Department of Urology, East Surrey Hospital, Redhill, United Kingdom.
J Endourol. 2010 Apr;24(4):599-603. doi: 10.1089/end.2009.0453.
The objective of this study was to evaluate the efficacy of TachoSil (Nycomed UK, Oxford, Buckinghamshire, UK), a hemostatic sponge, to seal major collecting system injuries (in addition to providing an adjunct to hemostasis) after partial nephrectomy in a porcine chronic survival model.
Laparoscopic upper-pole partial nephrectomies were performed in 10 farm pigs (>40 kg). After hilar clamping, an energyless incision was made at a point halfway between the hilum and the upper pole of the kidney and the collecting system was opened widely. TachoSil was applied to cover the defect; 15 to 20 minutes after the application of TachoSil, the hilar clamp was removed, hemostasis confirmed, and the pig survived. Assessment was made for hematoma and urinoma. Four weeks postoperatively, the pigs were euthanized. Ex-vivo retrograde studies were performed to assess collecting system leak. Weight, blood pressure, estimated blood loss, the weight of the partial and completion nephrectomy specimen, presence/absence of urinary leak on retrograde study, histopathologic findings, and complications were recorded.
All pigs survived. Mean warm ischemia time was 18 minutes, mean blood loss was 90 mL, and mean resected weight was 13.7 g. There was no evidence of leak on retrograde study. Histologically, nonspecific changes were noted in all specimens, which included dystrophic calcification, scarring, and areas of fibrosis at the partial nephrectomy surgical margin.
TachoSil seals the collecting system after partial nephrectomy on a porcine chronic survival model, in addition to providing an adjunct to hemostasis. More studies, including human trials, are warranted to evaluate this observation further.
本研究旨在评估 TachoSil（Nycomed UK，牛津，白金汉郡，英国），一种止血海绵，在猪慢性生存模型中对上极部分肾切除术后主要收集系统损伤（除了提供辅助止血）的疗效。
对 10 头（>40 公斤）农场猪进行腹腔镜上极部分肾切除术。在肾门夹闭后，在离肾门和上极中间的位置进行无能量切割，并广泛打开收集系统。应用 TachoSil 覆盖缺损；应用 TachoSil 15 至 20 分钟后，松开肾门夹，确认止血，然后猪存活。评估血肿和尿囊肿。术后 4 周，猪被安乐死。进行逆行外研究以评估收集系统泄漏。记录体重、血压、估计失血量、部分和完整肾切除术标本的重量、逆行研究中是否存在尿漏、组织病理学发现和并发症。
所有猪均存活。平均热缺血时间为 18 分钟，平均失血量为 90 毫升，平均切除重量为 13.7 克。逆行研究未发现泄漏。组织学上，所有标本均出现非特异性变化，包括营养不良性钙化、瘢痕和部分肾切除术手术边缘的纤维化区域。
TachoSil 在猪慢性生存模型中对上极部分肾切除术后的收集系统进行密封，除了提供辅助止血。需要进行更多的研究，包括人体试验，以进一步评估这一观察结果。
