纤维蛋白胶对胃肠道吻合口愈合的封闭作用：对内镜下漏口治疗的启示

Sealing effect of fibrin glue on the healing of gastrointestinal anastomoses: implications for the endoscopic treatment of leaks.

作者信息

Bonanomi G, Prince J M, McSteen F, Schauer P R, Hamad G G

机构信息

Minimally Invasive Surgery, University of Pittsburgh Medical Center, Magee-Womens Hospital, Pittsburgh, PA 15213, USA.

出版信息

Surg Endosc. 2004 Nov;18(11):1620-4. doi: 10.1007/s00464-004-8803-3. Epub 2004 Oct 11.

DOI:10.1007/s00464-004-8803-3

PMID:15931477

Abstract

BACKGROUND

The adoption of advanced laparoscopic techniques for complex surgical procedures has raised the concern that the leak rate might be higher than for open surgery, particularly in the surgeon's early experience or in difficult cases. In this study, the sealing effect of fibrin glue on leaking gastrointestinal anastomoses was evaluated in an experimental swine model.

METHODS

A standardized gastrojejunostomy was performed on 20 female pigs (mean weight, 47.7 +/- 5.7 kg). A leak was created on the anterior surface of the anastomosis. The animals were randomized to either fibrin glue or no treatment of the leak. Clinical conditions and vital signs, including body temperature, heart rate and, respiratory rate, were collected three times a day. Preoperative and postoperative complete and differential blood count and lactate dehydrogenase levels were determined. Postmortem analysis was performed when the animals were killed.

RESULTS

Clinical signs of peritonitis developed in the control animals by the second or third postoperative day. Findings that confirmed the presence of an anastomotic leak at the postmortem examination were the presence of food or gastrojejunal juices in the abdominal cavity, a localized abscess, or a positive air leak test. Fibrin glue treatment prevented the development of peritonitis in all the animals. Complete sealing of the leak was observed on postoperative day 7 in all treated animals, except one in which an asymptomatic contained leak developed. The postoperative total white blood count was significantly increased in the untreated group (24.69 +/- 5.5 vs 12.74 +/- 3.7 10(3)/ul p < 0.001, paired t-test), as compared with the treated group (15. 55 +/- 2.4 vs 14.89 +/- 2.7 10(3)/ul; p = 0.24).

CONCLUSION

In this study, fibrin glue showed reproducible sealing effects on leaking gastrojejunal anastomoses. Fibrin glue application may be a valuable approach for the treatment of gastrointestinal anastomotic leaks.

摘要

背景

复杂外科手术中采用先进的腹腔镜技术引发了人们的担忧，即渗漏率可能高于开放手术，尤其是在外科医生的早期经验中或困难病例中。在本研究中，在实验猪模型中评估了纤维蛋白胶对胃肠道吻合口渗漏的封闭效果。

方法

对20只雌性猪（平均体重47.7±5.7千克）进行标准化的胃空肠吻合术。在吻合口前表面制造渗漏。将动物随机分为接受纤维蛋白胶治疗或不治疗渗漏的两组。每天收集三次临床状况和生命体征，包括体温、心率和呼吸频率。测定术前和术后的全血细胞计数、分类计数以及乳酸脱氢酶水平。动物处死时进行尸检分析。

结果

对照组动物在术后第二天或第三天出现腹膜炎的临床症状。尸检时证实存在吻合口渗漏的表现为腹腔内有食物或胃肠液、局部脓肿或漏气试验阳性。纤维蛋白胶治疗可防止所有动物发生腹膜炎。除一只出现无症状的包裹性渗漏外，所有接受治疗的动物在术后第7天渗漏均完全封闭。与治疗组相比，未治疗组术后白细胞总数显著升高（24.69±5.5对12.74±3.7×10³/微升，配对t检验，p<0.001），治疗组为（15.55±2.4对14.89±2.7×10³/微升；p = 0.24）。