纤维蛋白胶封堵法治疗肠外瘘32例报告

目的探讨纤维蛋白胶封堵法治疗肠外瘘临床应用价值。方法2003年2月至2006年2月第二军医大学附属长海医院对32例术后肠外瘘病人应用纤维蛋白胶封堵法治疗肠外瘘,观察其临床疗效。结果31例获得愈合,封堵开始至愈合平均时间(8.9±3.6)d,平均封堵次数(2.3±1.3)次,其中1次者11例,2次者9例,3次及以上者12例,成功率为96.9%。结论纤维蛋白胶能有效地促进肠外瘘愈合。     

Conservative treatment of a traumatic direct low-flow carotid-cavernous sinus fistula: A case report

Summary A case of a 17-year-old boy presenting with a traumatic carotid-cavernous sinus fistula (CCSF), associated with an intracavernous pseudo-aneurysm, is reported. On angiography, the CCSF proved to be a direct and low-flow shunt. Conservative management was chosen and definitive closure of the fistula was obtained in two months by daily self-compression of the common carotid artery.     

Application of fibrin adhesive in the urinary bladder

Summary The investigations on rats and pigs showed that the transuretheral haemostasis of the urinary bladder damaged by radiotherapy is possible by means of fibrin adhesion. The spraying procedure has to be carried out by means of a special balloon-catheter in a bladder filled with CO₂. During spraying the bladder must be kept constantly free of pressure.     

Management of spontaneous carotid-cavernous fistulae

Fifteen cases of spontaneous carotid-cavernous fistulae, including 4 patients with spontaneous cure and 8 treated with electrothrombosis, are reviewed. Careful angiographic observation will verify closure of the fistula. Aggravation of visual and/or ocular symptoms can also develop with spontaneous carotid-cavernous fistulae. Recurrence of symptoms and development of collaterals were noted, especially after carotid ligation or embolization of the external carotid artery. Electrothrombosis successfully closed the fistulae in 7 patients. The internal carotid artery was occluded in 1 patient who had a preoperative carotid stenosis at the cervical level. The ability to differentiate angiographically between single and multiple fistulae provides a new possibility that spontaneous carotid-cavernous fistulae can be treated with detachable balloon catheters.     

腹腔镜肠黏连松解联合应用生物蛋白胶治疗黏连性肠梗阻

目的探讨腹腔镜肠黏连松解联合应用生物蛋白胶治疗黏连性肠梗阻的可行性及其疗效。方法总结1998年5月至2003年10月间,28例黏连性小肠梗阻患者进行腹腔镜黏连松解术、并配合留置医用生物蛋白胶防止再黏连的临床资料。结果应用腹腔镜全组均成功实施黏连松解术解除肠梗阻,均于术中留置医用生物蛋白胶防止再黏连,未出现手术并发症和过敏现象;随访3～60个月,未发现肠梗阻症状复发。结论腹腔镜肠黏连松解术配合生物蛋白胶治疗黏连性肠梗阻安全实用,疗效满意,是处理黏连性肠梗阻的理想手段之一。     

Pathogenetic and therapeutic considerations of carotid-cavernous sinus fistulas

Summary Carotid-cavernous sinus fistula (CCF) is a syndrome in which arteriovenous shunts exist between the carotid artery and the cavernous sinus. These shunts vary widely in pathogenesis, angiogram, haemodynamics and treatment. Several systems of classification in terms of either haemodynamics, aetiology and/or pathogenesis have been reported, but they are not comprehensive. A more comprehensive and simpler nomenclature of classification is now required.Fifty seven cases of CCFs were analyzed and were classified according to their pathogenesis, angiography and treatment modalities. There were 11 traumatic CCFs with direct shunts (T-D group), and 2 traumatic CCFs with indirect shunts (T-I group). Spontaneous CCFs were divided into three groups. There were 37 spontaneous CCFs caused by dural arteriovenous shunts that were naturally classified as being indirect shunts (SD-I group). There were 5 spontaneous CCFs caused by suspected connective tissue disorders, such as fibromuscular dysplasia, Ehlers-Danlos syndrome etc.; these had direct shunts. Care was needed to avoid dissection of the artery or complications due to the fragility of connective tissue (SC-D group). There were 2 spontaneous CCFs caused by the rupture of an inflaclinoid aneurysm without any background of connective tissue disorder; these had direct shunts (SA-D group).By this system of grouping and use of abbreviations, each case of CCF can be clearly delineated in terms of its pathogenesis and selection for appropriate treatment.     

