医用生物蛋白胶在面颈部扩张器埋置术中的应用

目的：探讨在面颈部扩张器埋置术中,应用生物蛋白胶辅助创面止血以降低血肿发生率的可行性。方法：选取我科2006～2007年的40名面颈部软组织扩张术患者,随机分为对照组和用药组,用药组术中应用生物蛋白胶对创面辅助止血。观察分析两组术后引流液量等指标。结果：用药组术后扩张皮瓣下引流液量和血肿的发生率均明显低于对照组且对扩张器后期扩张无影响,无任何副作用发生。结论：应用生物蛋白胶对创面辅助止血可明显减少面颈部扩张器置入后血肿的发生。     

医用生物蛋白胶在预防乳腺癌术后并发症中的应用价值

目的探讨医用生物蛋白胶在预防乳腺癌术后皮下积液、皮瓣坏死等中的临床应用价值。方法94例乳腺癌患者随机分成两组,实验组47例,对照组47例。实验组标本切除后给予止血、引流、创面喷洒医用生物蛋白胶并加压包扎。对照组切除标本后常规止血、引流、加压包扎,创面不喷洒医用生物蛋白胶。结果实验组第1、2、3天引流量及总引流量均较对照组减少,术后皮瓣坏死发生率较对照组低,拔管时间及住院时间较对照组明显减少。结论乳腺癌根治术中应用医用生物蛋白胶能有效减少创面渗液量,降低皮下积液及皮瓣坏死发生率,缩短拔管时间和住院天数。     

医用生物蛋白胶在皮肤扩张器植入术中的应用

目的：回顾总结生物蛋白胶在皮肤扩张器植入术中应用的临床经验。方法：皮肤扩张器植入术中应用生物蛋白胶18例，共41只扩张器。在拟植入扩张器部位常规剥离腔隙，手术创面均匀涂抹生物蛋白胶，短暂压迫后植入扩张器。观察术后24h和48h引流物的质、量，及有无血肿、感染和扩张器外露。结果：无一例发生并发症；负压引流物在术后的前24h多为淡红色，24h后转为淡黄色液体；引流量在术后的前24h为8-15mL，后24h为5-8mL；1例（耳部扩张器植入）术后24h出现过敏症状。结论：在扩张器植入术中应用生物蛋白胶具有以下优点：（1）止血效果肯定，明显缩短手术时间；（2）术后引流量明显减少；（3）促进组织愈合，减少并发症的发生率。     

胶原蛋白海绵在皮肤扩张术中的应用

目的：观察胶原蛋白海绵在皮肤扩张术中的临床应用效果。方法：选择40例（个）皮肤扩张器埋置和50例（个）皮肤扩张器取出及15例自身对照的病例组,应用胶原蛋白海绵术中贴敷于渗血创面,术后观察其吸收、止血效果。结果：术中渗血于2～10min内停止,病例组中无血肿发生,术后引流量明显减少,伤口愈合时间缩短。结论：在皮肤扩张术中胶原蛋白海绵是一种良好的生物止血材料。     

医用生物蛋白胶在甲状腺癌联合根治术中的应用

目的观察医用生物蛋白胶在甲状腺癌术中、术后对出渗血、引流量及淋巴管漏发生的影响。方法将已配制好的生物蛋白胶直接喷涂在术中渗血创面及预防性术终喷涂于左右淋巴管颈部走行位置区域。结果12例甲状腺癌联合根治术后患者术区渗血、引流量及淋巴管漏发生率均低于对照组。结论医用生物蛋白胶可通过创面封闭,减少甲状腺癌联合根治术后的出渗血及淋巴管漏发生率。     

医用生物蛋白胶在胸科手术中的应用

为探讨医用生物蛋白胶在胸科手术中的应用价值。观察组采用在肺,食管及纵隔手术中喷涂生物蛋白胶的方法,处理手术创面,残端及吻合口,封闭食管破裂口共57例,并与同期对照组比较术后引流量,并发症的发生率,疗效满意,术后引流量明显减少,可预防残端瘘及吻合口瘘的发生,未见与使用此胶有关的并发症,对照组发生肺创面持续漏气4例,食管胃吻合口瘘1例,胸外手术中可使用生物蛋白胶辅助止血,粘合,堵漏,无异物吸收及排异反应,操作简便,安全可靠,适用于临床,易于推广。     

