医用生物蛋白胶在皮肤移植术中的应用

目的:研究医用生物蛋白胶在皮肤移植术中的应用前景。方法:对7例双手瘢痕的患者行左右手对照实验,比较两者止血时间及皮片成活率,并观察18例其他部位瘢痕切除合并使用医用生物蛋白胶后皮片的成活情况。结果:7例手部皮片成活良好,使用医用生物蛋白胶组手术时间明显缩短;其他部位中17例皮片基本完全成活,1例有2cm×3cm的皮片坏死,经补充植皮后出院。结论:医用生物蛋白胶有良好的止血作用,只要使用合适,在皮肤移植术中也有较大的使用价值。     

New application method of fibrin glue for more effective hemostasis in cardiovascular surgery

Objective: This study was performed to determine the most effective application method of fibrin glue as a hemostatic sealant in cardiovascular surgery. Methods: The effectiveness of fibrin glue as a hemostatic sealant was compared between 4 methods of application; dripping, spray, spray-and-rub, and rub-and-spray methods. I. In vitro ‘burst pressure’ was measured in fibrin glue-sealed needle holes of polytetrafluoroethylene (PTFE) graft in each method. II. Fibrin glue-sealed needle holes of PTFE grafts implanted between an abdominal aorta and iliac arteries of a pig was microscopically examined to determine the effectiveness of fibrin glue sealing in each method. Results: I. Burst pressures were 24.1±7.9 minHg in dripping, 98.1±35.4 mmHg in spray, 140.8±34.8 mmHg in spray-and-rub and 206.7±26.1 mmHg in rub-and-spray method (statistically significant, p<0.01, between each method). II. Microscopically, no fibrin glue remained on the external surface of the PTFE graft in the dripping method. Fibrin glue plugged 1/3 or 2/3 of the depth of the needle hole in the spray method and spray-and-rub methods respectively. In the rub-and-spray method, fibrin glue covered the needle hole over the external surface of the graft, completely plugged the needle hole to its whole depth, leaving no spaces where blood came into the needle hole. Conclusion: The rub-and-spray method of fibrin glue application revealed the strongest sealing and hemostatic effects, and can be safely and effectively used for hemostasis in cardiovascular surgery that requires systemic heparinization or prolonged extracorporeal circulation.     

生物蛋白胶封堵术治疗高位肛瘘的临床研究

目的探讨生物蛋白胶封堵术治疗高位肛瘘的临床应用。方法将我科2010年3月至2011年4月期间60例高位肛瘘,随机分为治疗组和对照组各30例。治疗组采用生物蛋白胶封堵术,对照组采用肛瘘切除术,比较两组术后创面愈合时间、创面换药疼痛、肛管压力测定。结果治疗组术后疼痛及创面愈合时间均比对照组低（P〈0．05）;复发率的差异无统计学意义（P〉0．05）;术后肛管静息压比较,差异有统计学意义（P〈0．05）。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,保护肛管静息压。     

纤维蛋白胶在泌尿外科手术中的应用

纤维蛋白胶(fibrin glue,FG)是一种生物蛋白制剂,兼具止血、组织粘合、封闭组织缺损和促进组织愈合的功能。其止血效果良好,且具有良好的生物相容性和可降解性,已在普外科、骨科、心血管外科、整形外科、泌尿外科等众多科室应用并取得了较好的疗效。本文对FG在泌尿外科手术中的应用进展作一综述。     

The effect of fibrin glue on tendon healing and adhesion formation in a rabbit model of flexor tendon injury and repair

Abstract

Fibrin glue has been widely used in a variety of surgical procedures to promote haemostasis and tissue bonding. It can also be used as a cell carrier for stem cells on tendons. However, the data about the effect of fibrin glue on flexor tendon healing is very limited. The present study examined the role of fibrin glue TISSEEL® in a rabbit model of flexor tendon injury. The rabbits were killed 3 or 8 weeks after the operation. The range-of-motion of the fingers and biomechanical properties of tendons were measured and compared between the control group and TISSEEL-treated group. The findings have shown that the range-of-motion in the TISSEEL-treated group was significantly different from that of the control group at 3 weeks after the operation. However, there is no significant difference in range-of-motion at 8 weeks after the operation. Moreover, there is no significant difference in biomechanical properties between the control group and TISSEEL-treated group. The results indicate that TISSEEL may attenuate adhesion formation at the early stage of flexor tendon repair. However, there is no significant effect on biomechanical features during tendon repair. In conclusion, this study has shown that it may be safe to use TISSEEL in tissue engineering applications for tendon regeneration and healing.     

