Gill Inderbir S, Ramani Anup P, Spaliviero Massimiliano, Xu Meng, Finelli Antonio, Kaouk Jihad H, Desai Mihir M
Section of Laparoscopic and Robotic Surgery, Glickman Urological Institute and Minimally Invasive Surgery Center, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Urology. 2005 Mar;65(3):463-6. doi: 10.1016/j.urology.2004.10.030.
To evaluate whether using a biologic hemostatic sealant facilitates hemostasis during laparoscopic partial nephrectomy. Secure and durable parenchymal hemostasis is a critical requirement during laparoscopic partial nephrectomy.
Since September 1999, laparoscopic partial nephrectomy has been performed in more than 300 patients by a single surgeon, duplicating open surgical principles. Recently, from patient 225 onward, we modified our technique by incorporating topical application of a gelatin matrix thrombin sealant (FloSeal) to cover the partial nephrectomy bed before sutured renorrhaphy over a Surgicel bolster. The impact of FloSeal on reducing hemorrhagic complications was evaluated by comparing two sequential groups of patients: group 1 consisted of 68 patients in whom FloSeal was not used (patients 156 to 224) and group 2 consisted of 63 patients in whom it was used (patients 225 to 288).
Groups 1 (no FloSeal) and 2 (FloSeal) were comparable in tumor size, number of central tumors, and performance of pelvicaliceal suture repair (84% versus 92%; P = 0.16). Intraoperative variables were also comparable in terms of mean warm ischemia time (36.1 versus 37.2 minutes; P = 0.55), blood loss (150 versus 106 mL; P = 0.36), operative time, and hospital stay. However, the FloSeal group had significantly fewer overall complications (37% versus 16%; P = 0.008) and tended toward a lower rate of hemorrhagic complications (12% versus 3%), although this did not achieve statistical significance (P = 0.08).
The results of this study have shown that adjunctive use of gelatin matrix thrombin sealant substantially enhances parenchymal hemostasis and has decreased our procedural and hemorrhagic complications to levels comparable with contemporary open partial nephrectomy series. This gelatin matrix-thrombin tissue sealant is now a routine part of laparoscopic partial nephrectomy at our institution.
评估使用生物止血密封剂是否有助于腹腔镜肾部分切除术期间的止血。在腹腔镜肾部分切除术中，安全且持久的实质止血是一项关键要求。
自1999年9月以来，由一名外科医生对300多名患者实施了腹腔镜肾部分切除术，遵循开放手术原则。最近，从第225例患者开始，我们改进了技术，在 Surgicel 支撑物上进行缝合肾缝合术之前，通过局部应用明胶基质凝血酶密封剂（FloSeal）覆盖肾部分切除床。通过比较两组连续患者评估 FloSeal 对减少出血并发症的影响：第1组由68例未使用 FloSeal 的患者组成（第156至224例患者），第2组由63例使用 FloSeal 的患者组成（第225至288例患者）。
第1组（未使用 FloSeal）和第2组（使用 FloSeal）在肿瘤大小、中央肿瘤数量以及肾盂输尿管缝合修复情况方面具有可比性（84% 对 92%；P = 0.16）。术中变量在平均热缺血时间（36.1对37.2分钟；P = 0.55）、失血量（150对106 mL；P = 0.36）、手术时间和住院时间方面也具有可比性。然而，FloSeal 组的总体并发症明显较少（37% 对 16%；P = 0.008），出血并发症发生率有降低趋势（12% 对 3%），尽管未达到统计学意义（P = 0.08）。
本研究结果表明，辅助使用明胶基质凝血酶密封剂可显著增强实质止血，并将我们的手术和出血并发症降低至与当代开放肾部分切除术系列相当的水平。这种明胶基质 - 凝血酶组织密封剂现已成为我们机构腹腔镜肾部分切除术的常规组成部分。
