纤维蛋白胶预防内镜黏膜下剥离术后出血疗效的对照研究

目的 探讨内镜黏膜下剥离术（ESD）术中使用纤维蛋白胶喷洒创面预防术后出血的临床效果。方法 2015年7月至2016年6月，因消化道肿瘤在南京医科大学第一附属医院消化科行ESD治疗的连续病例纳入研究，2015年12月31日前的病例选入观察组，之后的病例选入对照组，观察组退镜结束操作前于手术创面喷洒纤维蛋白胶，对照组则无，对比分析2组的术后出血率、平均住院时间及费用等指标。结果 观察组的术后出血率为7.45%（12/161），平均住院时间（9.09±2.65）d，平均住院费用（24 246±5 519）元；对照组的术后出血率为14.79%（25/169），平均住院时间（9.20±2.99）d，平均住院费用（25 214±6 258）元。观察组术后出血率明显低于对照组（P=0.035），平均住院时间（P=0.744）及平均住院费用（P=0.138）组间差异均无统计学意义。多因素回归分析同样显示术中使用纤维蛋白胶是ESD术后出血的保护因素。结论 ESD术中使用纤维蛋白胶能够有效预防术后出血，并且不会明显增加住院时间和费用，是一种有效且经济的方法。

Effects of fibrin glue on prevention of bleeding after endoscopic submucosal dissection: a randomized controlled trial

Objective To study the utility of fibrin glue on prevention of bleeding after endoscopic submucosal dissection (ESD).Methods Consecutive patients with gastrointestinal tumors who underwent ESD between July 2015 and June 2016 in the first Affiliated Hospital of Nanjing Medical University were enrolled in the study. The patients receiving ESD before December 31, 2015 were assigned into the fibrin glue group, and patients receiving ESD after December 31, 2015 were assigned into the control group. The treated group was sprayed with fibrin glue on wound post-ESD followed by routine hemostasis method, and the control group was given routine hemostasis method only. The bleeding rate after ESD, mean hospital stays and cost were compared between the two groups. Results The bleeding rate after ESD in the fibrin glue group was significantly lower than that in the control group [7.45% (12/161) VS 14.79% (25/169), P=0.035]. There was no significantly difference in the mean hospital stays (9.09±2.65 days VS 9.20±2.99 days, P=0.744) and mean cost (24 246±5 519 yuan VS 25 214±6 258 yuan, P=0.138) between the two groups. Multivariate analysis revealed that the use of fibrin glue was a protective factor for bleeding after ESD.Conclusion Fibrin glue is safe, effective and economical in prevention of bleeding after ESD.