Beduschi R, Beduschi M C, Wojno K J, Jhung M, Williams A L, Wolf J S
Department of Surgery, University of Michigan, Ann Arbor, USA.
J Endourol. 1999 May;13(4):283-7. doi: 10.1089/end.1999.13.283.
Fibrinolytic activity of urine may rapidly degrade fibrin glue used in the urinary tract, thereby limiting tissue adhesion. The goals of this study were to verify the ability of antifibrinolytic agents to delay the degradation of fibrin glue in the urinary tract and to assess the results of this delay on subsequent wound healing.
In 25 domestic pigs, a 3.5-cm incision in the urinary bladder was left open (N = 6) or closed laparoscopically with fibrin glue alone (N = 6), fibrin glue containing aprotinin 5000 KIU/mL (N = 6), or fibrin glue containing aprotinin 2500 KIU/mL with (N = 4) or without (N = 3) aminocaproic acid 12.5 mg/mL. At harvest 7 days later, the bladder was tested for leakage. Histologic features were scored by a pathologist blinded to the closure method.
There were no significant differences among the groups in the amount of leakage at harvest. Significant fibrin glue material in the wound was noted more often in the pigs treated with fibrin glue plus aprotinin (7 of 13) than in the fibrin glue-only group (0 of 6; P = 0.04). The presence of significant fibrin material in the wound correlated well with absence of granulation tissue (P < 0.001), such that granulation tissue bridging the wound edges was found more often in the fibrin glue-only group (6 of 6) than in the groups treated with fibrin glue plus aprotinin (4 of 13; P = 0.01).
Although aprotinin +/- aminocaproic acid did delay the degradation of fibrin glue used to close a bladder wound, it was associated with inhibition of granulation tissue in the glued wound. These findings suggest that aprotinin alone and aprotinin plus aminocaproic acid are not useful additives to fibrin glue used for wound closure in the urinary tract.
尿液的纤溶活性可能会迅速降解用于泌尿道的纤维蛋白胶，从而限制组织粘连。本研究的目的是验证抗纤溶药物延缓纤维蛋白胶在泌尿道中降解的能力，并评估这种延缓对后续伤口愈合的影响。
选取25头家猪，在膀胱上做一个3.5厘米的切口，使其敞开（N = 6），或仅用纤维蛋白胶进行腹腔镜缝合（N = 6），或用含5000 KIU/mL抑肽酶的纤维蛋白胶（N = 6），或用含2500 KIU/mL抑肽酶且添加（N = 4）或不添加（N = 3）12.5 mg/mL氨基己酸的纤维蛋白胶。7天后取材时，检测膀胱是否渗漏。由对缝合方法不知情的病理学家对组织学特征进行评分。
取材时，各组间渗漏量无显著差异。与仅使用纤维蛋白胶的组（6头中的0头；P = 0.04）相比，使用纤维蛋白胶加抑肽酶治疗的猪（13头中的7头）伤口中显著的纤维蛋白胶物质更常见。伤口中存在显著的纤维蛋白物质与无肉芽组织密切相关（P < 0.001），因此，仅使用纤维蛋白胶的组（6头中的6头）比使用纤维蛋白胶加抑肽酶治疗的组（13头中的4头；P = 0.01）更常发现肉芽组织跨越伤口边缘。
虽然抑肽酶±氨基己酸确实延缓了用于闭合膀胱伤口的纤维蛋白胶的降解，但它与胶合伤口中肉芽组织的抑制有关。这些发现表明，单独使用抑肽酶以及抑肽酶加氨基己酸并非用于泌尿道伤口闭合的纤维蛋白胶的有用添加剂。
