Department of Surgery, NTT, West Osaka Hospital, Osaka, Japan.
Am J Surg. 2009 Nov;198(5):715-9. doi: 10.1016/j.amjsurg.2008.10.026. Epub 2009 May 1.
The injection of the biological adhesive fibrin glue is often performed to treat postoperative digestive fistulas. However, it is not always effective especially in case of complex fistulas with large cavities, because the fibrin glue will coagulate before the mixed solutions fill the cavity, creating dead space. We report the results of fibrin glue injection with diluted thrombin solution.
We studied the tensile strength and coagulation time of the resulting fibrin glue at each dilution of the thrombin solution. Based on in vitro study, 18 patients who had developed postoperative digestive fistula were treated by fibrin glue injection with diluted thrombin solution.
In vitro study proved that the dilution of thrombin prolonged the coagulation time of the fibrin glue to more than 1 minute with almost no change to the tensile strength of the glue until a certain dilution was reached. The fistulas of 16 patients were successfully closed.
Our simple method of fibrin glue injection is useful for refractory postoperative digestive fistula, even in cases of complex fistula with large cavities.
生物胶纤维蛋白粘合剂的注射常用于治疗术后消化瘘，但并不总是有效，尤其是在有大腔隙的复杂瘘中，因为纤维蛋白粘合剂在混合溶液充满腔之前就会凝固，形成死腔。我们报告了用稀释的凝血酶溶液进行纤维蛋白胶注射的结果。
我们研究了不同浓度的凝血酶溶液对纤维蛋白胶的拉伸强度和凝固时间的影响。基于体外研究，我们对 18 例术后发生消化瘘的患者采用稀释的凝血酶溶液进行纤维蛋白胶注射治疗。
体外研究表明，凝血酶的稀释使纤维蛋白胶的凝固时间延长至 1 分钟以上，而胶的拉伸强度几乎没有变化，直到达到一定的稀释度。16 例患者的瘘管成功闭合。
我们简单的纤维蛋白胶注射方法对难治性术后消化瘘有效，即使是在有大腔隙的复杂瘘中也是如此。
