to demonstrate the lack of increased and uncontrolled replication rate, an index of potentially tumorigenic tissue. In conclusion, we have demonstrated a potentially new and safe source of tissue augmentation in the rat model.     

Combination of Fibrin Glue with Growth Hormone Augments Healing of Incomplete Intestinal Anastomoses in a Rat Model of Intra-Abdominal Sepsis: A Dynamic Study

This study was devised to investigate whether fibrin glue (FG) in combination with growth hormone (GH) could have a beneficial effect at a late period (14 days) after injury. Male Wistar rats, with abdominal sepsis induced by an incomplete anastomosis, were divided into three groups. In the control group, the rats got incomplete anastomoses sutured alone; in the FG and FG/GH groups, anastomoses protection was performed with application of FG alone or in combination with GH. The anastomotic bursting pressure (ABP) was significantly higher in the FG/GH group than that of the FG group on postoperative day (POD) 5 (p <. 01), while it could not be measured from POD 7 to POD 14 because of intestinal dehiscence. There was no difference between FG and FG/GH group on POD 3 and POD 5 in anastomotic tensile strength, which was significantly higher in the FG/GH group than that of the FG group from POD 7 to POD 14 (p <. 001). Hydroxyproline content of the FG/GH group was significantly higher than that of the control from POD 3 and that of the FG group from POD 5 (p <. 05). Combination of FG with GH had a synergistic effect to improve intestinal anastomotic healing over a limited 14-day course of observation.     

Comparison of the Two Types of Bioresorbable Barriers to Prevent Intra-Abdominal Adhesions in Rats

Purpose  The aim of this study was to evaluate the efficacy of two absorbable film barriers, polylactic acid and sodium hyaluronate–carboxymethyl cellulose, in preventing postoperative intra-abdominal adhesions, inflammation, and fibrosis in an animal model. Methods  Forty Wistar albino rats were grouped as polylactic acid, sodium hyaluronate–carboxymethyl cellulose, and control. All rats underwent laparotomy with subsequent cecal wall abrasion and abdominal wall injury. The two treatment groups received polylactic acid or sodium hyaluronate–carboxymethyl cellulose film barriers, while control group received nothing. On postoperative day 21, three observers graded the intra-abdominal adhesions and resected specimens. Fibrosis, inflammation, and adhesions were graded using quantitative scoring systems. Results  When compared to control group, polylactic acid group showed significantly less inflammation and adhesion (p < 0.005), while there was no significant difference for fibrosis. Sodium hyaluronate–carboxymethyl cellulose group has showed significantly less adhesions (p < 0.005), but there were no significant differences among fibrosis and inflammation when compared to control group. There were no significant differences between polylactic acid and sodium hyaluronate–carboxymethyl cellulose groups on adhesion formation, inflammation, or fibrosis. Conclusions  Placement of polylactic acid or sodium hyaluronate–carboxymethyl cellulose film barriers between injured surfaces is associated with a significantly reduced rate of postoperative adhesions. No superiority was detected between two barriers.     

纤维蛋白用作BMP载体的研究

目的：将纤维蛋白用作ＢＭＰ（骨形态发生蛋白）的载体材料。方法：用５ｍｇ ＢＭＰ分别与３种不同浓度的纤维蛋白制成复合物，植入小鼠肌囊后不同时间进行组织学观察、测定碱性磷酸酶活性和钙含量等。结果：纤维蛋白浓度为１２０ｍｇ／ｍｌ的复合物具有良好的骨诱导活性，成骨量是单纯５ｍｇ ＢＭＰ的两倍。结论：纤维蛋白是理想的ＢＭＰ载体材料，复合物可望应用于临床骨缺损的修复。     

Recurrent Auricular Pseudocyst: A New Treatment Recommendation With Curettage and Fibrin Glue

BACKGROUND: Pseudocyst of the auricle is a rarely seen fluctuant swelling of the ear. Although various hypotheses on the etiology have been suggested, the exact cause still remains unclear. Chronic minor trauma, which is believed to create intracartilaginous cavity, is accepted to be the most probable cause. Several treatment methods have been used for this benign lesion, but higher recurrence rates can be seen if not properly treated. OBJECTIVE: To discuss a new treatment modality for this rare disorder. METHOD: A 44-year-old man presented with a large pseudocyst of the auricle that had been treated several times previously with unsuccessful outcomes. For its treatment, we performed curettage and then used fibrin glue as a sealer between the two leaves of the cartilage. RESULTS: At postoperative 6-months follow-up, there was no evidence of recurrence. The cosmetic outcome was excellent. CONCLUSION: The use of fibrin glue both to obliterate the pseudocyst space and to make the two leaves of the cartilage adhere to each other should be kept in mind in this rare disorder in order to avoid recurrences.     

Histological Analysis of Intra-Abdominal Adhesions Treated with Sodium Hyaluronate and Carboxymethylcellulose Gel

Purpose: To evaluate macro and microscopically the adhesions developed after using the anti-adherence compound sodium hyaluronate and carboxymethylcellulose (SH-CBMC) gel and to determine the volume of the adhesions using a stereological estimation. Methods: The study was experimental, random, comparative, and prospective. The subjects of the study were male Wistar rats divided in three groups (n = 10). Group I (control) included rats with no peritoneal injury. Group II rats had a 2 cm diameter injury created bilaterally in the parietal peritoneum at 3 cm from the abdominal midline with electrocautery coated with physiological solution. Group III rats were given the same injuries and coated with SH-CBMC gel. All groups were followed up postoperatively for 30 days, after which a laparotomy was performed to macroscopically determine the presence and type of adhesions. Experimental models were euthanized with anesthetic overdose and biopsies were taken for histopathological examination and stereological estimate of the volume of adhesions. Results: Macroscopic adhesions were 20% less prevalent in Group III compared to Group II, which presented 40% more multiple and firm adhesions, unlike in Group III, in which they were unique and lax. There was a statistically significant decrease in the presence and number of adhesions in rats treated with SH-CBMC gel. Inflammatory infiltrate was significantly lower in rats treated with SH-CBMC gel, but there were no differences in connective tissue, fibrosis, and angiogenesis among groups. There was no statistical difference in the overall volume of adhesions among the treatment groups. Conclusions: SH-CBMC gel reduces macroscopic presence and number of adhesions and the severity of the inflammatory infiltrate.