颈内动脉-海绵窦瘘的血管内治疗

目的探讨颈内动脉－海绵窦瘘的血管内治疗效果。方法回顾分析了１９９０年１月以来经血管内治疗的４３例（６０例次）颈内动脉－海绵窦瘘。男性３７例,女性６例。外伤性３９例,自发性４例。单纯闭塞瘘口３１例,颈内动脉闭塞１２例;颈内动脉通畅率７２．１％。结果治愈３９例（９０．７％）,好转４例（９．３％）,并发偏瘫１例（２．３％）。结论球囊栓塞应作为颈内动脉－海绵窦瘘首选疗法。     

Closure of a pharyngocutaneous fistula using a sternomastoid muscle flap

Presented here is a case of a pharyngocutaneous fistula which was closed primarily using a sternomastoid muscle flap, without skin coverage, thus obviating the need for a three-layered closure. Providing an intermediate cover was sufficient for the closure because the mucosal lining on the inside and the cutaneous covering on the outside grew using the muscle for support.     

Fibrin tissue adhesive sealant for the prevention of CSF leakage following transsphenoidal microsurgery

Summary Fibrin glue (Beriplast, Behring or Tissucol, Immuno) was used for 126 sublabial transseptal transsphenoidal operations in 119 patients from April 1981 to March 1987 in a variety of sellar pathologies together with septal bone and spongycel to seal the sellar floor and the anterior wall of the sphenoid sinus.The incidence of postoperative rhinorrhea was 1.6%. A review of the literature revealed an incidence of 1.5%–9.6% with the use of autologous tissue for sellar packing such as fat or muscle; fibrin glue combined with autologous grafts led to postoperative rhinorrhea in 1%–4.4%. The present results support the view that sellar and sphenoidal sealing with fibrin glue instead of muscle or fat tissue does not raise the incidence of postoperative rhinorrhea.     

Navigation-assisted transsphenoidal deflation of a detachable balloon in the cavernous sinus after embolization of a direct carotid-cavernous fistula

Summary We describe a case of transsphenoidal deflation of a detachable balloon after embolization of a carotid-cavernous fistula (CCF). The patient developed complete third and sixth nerve palsies immediately after detachable balloon embolization of the CCF, which was considered to be caused by cavernous sinus (CS) compression by the over-inflated balloon. We performed direct puncture of the balloon via the transsphenoidal route using a frameless neuronavigation system. Navigation-assisted transsphenoidal approach (TSA) is technically feasible for balloon deflation in cases of severe cranial nerve palsies due to an over-inflated balloon.     

Minimal suture blepharoplasty: Closure of incisions with autologous fibrin glue

Blepharoplasty incisions can be closed safely with autologous fibrin glue. The fibrinogen, prepared either from a whole-blood or plasmapheresis source, is mixed with commercially available thrombin to form a seal that is both hemostatic and adhesive. The complication rate is low and primarily due to technical factors in the initial cases. 'When compared with standard suture techniques, the incidence of minor problems such as milia formation was much lower. In select cases, the technique of using fibrin glue and a minimal number of sutures may be useful as an alternative method of would closure in blepharoplasty patients.Presented at the annual meeting of the American Society of Aesthetic Plastic Surgery, April 30, 1990, New York, NY, USA     

An improved balloon catheter technique for the occlusion of carotid-cavernous sinus fistulas (CCF)

Summary By means of a case report a shortcoming of balloon catheter techniques for intravascular occlusion of CCF is demonstrated: the procedure by which the balloon is detached from the filling catheter is unreliable and may further traumatise the vessel wall.We describe a new technique that allows careful, gentle, and effortless detachment of the balloon by means of a melting-off technic.     

