Anegg Udo, Lindenmann Jörg, Matzi Veronika, Smolle Josef, Maier Alfred, Smolle-Jüttner Freyja
Division of Thoracic and Hyperbaric Surgery, University Medical School, Graz, Austria.
Eur J Cardiothorac Surg. 2007 Feb;31(2):198-202. doi: 10.1016/j.ejcts.2006.11.033. Epub 2006 Dec 21.
Persistent air leakage following pulmonary resection is a major limiting factor for discharge from hospital. The aim of this study was to evaluate the sealing capacity of TachoSil for the closure of alveolar air leaks following parenchymal resections and to determine its effect on time to chest drain removal and duration of hospitalisation.
A total of 173 patients undergoing lobectomy or segmentectomy were enrolled in a single-centre, randomised study to compare the efficacy of TachoSil with standard treatment. Alveolar air leaks were evaluated intraoperatively by submersion of the resection site in saline and were graded according to the Macchiarini scale as 0 (no bubbles), 1 (single bubbles), 2 (stream of bubbles), 3 (coalescent bubbles). Patients with grade 1 or 2 air leaks were randomised to TachoSil or standard treatment. Grade 3 patients received standard treatment until the air leak was downgraded to grade 1 or 2 at which point they were randomised. Patients with grade 0 leakage were excluded. The primary efficacy endpoints of the study were postoperative quantification of air leakage on postoperative days 1 and 2. Other efficacy measurements included mean time to chest drain removal and mean time to hospital discharge.
The mean intraoperative post-treatment air leakage was significantly lower in the TachoSil group (153.32ml/min, range: 10-450ml/min) compared with the standard treatment group (251.04ml/min, range: 15-970ml/min; P=0.009). The significant difference in air leakage volume observed intraoperatively post-treatment was maintained postoperatively. TachoSil showed a trend towards reduced incidence of postoperative leakage when measured >48h or >7 days after surgery (30.7% vs 38.96% and 24% vs 32.46%, respectively). The mean times to chest drain removal and to hospital discharge were significantly reduced following the use of TachoSil (5.1 days vs 6.3 days, P=0.022 and 6.2 days vs 7.7 days, P=0.01, respectively).
The use of TachoSil following pulmonary resection resulted in a reduction in air leakage compared with standard techniques. This reduction in air leakage resulted in a significant reduction in both the time to chest drain removal and the period of hospitalisation.
肺切除术后持续漏气是限制患者出院的主要因素。本研究旨在评估速即纱（TachoSil）对实质性切除术后肺泡漏气的封闭能力，并确定其对胸腔引流管拔除时间和住院时间的影响。
173例行肺叶切除术或肺段切除术的患者纳入一项单中心随机研究，以比较速即纱与标准治疗的疗效。术中通过将切除部位浸入盐水中评估肺泡漏气情况，并根据马基亚里尼（Macchiarini）分级标准分为0级（无气泡）、1级（单个气泡）、2级（气泡流）、3级（融合气泡）。1级或2级漏气患者被随机分为速即纱组或标准治疗组。3级患者接受标准治疗，直至漏气降至1级或2级，此时再进行随机分组。0级漏气患者被排除。本研究的主要疗效终点是术后第1天和第2天漏气情况的量化。其他疗效指标包括胸腔引流管拔除的平均时间和出院的平均时间。
与标准治疗组（251.04ml/分钟，范围：15 - 970ml/分钟；P = 0.009）相比，速即纱组术中治疗后平均漏气量显著更低（153.32ml/分钟，范围：10 - 450ml/分钟）。术中治疗后观察到的漏气量显著差异在术后得以维持。术后超过48小时或超过7天测量时，速即纱组术后漏气发生率呈降低趋势（分别为30.7%对38.96%和24%对32.46%）。使用速即纱后，胸腔引流管拔除的平均时间和出院的平均时间显著缩短（分别为5.1天对6.3天，P = 0.022；6.2天对7.7天，P = 0.01）。
与标准技术相比，肺切除术后使用速即纱可减少漏气。漏气的减少导致胸腔引流管拔除时间和住院时间均显著缩短。
