Breda Alberto, Stepanian Sevan V, Lam John S, Liao Joseph C, Gill Inderbir S, Colombo Jose R, Guazzoni Giorgio, Stifelman Michael D, Perry Kent T, Celia Antonio, Breda Guglielmo, Fornara Paolo, Jackman Stephen V, Rosales Antonio, Palou Juan, Grasso Michael, Pansadoro Vincenzo, Disanto Vincenzo, Porpiglia Francesco, Milani Claudio, Abbou Claude C, Gaston Richard, Janetschek Gunter, Soomro Naeem A, De la Rosette Jean J, Laguna Pilar M, Schulam Peter G
Department of Urology, David Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, California, USA.
Eur Urol. 2007 Sep;52(3):798-803. doi: 10.1016/j.eururo.2007.02.035. Epub 2007 Feb 22.
Laparoscopic partial nephrectomy (LPN) is a technically challenging procedure for the management of renal tumours. Major complications of LPN include bleeding and urine leakage. Haemostatic agents (HAs) and/or glues may reduce haemorrhage and urine leakage. We sought to examine the current practice patterns for urologists performing LPN with regard to HA use and its relationship with bleeding and urine leakage.
A survey was sent via e-mail to urologists currently performing LPN in centres in the United States and Europe. We queried the indications for HA/glue usage, type of HAs/glues used, and whether concomitant suturing/bolstering was performed. In addition, the total number of LPNs performed, laparoscopic tools used to resect the tumour, tumour size, and tumour position were queried.
Surveys suitable for analysis were received from 18 centres (n=1347 cases). HAs and/or glues were used in 1042 (77.4%) cases. Mean tumour size was 2.8cm, with 79% of the tumours being defined as exophytic and 21% deep. The HAs and glues used included gelatin matrix thrombin (FloSeal), fibrin gel (Tisseel), bovine serum albumin (BioGlue), cyanoacrylate glue (Glubran), oxidized regenerated cellulose (Surgicel), or combinations of these. Sixteen centres performed concomitant suturing/bolstering. The overall postoperative bleeding requiring transfusion and urine leakage rates were 2.7% and 1.9%, respectively.
The use of HAs and/or glues is routine in most centres performing LPN. The overall haemorrhage and urine leakage rates are low following LPN. More studies are needed to assess the potential role of HAs and/or glues in LPN.
腹腔镜部分肾切除术（LPN）是一种技术上具有挑战性的肾肿瘤治疗方法。LPN的主要并发症包括出血和尿漏。止血剂（HAs）和/或胶水可能会减少出血和尿漏。我们试图研究泌尿外科医生在进行LPN时使用HA的当前实践模式及其与出血和尿漏的关系。
通过电子邮件向美国和欧洲各中心目前进行LPN的泌尿外科医生发送了一份调查问卷。我们询问了HA/胶水使用的指征、所使用的HA/胶水类型，以及是否进行了同步缝合/支撑。此外，还询问了进行LPN的总数、用于切除肿瘤的腹腔镜工具、肿瘤大小和肿瘤位置。
从18个中心收到了适合分析的调查问卷（n = 1347例）。1042例（77.4%）使用了HA和/或胶水。平均肿瘤大小为2.8cm，其中79%的肿瘤为外生性，21%为深部肿瘤。所使用的HA和胶水包括明胶基质凝血酶（FloSeal）、纤维蛋白胶（Tisseel）、牛血清白蛋白（BioGlue）、氰基丙烯酸酯胶水（Glubran）、氧化再生纤维素（Surgicel）或这些的组合。16个中心进行了同步缝合/支撑。术后需要输血的总体出血率和尿漏率分别为2.7%和1.9%。
在大多数进行LPN的中心，HA和/或胶水的使用是常规操作。LPN后的总体出血和尿漏率较低。需要更多研究来评估HA和/或胶水在LPN中的潜在作用。