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。     

医用生物蛋白胶在腭裂修复术中的应用

目的:观察医用生物蛋白胶在腭裂修复术创口中的应用对伤口愈合效果的影响。方法:将已配制的医用生物蛋白胶喷涂在腭裂双侧松弛切口及裸露创面。结果:48例腭裂术后伤口愈合良好,未出现明显伤口出血、糜烂及穿孔。结论:生物蛋白胶可通过封闭创口促进伤口愈合,在腭裂整复术中应用可靠、安全。     

以纤维蛋白凝胶为支架构建组织工程胃新膀胱的研究

目的探讨以纤维蛋白凝胶为支架，通过组织工程技术以胃．重建膀胱的可行性。方法从实验动物获取膀胱黏膜，体外培养并扩增移行上皮细胞。分别通过纤维蛋白凝胶（实验组）和keratinocyte-SFM（对照组）将单个细胞悬液移植于带血管蒂的去黏膜胃片，将胃片缝成囊状（新膀胱），固定于腹壁。于术后2、4、6、8周取胃片进行组织学及免疫组化分析。结果实验组术后随时间延长新膀胱有不同程度挛缩；HE染色提示胃囊腔面有上皮样细胞覆盖，2周时细胞覆盖率约50％，4—8周时约70％。这些细胞分布不均匀，分层不明显；上皮样细胞AE1／AE3染色和CK7染色均阳性。对照组各标本均严重挛缩，腔隙消失，无上皮覆盖。结论将体外培养扩增的尿路上皮细胞通过纤维蛋白凝胶移植至去黏膜胃片，可以使去黏膜胃片移行上皮化，从而重建膀胱。     

Fibrin glue for the suture-less correction of penile chordee: a pilot study in a rabbit model

OBJECTIVE: To evaluate the use of fibrin glue as a scaffold for patching defects in the tunica albuginea in a rabbit model for a future application in correcting chordee. MATERIALS AND METHODS: Nine New Zealand white male rabbits were utilized. All had a 15 x 5-mm defect created in the ventral tunica albuginea. Fibrin glue (1 mL) was applied to cover the defect in tunica albuginea and the penile skin closed with a continuous 5/0 chromic catgut suture. Animals were killed in groups of three at 2, 6 and 12 weeks afterward. The evaluation included an artificial erection test with intracavernosal injection of prostaglandin E1 (5 microg), cavernosography and histopathological examination of sections of the penis stained with haematoxylin and eosin or Masson trichrome. RESULTS: None of the rabbits died during the procedure or developed bleeding or haematoma afterward. All animals had straight erections on testing with prostaglandin (5 microg). There was no evidence of corporal narrowing or venous leakage on cavernosography. Histopathological evaluation showed evidence of the fibrin sealant layer, with angiogenesis and a cell infiltrate at 2 weeks. At 6 and 12 weeks there was completely normal regeneration of the tunica albuginea. CONCLUSIONS: In this pilot study in a rabbit model the haemostatic effect of fibrin glue was confirmed on covering a defect in the tunica albuginea. Moreover, there was regeneration of normal tunica albuginea with no scarring at 6 weeks and maintained at 12 weeks. Further well-controlled studies are required before using fibrin glue for corporal body grafting to treat chordee.     

Usefulness of fibrin glue in oncologic plastic surgery

Summary Human fibrin glue (Tissucol) is a plasma-derived compound endowed with adhesive and hemostatic properties and possessing a specific local anti-infection function mediated through activation of nonspecific immunity elements. The aim of this study is to show that in patients who have undergone prolonged reconstructive plastic surgery following cancer resection, Tissucol decreases infectious complications as compared to a control group. Between June 1985 and February 1988, 51 subjects were treated with fibrin glue during reconstruction operations. Analysis of the results showed that Tissucol produced a statistically significant reduction both of immediate complications, such as inflammation and partial separation of the surgical wound, and of delayed complications, such as scar hypertrophy and cutaneous fistulae. In conclusion, patients treated with Tissucol showed a better quality of surgical wound, a more rapid postoperative functional recovery and consequently a decrease in the duration of hospitalization.     

医用生物蛋白胶在而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.     

脱蛋白骨复合纤维蛋白胶构建骨组织工程支架的体外实验研究

[目的]探讨复合纤维蛋白胶的脱蛋白骨与单纯脱蛋白骨作为骨髓基质干细胞（MSCs）支架材料的差异，为骨组织工程提供合适的复合支架材料。[方法]实验组使用复合纤维蛋白胶的脱蛋白骨与MSCs复合培养，对照组用单纯脱蛋白骨与MSCs复合培养，取不同时间点进行光学显微镜观察、扫描电镜观察、细胞DNA含量检测及钙结节染色比较两组细胞的情况。[结果]实验组骨髓基质干细胞在黏附能力与分泌情况明显优于对照组，细胞DNA检测表明实验组细胞增殖明显优于对照组（P〈0．05）。[结论]复合纤维蛋白胶的脱蛋白骨比单纯脱蛋白骨更适合细胞生长，可作为MSCs的载体应用于骨组织工程的构建。     

Histological effects of fibrin glue on nervous tissue: a safety study in rats

BACKGROUND

Little is known of the histologic effects of fibrin glue on normal nervous tissue. To verify the safety of intracranial application of fibrin glue, we investigated the histologic effects of fibrin glue on brain tissue and intracranial nerves of rats.

