Department of Surgery, Tufts Medical Center, 800 Washington St, Box # 437, Boston, MA 02111, USA.
Surg Endosc. 2011 Apr;25(4):1148-52. doi: 10.1007/s00464-010-1331-4. Epub 2010 Sep 11.
The use of staplers in gastrointestinal surgery is widespread, especially in advanced laparoscopic procedures. Staple line reinforcement with a buttress reduces bleeding and associated complications through a combination of factors. The intrinsic hemostatic properties of buttress materials have not been examined. This study examined the intrinsic hemostatic properties of two different types of material used in buttressing in an accepted hemostasis model that does not involve stapling or its effects by compression.
An acellular collagen buttress (Veritas) and a synthetic polymer buttress (Duet) were compared to two commonly used hemostatic agents, Syvek and Surgicel, with gauze as control.
In a swine capsular stripping hemostasis model, a 1 × 1 cm section of spleen capsule was removed and used as a source of bleeding, with one patch of material tested per bleeding site. A total of 51 wounds were created in five pigs (each patch n = 10, control n = 11). Hemostatic efficacy was assessed by quantitating the number of applications and total time needed for bleeding to stop.
The mean time needed for hemostasis for Syvek and Veritas patches was significantly less than gauze, Duet and Surgicel (4.02, 4.51 vs. 8.97, 9.22, and 10.30 min respectively; p < 0.05). The Syvek and Veritas patches required significantly fewer applications than gauze, Duet™ and Surgicel (1.7, 2.2 vs. 4.1, 4.6, and 4.9 respectively; p < 0.01).
The intrinsic hemostatic properties of different buttressing materials vary widely. In this study, a collagen buttress was significantly better at promoting hemostasis than the synthetic buttress material in a nonstapling model. This could be another factor to consider when choosing a buttress for staple line reinforcement.
在胃肠外科手术中，吻合器的使用非常广泛，尤其是在高级腹腔镜手术中。使用合成补片加固吻合口可以通过多种因素减少出血和相关并发症。但目前尚未研究补片材料的固有止血特性。本研究在一种不涉及吻合器或其压迫作用的公认止血模型中，检查了两种不同类型的合成补片材料的固有止血特性。
无细胞胶原补片（Veritas）和合成聚合物补片（Duet）与两种常用的止血剂（Sykvek 和 Surgicel）以及纱布进行了比较，纱布作为对照。
在猪囊膜剥离止血模型中，切除 1×1cm 猪脾包膜作为出血源，每个出血部位使用一块材料贴片。在五只猪中总共创建了 51 个伤口（每个贴片 n=10，对照组 n=11）。通过量化止血所需的应用次数和总时间来评估止血效果。
Sykvek 和 Veritas 贴片的平均止血时间明显短于纱布、Duet 和 Surgicel（分别为 4.02、4.51 分钟与 8.97、9.22 和 10.30 分钟；p<0.05）。Sykvek 和 Veritas 贴片所需的应用次数明显少于纱布、Duet 和 Surgicel（分别为 1.7、2.2 次与 4.1、4.6 和 4.9 次；p<0.01）。
不同合成补片材料的固有止血特性差异很大。在本研究中，在非吻合器模型中，胶原补片在促进止血方面明显优于合成补片材料。这可能是在选择用于加固吻合口的补片时需要考虑的另一个因素。