急性炎症期腹腔镜胆囊切除术中生物蛋白胶的应用

目的探讨医用生物蛋白胶对减少急性胆囊炎LC术后胆囊床创面渗漏的价值。方法2005年1月至2008年12月随机选取生物蛋白胶治疗组36例患者和42例对照组患者。通过比较术中止血时间、术后腹腔引流量及引流时间、胆漏情况、住院时间等5项指标来说明其有效性。结果除胆漏外,治疗组与对照组差异无统计学意义。结论急性炎症期LC医用生物蛋白胶能有效减少创面出血和渗漏,同时缩短住院时间,减少住院费用。     

医用生物蛋白胶应用于扩张器置入时的临床研究

近年来 ,国外有研究报道纤维蛋白作为生物粘合剂对慢性出血灶 ,大面积组织渗血有明显的止血作用[1 ] ,国内亦有报道 ,含纤维蛋白的医用生物蛋白胶在普通外科[2 ] 、口腔颌面外科[3] 、整形外科[4] 手术中使用有良好的止血和防止吻合口瘘的功效。我科于 1998～ 1999年应用生物蛋白胶对 30例耳后扩张器置入术时的创面辅助止血 ,取得良好效果。1　临床资料与方法1 1　病例与分组　用药组 :本组选取住院病人 30例 ,男 2 3例 ,女 7例。均为先天性小耳畸形行耳后扩张器置入术的患者。年龄 5～ 2 9岁。扩张器容量均为 5 0ｍｌ。对照组 :选取同期住…     

聚桂醇对皮肤扩张术中止血效果的应用研究

目的:探讨聚桂醇在皮肤软组织扩张器埋植术中的止血效果,为防止术后血肿的发生提供安全有效的方法.方法:以40个患者为实验对象,随机分成两组,每组20人,在实验组分离的腔隙内涂以聚桂醇注射液,对照组涂以生理盐水作为对照,观察止血和扩张效果.结果:实验组的出血量和血肿发生率都小于对照组,并且没有出现皮瓣血运障碍,扩张速率与对照组基本一样.结论:聚桂醇用于扩张器埋植术中能发挥较好的止血效果,并且不会影响后期扩张.     

皮肤软组织扩张术治疗面颈部瘢痕23例临床分析

目的 总结应用皮肤软组织扩张技术治疗面颈部瘢痕的临床经验.方法 对23例面颈部瘢痕患者分别采用单个或多个皮肤软组织扩张器置入面颈部正常皮肤下,经1～2个月注水扩张后,利用扩张后皮瓣直接推进或形成异位皮瓣修复面颈部瘢痕切除后创面.观察治疗过程中的并发症,术后皮瓣的成活、皮肤的色泽,以及最后面部的瘢痕情况.从而判断治疗的临床效果.结果 本组患者23例,其中1 例术后出现血肿、1例发生扩张器渗漏、2例在扩张过程中出现感染,经处理后正常扩张.扩张后皮瓣均满足修复区所需.术后随访6～12个月患者面颈部皮肤色泽正常,外形良好,无功能障碍,面部为线状瘢痕,较为平整,无增生性瘢痕,治疗效果满意.结论 采用皮肤软组织扩张术治疗面颈部瘢痕方法 简单,效果满意,是一种行之有效的方法.     

医用生物蛋白胶在腮腺浅叶良性肿瘤切除术中的应用研究

目的:探讨医用生物蛋白胶在腮腺浅叶良性肿瘤切除术中的临床应用。方法:2006年1月~2011年6月来我院口腔颌面外科住院手术治疗的腮腺浅叶良性肿瘤患者50例,随机分为医用生物蛋白胶组(n=24)和对照组(n=26),术后从术区引流量、拔管时间、术区有无感染、面瘫、涎瘘及Frey综合征进行观察和评价。结果:两组患者均未发生切口感染,与对照组比较,医用蛋白胶组患者术后第1天和术后总引流量均明显减少,拔管时间提前,差异有统计学意义(P0.05)。医用蛋白胶组发生术后并发症的例数明显少于对照组(P0.05)。结论:在腮腺浅叶良性肿瘤切除术中应用医用生物蛋白胶可明显减少术后并发症的发生,并在一定程度上促进术后创口的愈合。     

Z形皮瓣与纤维蛋白胶联合应用预防乳腺癌术后皮下积液

目的探讨Z形皮瓣联合纤维蛋白胶对乳腺癌术后皮下积液的预防作用。方法观察组74例,采用Z形皮瓣,术中创面喷洒纤维蛋白胶;对照组36例,采用传统纵形切口,创面不喷洒纤维蛋白胶,腋窝常规放置引流管3~4 d。结果观察组术后皮下积液、患侧上肢水肿发生率为1.4%,明显低于对照组的11.1%(P<0.05)。观察组术后患侧上肢功能受限发生率为0%,明显低于对照组的22.2%(P<0.05)。结论Z形皮瓣联合纤维蛋白胶创面喷洒有利于乳腺癌术后皮下积液的预防。     

