Figueras Juan, Llado Laura, Miro Mónica, Ramos Emilio, Torras Jaume, Fabregat Juan, Serrano Teresa
Departments of Surgery, Hospital de Bellvitge, University of Barcelona, Barcelona, Spain.
Ann Surg. 2007 Apr;245(4):536-42. doi: 10.1097/01.sla.0000245846.37046.57.
To evaluate the efficacy, amount of hemorrhage, biliary leakage, complications, and postoperative evolution after fibrin glue sealant application in patients undergoing liver resection.
Fibrin sealants have become popular as a means of improving perioperative hemostasis and reducing biliary leakage after liver surgery. However, trials regarding its use in liver surgery remain limited and of poor methodologic quality.
A total of 300 patients undergoing hepatic resection were randomly assigned to fibrin glue application or control groups. Characteristics and debit of drainage and postoperative complications were evaluated. The amount of blood loss, measurements of hematologic parameters liver test, and postoperative evolution (particularly involving biliary fistula and morbidity) was also recorded.
Postoperatively, no differences were observed in the amount of transfusion (0.15 +/- 0.66 vs. 0.17 +/- 0.63 PRCU; P = 0.7234) or in the patients that required transfusion (18% vs. 12%; P = 0.2), respectively, for the fibrin glue or control group. There were no differences in overall drainage volumes (1180 +/- 2528 vs. 960 +/- 1253 mL) or in days of postoperative drainage (7.9 +/- 5 vs. 7.1 +/- 4.7). Incidence of biliary fistula was similar in the fibrin glue and control groups, (10% vs. 11%). There were no differences regarding postoperative morbidity between groups (23% vs. 23%; P = 1).
Application of fibrin sealant in the raw surface of the liver does not seem justified. Blood loss, transfusion, incidence of biliary fistula, and outcome are comparable to patients without fibrin glue. Therefore, discontinuation of routine use of fibrin sealant would result in significant cost saving.
评估在肝切除患者中应用纤维蛋白胶封闭剂后的疗效、出血量、胆漏、并发症及术后恢复情况。
纤维蛋白封闭剂已成为改善肝手术后围手术期止血和减少胆漏的常用手段。然而，关于其在肝手术中应用的试验仍然有限且方法学质量较差。
总共300例行肝切除的患者被随机分为纤维蛋白胶应用组或对照组。评估引流的特征和引流量以及术后并发症。还记录了失血量、血液学参数、肝功能检查结果以及术后恢复情况（特别是胆瘘和发病率）。
术后，纤维蛋白胶组和对照组在输血量（分别为0.15±0.66对0.17±0.63个单位红细胞；P = 0.7234）或需要输血的患者比例（18%对12%；P = 0.2）方面均未观察到差异。总引流量（1180±2528对960±1253 mL）或术后引流天数（7.9±5对7.1±4.7）也无差异。纤维蛋白胶组和对照组的胆瘘发生率相似（10%对11%）。两组之间的术后发病率无差异（23%对23%；P = 1）。
在肝脏创面应用纤维蛋白封闭剂似乎并无必要。失血量、输血量、胆瘘发生率及预后与未使用纤维蛋白胶的患者相当。因此，停止常规使用纤维蛋白封闭剂可显著节省费用。
