Shah Hemendra N, Kausik Vikram, Hedge Sunil, Shah Jignesh N, Bansal Manish B
R.G. Stone Urological Research Institute, Mumbai, India.
J Endourol. 2006 Mar;20(3):194-8. doi: 10.1089/end.2006.20.194.
To report our initial experience with hemostatic fibrin glue as an adjuvant during tubeless percutaneous nephrolithotomy (PCNL).
Seventeen consecutive patients underwent tubeless PCNL with injection of 2 mL of Tisseel Vapor Heated Sealant (Baxter AG, Vienna, Austria) into the percutaneous tracts at the conclusion of the procedure. The perioperative outcomes of these patients were compared retrospectively with those of a control group of 25 consecutive patients who underwent tubeless PCNL without the use of fibrin glue. The safety and efficacy of the new approach was evaluated by comparing operative time, hemoglobin drop, transfusion requirement, length of hospitalization, postoperative pain, analgesic use, and postoperative complications in the two groups.
There was no difference in the mean drop in hemoglobin, transfusion requirement, or complications in the two groups. However, patients undergoing Tisseel tubeless PCNL required less analgesia postoperatively (P=0.05), and they were discharged an average of 7 hours earlier than the patients in the control group. There were no major postoperative complications.
Use of fibrin glue was safe and was associated with less analgesic requirement and a shorter hospital stay. Randomized studies are needed to evaluate its clinical role in the future.
报告我们在无管经皮肾镜取石术（PCNL）中使用止血纤维蛋白胶作为辅助手段的初步经验。
17例连续患者接受了无管PCNL，在手术结束时向经皮通道内注入2毫升Tisseel Vapor Heated Sealant（百特医疗用品公司，奥地利维也纳）。将这些患者的围手术期结果与25例连续接受无管PCNL但未使用纤维蛋白胶的对照组患者的结果进行回顾性比较。通过比较两组的手术时间、血红蛋白下降情况、输血需求、住院时间、术后疼痛、镇痛药物使用情况及术后并发症，评估新方法的安全性和有效性。
两组患者的血红蛋白平均下降幅度、输血需求或并发症方面无差异。然而，接受Tisseel无管PCNL的患者术后所需镇痛较少（P = 0.05），且比对照组患者平均早7小时出院。无重大术后并发症。
使用纤维蛋白胶是安全的，且与较少的镇痛需求和较短的住院时间相关。未来需要进行随机研究以评估其临床作用。
