Herget G W, Kassa M, Riede U N, Lu Y, Brethner L, Hasse J
Department of Thoracic Surgery, University of Freiburg, Hugstetterstrasse 55, 79106 i. Br., Freiburg, Germany.
Eur J Cardiothorac Surg. 2001 Jan;19(1):4-9. doi: 10.1016/s1010-7940(00)00613-8.
Despite advanced surgical techniques, major complications of bronchial anastomoses and parenchymal repair, including early leak, fistula formation and granulations still occur. The purpose of this study was to test the performance of an albumin-glutaraldehyde tissue adhesive (BioGlue), CryoLife Inc., Kennesaw, GA) as a sealant for bronchial anastomoses and parenchyma lesions.
Twenty-four sheep were split into two surgical groups. The first group consisted of six control sheep receiving standard sutured bronchial anastomosis with a 4-week end-point. The second group included 18 sheep receiving both a bronchial anastomosis and parenchymal defect repair using the adhesive with 2, 4, and 12 week end-point. Histopathologic evaluation was conducted at the study end-points.
Bronchial anastomosis and parenchymal tissue repair can be sealed successfully against air leakage with adhesive. Macroscopic evaluation revealed a tight closure of the anastomosis and parenchyma defect in all postoperative stages, initially by the adhesive layer, and later by connective tissue. On microscopic examination, an inflammatory tissue response consisting of polymorphonuclear neutrophils, macrophages, granulation tissue and foreign body giant cells were found surrounding the glued area after 2 weeks. After 4 weeks the tissue response presented a granulomatous character. No granulomatous or foreign body reaction was present in the hand sutured group. After 12 weeks few remnants of adhesive surrounded by fibrous scar tissue were detectable in bronchial anastomosis and parenchymal repair. Healing was not considerably complicated by foreign body reaction or tissue granulation.
This study supports BioGlue to be effective as an adjunct in sealing bronchial anastomosis and lung parenchyma defects in sheep, with minimal secondary healing disruptions such as granuloma formation. The results of this study indicate that the use of BioGlue in human pulmonary surgery should be effective.
尽管手术技术不断进步，但支气管吻合和实质修复的主要并发症，包括早期渗漏、瘘管形成和肉芽组织仍会出现。本研究的目的是测试一种白蛋白 - 戊二醛组织粘合剂（BioGlue，CryoLife公司，佐治亚州肯尼索）作为支气管吻合和实质病变密封剂的性能。
将24只绵羊分为两个手术组。第一组包括6只对照绵羊，接受标准缝合支气管吻合术，终点为4周。第二组包括18只绵羊，接受使用粘合剂进行支气管吻合和实质缺损修复，终点分别为2周、4周和12周。在研究终点进行组织病理学评估。
使用粘合剂可成功密封支气管吻合和实质组织修复以防漏气。宏观评估显示，在所有术后阶段，吻合口和实质缺损均紧密闭合，最初由粘合剂层，随后由结缔组织实现。显微镜检查发现，2周后，在粘合区域周围有由多形核中性粒细胞、巨噬细胞、肉芽组织和异物巨细胞组成的炎性组织反应。4周后，组织反应呈现肉芽肿特征。手工缝合组未出现肉芽肿或异物反应。12周后，在支气管吻合和实质修复中可检测到少量被纤维瘢痕组织包围的粘合剂残留。愈合未因异物反应或组织肉芽而显著复杂化。
本研究支持BioGlue作为辅助手段在密封绵羊支气管吻合和肺实质缺损方面有效，且继发性愈合干扰（如肉芽肿形成）最小。本研究结果表明，BioGlue在人类肺部手术中的应用应是有效的。
