Nogueira Lucas, Katz Darren, Pinochet Rodrigo, Kurta Jordan M, Coleman Jonathan A
Department of Surgery, Division of Urology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
BJU Int. 2008 Dec;102(11):1670-4. doi: 10.1111/j.1464-410X.2008.07926.x. Epub 2008 Sep 3.
To compare haemostasis and other outcomes after the use of bovine-derived or porcine-derived gelatine matrix-thrombin sealants (GMTS) in a continuous series of patients during and for 6 months after laparoscopic partial nephrectomy (LPN).
Between October 2006 and September 2007, a consecutive sample of 35 patients with renal tumours underwent LPN by a single surgeon at a referral centre. Group 1 (25 patients) received a bovine-derived GMTS and Group 2 (10 patients) a porcine-derived GMTS. All patients underwent LPN and received one of the two GMTS, applied to the resected bed before sutured renorrhaphy over oxidized nitrocellulose bolsters. Surgical and pathology variables, including ischaemia time, blood loss, tumour size, and serum creatinine values before and after LPN, were measured. Glomerular filtration rates were calculated before and after LPN. Haemostasis was ascertained by visual examination.
Intraoperative haemostasis was achieved in all cases. No associated complications occurred within 3 weeks of LPN. The two groups were comparable in age (median, 65 vs 69 years, P = 0.62), gender, tumour number and location, median ischaemia time (34 vs 28 min, P = 0.148), and blood loss (200 vs 150 mL, P = 0.518). One patient in Group 1 developed a urinary fistula. One patient in Group 2 experienced self-limited gross haematuria.
Both the porcine- and bovine-derived agents provided acceptable haemostasis without adverse events during LPN and in the early postoperative period. Occurrences of delayed haemorrhage and urinary fistula were not likely to be related to the choice of prothrombotic agent.
比较在一系列连续的患者中，腹腔镜部分肾切除术（LPN）期间及术后6个月使用牛源或猪源明胶基质凝血酶封闭剂（GMTS）后的止血情况及其他结果。
2006年10月至2007年9月，在一家转诊中心，由一名外科医生对35例肾肿瘤患者进行了连续抽样并实施LPN。第1组（25例患者）接受牛源GMTS，第2组（10例患者）接受猪源GMTS。所有患者均接受LPN并使用两种GMTS之一，在氧化硝化纤维素支撑物上缝合肾固定术之前将其应用于切除床。测量手术和病理变量，包括缺血时间、失血量、肿瘤大小以及LPN前后的血清肌酐值。计算LPN前后的肾小球滤过率。通过视觉检查确定止血情况。
所有病例均实现术中止血。LPN后3周内未发生相关并发症。两组在年龄（中位数，65岁对69岁，P = 0.62）、性别、肿瘤数量和位置、中位缺血时间（34分钟对28分钟，P = 0.148）和失血量（200毫升对150毫升，P = 0.518）方面具有可比性。第1组有1例患者发生尿瘘。第2组有1例患者出现自限性肉眼血尿。
牛源和猪源制剂在LPN期间及术后早期均能提供可接受的止血效果且无不良事件。迟发性出血和尿瘘的发生不太可能与促凝血剂的选择有关。