Initial experience with the endoscopic application of fibrin tissue adhesive in the upper gastrointestinal tract

Summary During a 15-month period, a total of 11 patients underwent endoscopic application of fibrin tissue adhesive in the upper gastrointestinal tract. Our sample consisted of 6 patients with control of bleeding, 4 patients with management of anastomotic leaks, and one very old man undergoing prophylactic sealing of a chronic gastric ulcer with a visible vessel and repeated episodes of bleeding. The method described has proven to be successful in control of bleeding in every case and has resulted in quick cleaning of perianastomotic abscess cavities, growth of granulation tissue, and complete healing in 3 of 4 cases so far. This preliminary report suggests that fibrin adhesive application is effective in the control of oozing gastrointestinal bleeding and may support the healing process in difficult situations, such as chronic peptic ulcers and anastomotic leakages.     

Intracerebral hematomas in cases of dural arteriovenous malformation and carotid-cavernous fistula

Intracerebral hematomas in cases of dural arteriovenous malformation and carotid cavernous fistula are reported. The origin of hemorrhage is concluded to have been the engorged cortical veins through which the arterial blood drained in a retrograde fashion. The necessity of early treatment of the underlying condition is stressed, as retrograde drainage may cause acute complications.     

纤维蛋白胶携载的粒细胞集落刺激因子促进大鼠缺血后肢血管再生

目的 观察纤维蛋白胶携载的粒细胞集落刺激因子(Gel+ G-CSF)对大鼠外周血白细胞总数和缺血下肢血管再生的影响.方法 雄性SD大鼠30只,制成右下肢缺血模型,随机分成3组:Gel+ G-CSF组、G-CSF组和PBS组,每组10只,分别肌肉注射Gel+ G-CSF、G-CSF和PBS.造模术前及术后第1、3、5、7天计数外周血白细胞总数,造模后第1周和第4周每组分别处死5只大鼠,行组织学检测,计数血管密度.结果 Gel+G-CSF组外周血白细胞总数在术后第1天达峰值[(14.69±1.11)×109/L],且明显低于G-CSF组在术后第3天达到的峰值[(21.00±2.26)×109/L].Gel+ G-CSF组[(686±108)/mm2]的毛细血管密度明显高于G-CSF组[(491±110)/mm2]和PBS组[(252±78)/mm2],P ＜0.05.Gel+ G-CSF组[(6.1±0.8)/mm2]的α-SMA阳性血管密度明显高于PBS组[(2.6±1.3)/mm2],P＜0.05.Gel+ G-CSF组肌组织中有大量血管内皮生长因子阳性细胞的浸润.结论 Gel+ G-CSF可以促进缺血肌组织血管再生,而刺激外周血白细胞计数升高的不良反应较小.     

纤维蛋白胶抗生素复合体治疗深部创口白细胞计数和中性粒细胞分类变化的研究

目的 观察纤维蛋白胶抗生素复合体治疗深部创口的细胞计数和中性细胞分类变化. 方法采用临床病例对照研究方法进行研究对比试验组与对照组在白细胞计数和中性粒细胞分类存在的差异.试验组和对照组在性别分布、平均年龄、受伤机制基本相同(P>0.05),试验组和对照组具有可比性. 结果试验组组内不同时间白细胞计数和中性粒细胞分类计数差异有统计学意义(P<0.05),术后24 h白细胞计数和中性粒细胞分类计数最高,以后随着治疗时间的延长而逐渐下降,术后24 d或出院前一天最低.试验组和对照组术后除了术后24小时无差别外,其余不同时间白细胞计数差异有统计学意义(P<0.05),试验组白细胞计数均比对照组低.试验组和对照组术后不同时间中性粒细胞分类(%)比较,在术后24 h、术后48 h、术后12 d两组中性粒细胞分类差异无统计学意义(P>0.05),其余小同时间两组中性粒细胞分类差异均有统计学意义(P<0.05),试验组不同时间中性粒细胞分类均比对照组低. 结论纤维蛋白胶抗生素复合体治疗深部创口有较好的临床效果,安全性高,无小良反应和毒副作用.具有较好的社会效益和经济效益,值得推广使用.     

