Avanogmacr;lu A, Celik A, Ulman I, Ozcan C, Kavakli K, Nişli G, Gökdemir A
Ege University Faculty of Medicine, Department of Paediatric Surgery, Division of Paediatric Urology, Izmir, Turkey.
BJU Int. 1999 Jan;83(1):91-4. doi: 10.1046/j.1464-410x.1999.00909.x.
To evaluate the efficacy and the reduced costs of factor concentrates in circumcision by using fibrin glue in patients with haemophilia.
Eleven patients with haemophilia (age range 6-14 years, 10 with haemophilia A, one with haemophilia B) were circumcised using fibrin glue for local haemostasis and to reduce the duration of clotting factor replacement after surgery. Circumcision was carried out under general anaesthesia; the prepuce was incised circumferentially and excised using the Gomco clamp technique. Haemophiliac patients were divided into two groups: in group 1 (four patients, three with haemophilia A and one with haemophilia B) the factor levels were assessed every 8 h and bolus injections of factor repeated during the first 4 days after surgery; in group 2, the seven remaining haemophilia A patients received a postoperative bolus injection and approximately 4 U/kg per hour of factor substitution for the first 2 days after surgery by continuous infusion. Eleven other patients with haemophilia A underwent circumcision using same surgical procedure but were given only factor substitution without fibrin glue, and served as a control group (group 3).
None of the patients had significant bleeding or complications. The total costs were significantly reduced, to $8898 per patient in group 1 and $4866 per patient in group 2, when compared with $12875 per patient in group 3 (both P<0.05).
Fibrin glue is a useful treatment for circumcision in patients with haemophilia; it lessens the need for factor substitution after circumcision and thus reduces the high cost of treatment.
评估在血友病患者包皮环切术中使用纤维蛋白胶浓缩因子的疗效及成本降低情况。
11例血友病患者（年龄6 - 14岁，10例甲型血友病，1例乙型血友病）接受包皮环切术，使用纤维蛋白胶进行局部止血并减少术后凝血因子替代的持续时间。包皮环切术在全身麻醉下进行；包皮环切并使用Gomco钳技术切除。血友病患者分为两组：第1组（4例患者，3例甲型血友病和1例乙型血友病）每8小时评估一次因子水平，并在术后第1个4天内重复推注因子；第2组，其余7例甲型血友病患者术后接受一次推注，并在术后第1个2天内通过持续输注以约4 U/kg每小时的剂量进行因子替代。另外11例甲型血友病患者采用相同手术方法进行包皮环切术，但仅给予因子替代而未使用纤维蛋白胶，作为对照组（第3组）。
所有患者均无明显出血或并发症。与第3组每位患者12875美元相比，第1组每位患者的总成本显著降低至8898美元，第2组每位患者为4866美元（P均<0.05）。
纤维蛋白胶对血友病患者包皮环切术是一种有用的治疗方法；它减少了包皮环切术后因子替代的需求，从而降低了高昂的治疗成本。