纤维蛋白粘合剂在腹腔镜肝囊肿开窗引流术中的应用

目的研究在腹腔镜肝囊肿开窗引流术中应用纤维蛋白粘合剂的价值。 方法前瞻性选择2012年1月至2018年6月中山大学附属第八医院行腹腔镜肝囊肿开窗引流术患者60例,随机分为试验组和对照组,各30例。对照组常规行腹腔镜肝囊肿开窗引流术,试验组完成同样术式后,在囊肿残腔和囊壁切缘残端处喷涂纤维蛋白粘合剂,比较两组手术时间、出血量、拔管时间、禁食时间、住院天数、总费用、并发症发生率以及术后1、2 d血清C反应蛋白（CRP）水平、白细胞计数（WBC）和丙氨酸氨基转移酶（ALT）水平。 结果（1）与对照组相比,试验组患者术后的手术时间、术中出血量、拔管时间、禁食时间显著减少,住院天数更短,总费用更少,差异均有统计学意义（t=7.943、11.932、25.676、18.821、15.823、3.458,均P<0.001）。（2）试验组患者术后1、2 d时CRP、WBC以及ALT水平均显著低于对照组（F=52.278、46.386、77.924,均P<0.001）。（3）试验组患者无胆漏、腹水发生,复发1例;对照组患者发生胆漏2例,腹水2例,复发3例。试验组的术后总并发症发生率显著低于对照组,差异有统计学意义（3.33% vs 23.33%,χ²=5.192,P=0.023）。 结论腹腔镜肝囊肿开窗引流术中应用纤维蛋白粘合剂,对于封闭创面、促进组织愈合、预防胆漏及腹水等方面起到显著疗效,且无明显不良反应,值得推广。     

Seroma prevention using fibrin glue during modified radical neck dissection in a rat model

Seroma is a frequent sequelae of neck dissection involving cervical lymphadenectomy. The incidence is correlated with flap elevation, lymphovascular interruption, and tissue removal. Current methods of resolving seroma, such as vacuum drainage, are not risk free. A novel approach to this problem was the use of intraoperative topical fibrin glue. A model producing seromas was developed by modified radical neck dissection on Sprague-Dawley rats. Forty rats underwent this procedure. Twenty rats were treated with saline solution (control group) and 20 were treated with fibrin glue. At necropsy on day 5, a significant reduction in the frequency of seroma was noted in the fibrin glue group. Seventeen of 20 control rats had seroma whereas only 2 of 20 experimental animals had serous collection. The Fisher exact statistical correlation revealed p less than 0.000002; therefore, the use of fibrin glue in this role merits further evaluation.     

生物蛋白胶在腹腔镜治疗消化性溃疡穿孔中的应用

目的 探讨生物蛋白胶在腹腔镜治疗消化性溃疡穿孔中的应用价值.方法 选择消化性溃疡穿孔患者126例,按入院次序随机分成观察组和对照组各63例.对照组作常规修补,观察组按对照组修补方法完成修补后在修补处喷涂生物蛋白胶.比较两组术后引流量、拔管时间、消化道瘘发生率、肠粘连发生率、过敏反应及平均住院天数.结果 观察组未发生过敏反应;其术后引流量为(65.3±7.5)mL,显著低于对照组的(110.2±9.6)mL(P＜0.01).观察组无肠瘘及肠粘连发生;对照组经口服造影剂证实修补处有渗漏4例(4/63),均经B超引导下穿刺引流后痊愈.对照组术后肠粘连2例(2/63),均经非手术治疗后好转.两组并发症比较,差异有统计学意义(P＜0.05).观察组拔管时间为(25.4±3.2)h,显著低于对照组的(49.4±3.5)h(P＜0.01).观察组平均住院天数为(4.3±1.2)d,显著低于对照组的(6.5±1.4)d(P＜0.01).结论 生物蛋白胶应用于腹腔镜消化性溃疡穿孔修补术中,在封闭创面、促进溃疡愈合、预防胃或肠瘘及肠粘连等方面的效果确切,且无不良反应,值得临床推广.     

