Gagarine A, Urschel J D, Miller J D, Bennett W F, Young J E M
Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
J Cardiovasc Surg (Torino). 2003 Dec;44(6):771-3.
Air leaks are a common cause of morbidity and prolonged hospital stay after pulmonary lobectomy. We reviewed our experience with intraoperative fibrin glue to determine if it reduced air leak and improved patient outcomes.
Records of patients undergoing pulmonary lobectomy for benign or malignant disease over a 4-year period (1998-2001) were reviewed. Data was collected on age, sex, pulmonary function, pulmonary pathology, use of fibrin glue, duration of chest tube drainage, length of hospital stay, and postoperative complications.
Three hundred and sixty patients underwent lobectomy. Fibrin glue was used intraoperatively to seal air leaks in 102 of the 360 patients (study group: 102;control group: 258). Fibrin glue was used at the discretion of the surgeon, with some surgeons using it routinely. The groups did not differ in age (p=0.29), sex (p=0.42), FEV1 (p=0.57), or pathology (p=0.08). There were no differences in outcomes such as operative mortality (study: 2 of 102, control 6 of 258, p=0.85), empyema (study: 0 of 102, control: 3 of 258, p=0.55), prolonged (>7 days) air leaks (study: 10 of 20; control: 20 of 258, p=0.71), or length of hospital stay (study: 6.3+/-2.5 days, control:7.7+/-7.2 days, p=0.83). The use of fibrin glue was associated with a reduction in the duration of chest tube intubation (study: 4.1+/-3.2 days, control: 5.5+/-3.8 days, p=0.001).
Patients treated intraoperatively with fibrin glue had a significantly shorter duration of chest tube intubation after pulmonary lobectomy than those treated conventionally. However, the use of fibrin glue did not significantly influence more clinically relevant outcomes such as length of hospital stay and incidence of prolonged (>7 days) air leaks.
漏气是肺叶切除术后发病和延长住院时间的常见原因。我们回顾了术中使用纤维蛋白胶的经验，以确定其是否能减少漏气并改善患者预后。
回顾了1998年至2001年这4年间因良性或恶性疾病接受肺叶切除术患者的记录。收集了患者的年龄、性别、肺功能、肺部病理、纤维蛋白胶的使用情况、胸管引流时间、住院时间和术后并发症等数据。
360例患者接受了肺叶切除术。360例患者中有102例术中使用纤维蛋白胶封闭漏气（研究组：102例；对照组：258例）。纤维蛋白胶由外科医生酌情使用，一些外科医生常规使用。两组在年龄（p=0.29）、性别（p=0.42）、第一秒用力呼气量（p=0.57）或病理（p=0.08）方面无差异。在手术死亡率（研究组：102例中有2例，对照组：258例中有6例，p=0.85）、脓胸（研究组：102例中0例，对照组：258例中3例，p=0.55）、持续性（>7天）漏气（研究组：20例中有10例；对照组：258例中有20例，p=0.71）或住院时间（研究组：6.3±2.5天，对照组：7.7±7.2天，p=0.83）等结局方面无差异。纤维蛋白胶的使用与胸管插管时间缩短有关（研究组：4.1±3.2天，对照组：5.5±3.8天，p=0.001）。
与传统治疗的患者相比，术中使用纤维蛋白胶治疗的患者肺叶切除术后胸管插管时间明显缩短。然而，纤维蛋白胶的使用并未显著影响更具临床相关性的结局，如住院时间和持续性（>7天）漏气的发生率。