METHODS

In Group I (n = 12), bifrontal craniotomy with opening of the dura and arachnoid was performed, and on one side one droplet of fibrin glue was applied into the subarachnoid space. In Group II (n = 12), a unilateral temporal craniotomy was performed, the cavernous sinus was opened, and one drop of fibrin glue was applied to the trigeminal nerve. The controls for Group II (n = 8) were operated in the same way but without application of the fibrin glue. Rats were sacrificed at 1, 3, 7, and 28 days after surgery. The brains and nerves were processed for histologic examination and were semi-quantitatively scored for neuronal damage, gliosis, edema, fibroplasia, inflammatory reaction, axonal damage, and myelin damage.

RESULTS

No differences were found in the occurrence of neuronal damage, gliosis, edema, fibroplasia, axonal damage, or myelin damage between rats with and without fibrin glue application. In Group I the inflammatory reaction seen at Day 7 was more severe on the fibrin glue side when compared to the control side. At Day 28, however, this difference had resolved.

CONCLUSIONS

In this morphological safety study, intracranial application of fibrin glue in a rat model does not induce extra brain damage, intracranial nerve damage, or scar tissue formation.     

Effect of the combination of fibrin glue and growth hormone on incomplete intestinal anastomoses in a rat model of intra-abdominal sepsis

BACKGROUND: The presence of established intra-abdominal sepsis has been considered a contraindication to primary anastomoses. Our hypothesis was that fibrin glue (FG), growth hormone (rhGH), and combination of them synergistically improve intestinal primary anastomotic healing in a rat model of intestinal fistulae with peritonitis. MATERIALS AND METHODS: Male Wistar rats, induced intestinal fistulae with peritonitis after 24 h, were performed an enterectomy and intestinal anastomoses. Group A, rats (n = 60) had a complete anastomoses (end-to-end single layer anastomoses using 12 inverted interrupted 6-0 sutures) without peritonitis, group B, rats (n = 60) had a complete anastomoses after 24 h of peritonitis, group C rats had an incomplete anastomoses (four inverted interrupted sutures), groups D, E, F rats (n = 60) received FG, rhGH, or both of them, respectively. rhGH was given daily for 5 days. Anastomoses indicated the anastomotic bursting pressure (ABP), tensile strength, and hydroxyproline content, were determined. RESULTS: On POD 1, ABP of group C and group D was significantly lower than that of other groups (P < 0.01); On POD 3, ABP could not be determined because of intestinal dehiscence in groups C and E, ABP was significantly higher in groups D and F than that of groups A and B (P < 0.01); the ABP increased after 5 days of operation in groups A, B, and F. At the same time, that of group D decreased (P < 0.01). On POD 5, the tensile strength was significantly higher in groups A, D, and F than that in groups C, and E. On POD 5, hydroxyproline content was higher in groups D and F compared to that in group C (P < 0.05). CONCLUSIONS: These data suggested that FG improve intestinal primary anastomotic healing within post-operative 5 days in a rat model of intestinal fistulae with peritonitis. RhGH alone fails to improve intestinal anastomotic healing, and the combination of FG and rhGH have no synergistic effect to improves intestinal anastomotic healing.     

Cultured keratinocytes suspended in fibrin glue to cover full thickness wounds on athymic nude mice: comparison of two brands of fibrin glue

 To circumvent well-known drawbacks inherent in cultured epidermal sheet grafts, a new keratinocyte delivery system was experimently investigated. Human subconfluent keratinocytes were labeled with fluorescence cell linker and cultured in two brands of fibrin glue (Tissucol^R and Beriplast^R) in vitro for 5 days. Keratinocyte fibrin glue suspensions were grafted onto full thickness wounds in athymic nude mice for macroscopic and microscopic investigation. Keratinocytes survived in both fibrin glues in vitro for at least 5 days. When grafted onto wounds, cells maintained a high proliferation potential and at 5 days formed small masses or well-organised cell clusters within the fibrin network. After 7 days new epithelia enlarged and became thicker with high keratinization and occasional downward projections. At 10 days, wounds in both fibrin groups were totally epitheliazied but only partially in the control group. Anti-involucrin and anti-laminin immunostainings indicated well-differentiated new epithelium derived from human keratinocytes and early reorganised basement membrane. The fibrin glues seem not only to deliver highly proliferative keratinocytes easily and effectively, but also provide an optimal milieu for their migration, proliferation and differentiation. Received: 7 February 1997 / Accepted: 7 May 1997     