Fibrin glue in pulmonary resection: a prospective,randomized, blinded study

BACKGROUND: In contrast to the rare large-airway bronchopleural fistulas after lung resection, peripheral or alveolar air leaks (AAL) are very common, often prolong hospital stay, increase utilization of resources, and on occasion result in significant morbidity. Various adjuncts have been used in attempts to reduce AAL. One of these, the topical application of fibrin glue, has to date failed to demonstrate efficacy in small clinical trials. This study reexamines the role of fibrin glue in routine lobar and wedge pulmonary resections. METHODS: Of 113 patients enrolled, 13 became ineligible because of intraoperative findings. The remaining 100 patients were randomly assigned to one of two groups at the conclusion of lung resection, regardless of the presence or absence of identifiable air leak. The control group received no additional intervention. The experimental group underwent application of 5 mL of fibrin glue delivered by a pressurized, aerosolized spraying mechanism. Postoperatively a blinded clinical observer recorded outcomes including the incidence and duration of AAL, prolonged AAL (PAAL), the volume of pleural drainage, the time to tube removal, and the postoperative length of stay (LOS), as well as any complications related to treatment. RESULTS: Both groups were comparable with regard to demographics, diagnoses, and procedures. Statistically significant reductions were found in the experimental group in the overall incidence of AAL (34% versus 68%, p = 0.001), mean duration of AAL (1.1 versus 3.1 days, p = 0.005), mean time to chest tube removal (3.5 versus 5.0 days, p = 0.02), and the incidence of PAAL (2% versus 16%, p = 0.015). There was no significant difference in the volume of chest tube drainage or LOS (4.6 days glue and 4.9 days control, p = 0.318). There were no complications related to the use of fibrin glue. CONCLUSIONS: Aerosolized fibrin glue appears to be safe and effective in reducing AAL. The overall incidence of AAL was reduced by 50% and PAAL occurred in only 1 treated patient (2% versus the usually reported 15%). Further studies with this and other methods are required to delineate routine versus selective use, to compare methods, and clarify cost benefit.     

Comparison of the Clinical Outcome and Complications in Laparoscopic Hernia Repair of Inguinal Hernia With Mesh Fixation Using Fibrin Glue vs Tacker

Although laparoscopic repair offers a quick and less morbid way of treating hernias, complications like hematoma, seroma, neuralgia, recurrence, mesh infection, hydrocele, etc. are known. The present study was undertaken to compare various clinical outcomes between mesh fixation using fibrin glue and mesh fixation with tacker in a 3-months follow-up. One hundred patients aged 18 to 60 years having inguinal hernia admitted in Poona Hospital and Research Centre, Pune, between October 2012 and November 2014 for laparoscopic hernia surgery and ready to participate in this study were included. All of them underwent laparoscopic repair of hernia by total extra peritoneal (TEP) method following sample surgical protocol in all of them except for method of mesh fixation. Mean time calculated from insertion of the first trocar to beginning of skin suturing was 54.9 min in tacker group and 50.3 min in fibrin glue group with no statistically significant difference between the two. The incidence of urinary retention was significantly higher in tacker (34 %) as compared to fibrin glue (12 %) group. Incidence of hematoma was significantly higher in tacker group in 15-day follow-up, but there was no significant difference in hematoma formation at hernial sites in both groups after 15 days of follow-up. The incidence of neuralgia was significantly higher in the tacker group (24 %) compared with the fibrin glue group (2 %). Significantly, more number of people in the fibrin glue group 68 and 90 %, respectively, returned to work during 15 and 30 days follow-up as compared to the tacker group 46 and 64 %. Fibrin glue can be considered as an alternative to tacker for mesh fixation.     

Does Fibrin Glue Reduce Lymph Leakage (Pleural Effusion) after Extended Esophagectomy? Prospective Randomized Clinical Trial

