Dalpiaz Orietta, Neururer Richard, Bartsch Georg, Peschel Reinhard
Department of Urology, Medical University Innsbruck, Innsbruck, Austria.
BJU Int. 2008 Dec;102(11):1502-8. doi: 10.1111/j.1464-410X.2008.08035.x. Epub 2008 Oct 16.
Surgical haemostatic agents have been increasingly applied for the control of bleeding, and have excellent potential in laparoscopy. Several factors are important when evaluating the use of sealants. We present a brief overview of the history, composition and mechanism of action of sealants, together with a report on experimental studies and clinical experience with haemostatic sealants. We searched for reports on haemostatic agents and their use in renal parenchymal haemostasis; 15 animal models studies and 11 papers on clinical experience were included. The development of haemostatic agents and instruments is allowing the wider diffusion of challenging procedures. Several experimental animal studies have shown the efficacy and safety of sealants for haemostasis during nephron-sparing surgery. Clinical studies confirm the effectiveness of synthetic or fibrin glue, in particular during laparoscopic surgery. Sealants are effective and safe topical agents to control bleeding during nephron-sparing surgery. They should not be viewed as an alternative, but as complementary agents to be used to improve surgical outcomes. Further prospective studies are necessary to validate their role in relation to other haemostatic support techniques.
外科止血剂已越来越多地用于控制出血，在腹腔镜手术中具有巨大潜力。评估密封剂的使用时，有几个因素很重要。我们简要概述了密封剂的历史、成分和作用机制，并报告了止血密封剂的实验研究和临床经验。我们检索了关于止血剂及其在肾实质止血中应用的报告；纳入了15项动物模型研究和11篇临床经验论文。止血剂和器械的发展使得具有挑战性的手术能够更广泛地开展。多项实验动物研究表明，密封剂在保留肾单位手术中止血有效且安全。临床研究证实了合成密封剂或纤维蛋白胶的有效性，尤其是在腹腔镜手术中。密封剂是保留肾单位手术中控制出血的有效且安全的局部用药。它们不应被视为替代品，而应作为用于改善手术效果的补充剂。有必要进行进一步的前瞻性研究，以验证它们相对于其他止血支持技术的作用。