生物蛋白胶作为骨髓间充质干细胞移植载体的体外相容性研究

[目的]构建骨髓间充质干细胞(bone marrow mesenchymal stem cells,BMSCs)-生物蛋白胶复合体评价其生物相容性,探讨其作为种子细胞载体的可行性。[方法]本实验分为两组,实验组5×107骨髓间充质干细胞(BMSCs)与生物蛋白胶相混制备MSC-生物蛋白胶复合体,空白组骨髓间充质干细胞(BMSCs)。通过Dead/live染色观察两组的细胞形态及21 d内细胞的存活情况,同时分别在1、3、7、14 d各取上清进行Elisa检测并计算其分泌释放NGF和BDNF的浓度。[结果]实验组培养3 d后光镜下观察呈多个突起,细胞形态良好,空白组呈菱形和多角形;Dead/live染色结果提示体外培养1 d,两组细胞的存活率都在90%,比较无差异,无统计学意义(P﹥0.05),7、14、21 d两组细胞的存活率有差异,具统计学意义(P﹤0.05),存活率在60%以上;Elisa检测结果显示两组中NGF在1 d时有差异,具统计学意义(P﹤0.05),3、7、14 d时NGF和BDNF的含量比较无统计学意义(P﹥0.05),结果显示生物蛋白胶对MSC分泌的细胞因子NGF和BDNF的释放没有明显影响。[结论]生物蛋白胶是一种理想的可用于临床的细胞载体,具有良好的生物相容性,BMSCs-生物蛋白胶复合体能持续稳定的释放神经生长因子BDNF和NGF。     

Perivenous application of fibrin glue reduces early injury to the human saphenous vein graft wall in an ex vivo model.

OBJECTIVES: From animal and clinical studies it is known that prevention of 'over-distention' of vein grafts by using extravascular support ameliorates the arterialization process in vein grafts with subsequent more favorable patency. The most ideal support is a biodegradable, porous, elastic graft (Biomaterials, 15 (1994) 83). However, a specific graft meeting these criteria is not available yet. Fibrin glue on the other hand, although used for other purposes in cardiac surgery, theoretically meets the criteria for ideal extravascular support. In this ex vivo study, we evaluated the possible beneficial effect of perivenous application of fibrin glue. METHODS: Segments of human vein graft obtained during CABG procedures in 14 consecutive patients were placed in a side loop of the extracorporeal perfusion circuit. In this way the study vein grafts did meet identical circumstances as the vein grafts implanted. Perfusion in the loop was started with a flow just enough to counteract the collapse of the vein, usually about 8 mm Hg, and alternately around the segments fibrin glue was applied or no perivenous support was administered as control. After 1 min of soldification, perfusion was started with a pressure of about 60 mm Hg (non-pulsatile flow). Perfusion was maintained for 60 min, after which the grafts were collected for light microscopic and electron microscopic assessment. RESULTS: Light microscopy and electron microscopy showed remarkable attenuation of endothelial cell loss and less injury of smooth muscle cells of the circular muscle layer of the media in the fibrin glue supported vein grafts compared to the non-supported group. CONCLUSION: Fibrin glue is able to accomplish adequate external vein graft support, preventing overdistention, in an ex vivo model. This provides a basis for clinical application. Further investigation is necessary to evaluate long-term effects.     

以生物蛋白胶为载体配合丝裂霉素缓释化疗腹腔恶性肿瘤的临床研究

目的　探讨以生物蛋白胶为载体配合丝裂霉素缓释化疗辅助治疗腹腔恶性肿瘤的有效性和安全性。方法　将 5 3例腹腔恶性肿瘤患者随机分为实验组 (n =2 7) ,对照组 (n =2 6) ,术后实验组将生物蛋白胶溶解丝裂霉素喷洒在腹腔及瘤床周围 ,对照组未使用 ,比较实验组与对照组的疗效差异。结果　术后实验组和对照组患者化疗不良反应的发生率分别为 5 4.2 % ,61.5 % ,两组无显著差异 (P >0 .0 5 )。术后 1年 ,对照组生存率为 5 0 % ,实验组生存率为 77.8% ,两组有统计学差异 (P <0 .0 5 )。结论　以生物蛋白胶为载体配合丝裂霉素术后腹腔缓释化疗能够延长病人的生存期 ,安全有效。