Fibrin glue has been shown to be effective in improving postoperative chylothorax following various thoracic procedures and in reducing lymphorrhea after axillary dissection. It is unknown, however, whether fibrin glue is effective in reducing lymph leakage (pleural effusion) after esophagectomy. A series of 43 consecutive patients with thoracic esophageal cancer who underwent extended esophagectomy were prospectively randomized to two groups: group A (n = 21), in whom 3 ml of fibrin glue was applied to the dissected mediastinum; and group B (n = 22), in whom fibrin glue was not applied. The time of drain removal and the volume of the thoracic drainage were compared. All data were expressed as the mean ± standard deviation. There were no significant differences in the clinicopathologic characteristics between the two groups. None of the patients developed chylothorax or died during their hospital stay. The daily volume from the thoracic drain (457 ± 273 ml) was significantly (p < 0.05) larger on postoperative day (POD) 1 in group A than in group B (298 ± 158 ml) and tended to be larger (p < 0.10) on PODs 4 and 6 in group A than in group B. The cumulative drainage volume was significantly (p < 0.05) larger on PODs 4 to 6 and POD 9, and it tended to be larger (p < 0.10) on PODs 1, 3, 7, 8, 10, and 11 in group A than in group B, suggesting that the cumulative drainage volume in group A was consistently larger than that in group B. The cumulative numbers of patients with a drain remaining in place were not significantly different for the two groups (p = 0.4683). Three patients in group A, however, had prolonged insertion (> 20 days) of the chest tube. There were no significant differences in the incidence of postoperative chest-related complications. No patients in group A developed viral infectious disease during the long-term follow-up. Application of fibrin glue to the dissected mediastinum seems to induce postoperative lymph leakage and thus be responsible for prolonged chest tube insertion in some patients. Hence the use of fibrin glue cannot be recommended for reducing lymph leakage after esophagectomy.     

Hematoma rates in drainless deep-plane face-lift surgery with and without the use of fibrin glue

OBJECTIVE: To determine the rate of hematoma formation in drainless deep-plane rhytidectomy and compare it with the rate using the same technique with the use of fibrin glue. METHODS: This is a retrospective review of 605 patients (78 male and 527 female) who, over a 6-year period, underwent deep-plane face-lift surgery (n = 544) or lateral superficial musculoaponeurotic system (SMAS)ectomy (n = 61) by the senior author (S.S.R.) without the use of surgical drains. One hundred forty-six consecutive patients underwent rhytidectomy without fibrin tissue glue, and the following 459 consecutive patients were sprayed with fibrin glue under the flap prior to flap closure. Pressure dressings were used on all patients for 24 hours. RESULTS: None of the patients in either group had major or expanding hematomas requiring operative intervention. In the group of patients treated without fibrin glue (n = 146), there were 5 minor, nonexpanding hematomas, all managed by needle aspiration. This is a minor hematoma rate of 3.4%. In the fibrin glue group (n = 459), there were 2 hematomas, for a rate of 0.4%. Using a Fisher exact test, we found a statistically significant decrease in the hematoma rate from 3.4% to 0.4% (P = .01). Male patients had a higher hematoma rate than female patients, and only men had significantly fewer hematomas when fibrin glue was applied (P = .01). All 7 hematomas were recognized in the first 24 hours after surgery. Of the 7 patients with hematomas, 2 (29%) had emesis in the recovery room despite medication. CONCLUSIONS: The use of fibrin glue demonstrates a significant decrease in the rate of hematoma formation. Fibrin glue may benefit male more than female patients. If meticulous hemostasis and pressure dressings are used, drains are not necessary. The prevention and prompt treatment of postoperative nausea may also help prevent hematoma formation.     

颈椎前路手术中硬膜损伤的预防与治疗

目的探讨如何预防与治疗颈椎前路手术中出现的硬膜损伤。方法回顾分析2011年10月—2015年10月在本院接受治疗的72例颈椎前路手术中硬膜损伤患者的临床资料。术中行明胶海绵、生物蛋白胶封堵30例,皮下筋膜组织覆盖缺损处加明胶海绵、生物蛋白胶黏合加固42例。其中32例术后48 h切口引流200 m L/d,后续采用持续常压引流加弹力绷带适度绕颈环形加压的方法治疗;40例术后48 h切口引流200 m L/d,后续采用腰大池引流结合弹力绷带适度绕颈环形加压的方法治疗。术后常规卧床,预防感染,营养支持治疗。结果 32例持续常压引流的患者恢复至脑脊液漏停止的平均时间为6.4 d,40例腰大池引流的患者平均恢复时间为11.2 d。所有患者术后神经功能均显著改善,切口愈合良好,无感染发生。仅1例发生颈前脑脊液假性囊肿,经反复穿刺抽吸加腰大池引流无效,于术后半年行颈椎前路囊肿切除修补术后痊愈。结论充分的术前评估及熟练的手术技巧对于减少颈椎前路手术中硬膜损伤至关重要。对于已经形成的硬膜损伤,术中采取明胶海绵、生物蛋白胶封堵或皮下筋膜组织覆盖缺损处结合明胶海绵、生物蛋白胶黏合加固,再辅以术后伤口引流、腰大池引流等措施,可以取得满意疗效。