纤维蛋白胶和生长激素促进腹腔感染条件下大鼠肠吻合口愈合的研究

目的应用纤维蛋白胶 (fibringlue ,FG)、生长激素 (growthhormone ,GH)于腹腔感染条件下的大鼠小肠吻合 ,探讨其有效性和作用机制。方法将大鼠分为正常对照组和在腹腔感染模型下行标准肠吻合组 (丝线吻合 12针 )、简易吻合组 (丝线吻合 4针 )、简易吻合 +FG组、简易吻合 +GH组、及简易吻合 +FG +GH组共 6组 ,于小肠局部切除吻合术后第 1、3、5天分别观察、测定其吻合口不良愈合率、吻合口爆破压、吻合口羟脯氨酸浓度等指标。结果在感染条件下标准吻合组吻合口爆破压于术后第 1天至第 3天分别为 (18± 10 )mmHg和 (36± 11)mmHg ,不良愈合率达 30 % ;而使用FG行胶合组吻合口强度显著提高 ,分别为 (32± 7)mmHg和 (6 5± 9)mmHg ,不良愈合显著减少 ,仅为11 76 %。在胶合的基础上加用GH与未加用GH组比较 ,羟脯氨酸浓度无显著性差异。结论大鼠在腹腔感染条件下可以使用FG实施小肠肠吻合并减少并发症的发生 ,加用GH后早期疗效提高不显著     

人纤维蛋白粘合剂封闭囊肿术治疗症状性骶管囊肿

目的 探讨经皮穿刺人纤维蛋白粘合剂封闭囊肿术治疗症状性骶管囊肿的疗效。方法 回顾分析2005年1月～2009年12月本院收治的采用CT引导下经皮穿刺抽吸囊液,人纤维蛋白粘合剂封闭囊肿术治疗的症状性骶管囊肿患者资料38例。其中男15例,女23例;年龄21～76岁,平均50岁。初发病例27例,再发11例。囊肿部位:L₅/S₁ 11例,S₁/S₂ 16 例,S₂/S₃ 7 例,骶前4例。经MRI检查均确诊为骶管囊肿。采用Oswestry功能障碍指数(Oswestry disability index,ODI)和疼痛视觉模拟量表(visual analogue scale, VAS)评分评估患者术后3个月、1年、5年腰骶区疼痛、麻木和功能改善情况。结果 所有患者均顺利完成手术, 手术时间(42.2±16.0) min,术中出血量(25.8±20.4) mL。38例均获随访,随访时间27～96个月,平均63个月。患者术后ODI和VAS评分均较术前明显改善,差异具有统计学意义(P< 0.01)。术后复查MRI, 患者囊腔消失29例(76.3%),囊腔缩小4例(10.5%),囊肿无缩小5例(13.2%)。结论 微创治疗症状性骶管囊肿具有创伤小、出血少、疗效佳、恢复快等优点,对于初发或开放手术术后再发的患者均有效果,是治疗骶管囊肿的良好方法。     

Endoscopic sealing of infected bronchus stump fistulae with fibrin following lung resections

Summary Bronchus stump insufficiency following lung resection, with an average incidence of 4%, is a serious complication which carries a mortality of up to 90%. Operative transthoracic approaches have been largely unsatisfactory because of the high operative risk and rapidly spreading infection. In an experimental study on 18 pigs, endoscopic occlusion of infected bronchus stump fistulae was achieved with fibrin sealant (1 ml, 500 units/ml thrombin, 3500 units/ml aprotinin) applied via a flexible bronchoscope. During autopsy, all bronchus stump fistulae were found to have healed after the second postoperative week. Transitory local abscesses of the pleura could be prevented by high-dose systemic antibiotic therapy for 5 postoperative days but not by antibiotics added to the fibrin sealant. This endoscopic method has already been performed successfully in 3 clinical cases; additional sclerotherapy with (2–3 ml Ethoxysclerol applied around the fistula orifice was carried out before fibrin sealing to stimulate fibrosis. Endoscopic controls demonstrated fistula closure by granulation tissue after 2 weeks. This procedure could become the method of choice for infected postoperative fistulae of the bronchus stump and should be attempted in any case before operative approaches are considered.