Borin James F, Deane Leslie A, Sala Leandro G, Abdelshehid Corollos S, White Shannon M, Poulson Alfred Krebs, Khan Farhan, Edwards Robert A, McDougall Elspeth M, Clayman Ralph V
Department of Urology, University of California-Irvine, 101 The City Drive, Orange, CA 92612, USA.
J Endourol. 2008 Jan;22(1):145-50. doi: 10.1089/end.2007.9861.
We compared healing after laparoscopic cystotomy using fibrin glue, sutures, or a combination to determine whether fibrin glue can obviate the need for sutures and whether there is any detriment when glue is used in the presence of sutures.
In 24 Yorkshire pigs, a 3.5 cm vertical cystotomy was created laparoscopically and repaired as follows: Group 1--no closure; group 2--fibrin glue closure; group 3--suture repair; group 4--combined fibrin glue and suture repair. All animals had a Foley catheter for 1 week. In each group, three animals were harvested at 1 week (acute) and three animals were harvested at 6 weeks (chronic).
Acute: Group 1--all pigs had an unhealed defect that leaked when evaluated by cystography. Groups 2, 3, 4--mean leak pressures were 80, 97, and 60 cm H(2)O (P = 0.36), respectively. Mean bladder capacity was not significantly different between groups. Chronic: No leakage seen on a cystogram at 1 week; at 6 weeks, bladders were filled at > or =95 to 100 cm H(2)O without leakage. Histologically, there was more inflammation in the acute group v chronic group pigs. In the acute group pigs repaired with glue or suture + glue, there was more inflammation and less epithelial continuity than in the suture alone group. At 6 weeks, there was no difference between groups.
Fibrin glue provoked an intense inflammatory response that might have delayed healing acutely, resulting in a lower burst pressure in both scenarios in which it was used (i.e., alone or in combination with sutures). However, by 6 weeks, there did not seem to be any difference between groups either clinically or histopathologically.
我们比较了使用纤维蛋白胶、缝线或两者结合进行腹腔镜膀胱切开术后的愈合情况，以确定纤维蛋白胶是否可以避免使用缝线，以及在有缝线的情况下使用胶水是否有任何不利影响。
对24只约克郡猪进行腹腔镜下3.5厘米垂直膀胱切开术，并按以下方式修复：第1组——不缝合；第2组——用纤维蛋白胶封闭；第3组——缝线修复；第4组——纤维蛋白胶与缝线联合修复。所有动物均留置Foley导尿管1周。每组中，3只动物在1周时（急性期）处死，3只动物在6周时（慢性期）处死。
急性期：第1组——所有猪的缺损均未愈合，膀胱造影检查时均有渗漏。第2、3、4组——平均渗漏压力分别为80、97和60厘米水柱（P = 0.36）。各组间平均膀胱容量无显著差异。慢性期：1周时膀胱造影未见渗漏；6周时，膀胱在压力≥95至100厘米水柱时充盈且无渗漏。组织学检查显示，急性期组猪的炎症比慢性期组更严重。在使用胶水或缝线+胶水修复的急性期组猪中，炎症比单纯缝线组更严重，上皮连续性更差。6周时，各组间无差异。
纤维蛋白胶引发了强烈的炎症反应，这可能在急性期延迟了愈合，导致在其使用的两种情况下（即单独使用或与缝线联合使用）破裂压力较低。然而，到6周时，各组在临床或组织病理学上似乎没有任何差异。
