Andreetti C, Ibrahim M, Ciccone A, D'Andrilli A, Poggi C, Maurizi G, Pavan A, Rendina E A
Department of Thoracic Surgery, La Sapienza, University of Rome, Sant'Andrea Hospital, Rome, Italy.
Minerva Chir. 2010 Dec;65(6):695-9.
Postoperative alveolar fistula (AF) associated with pleural cavity (PC) is a serious complication and a therapeutic challenge in thoracic surgery. The purpose of this study was to assess the efficacy of the use of the autologous platelet gel for the treatment of AF and PC. We treated a patient with post lung resection persistent alveolar fistula using a autologous platelet gel, a cellular compose produces at the Division of Immunohaematoligy and Trasfusion. The platelet gel-PRP (Platelet-Rich Plasma) is a biological material made of autologous platelets, extracted from a small amount of the patient's blood, centrifuged at 1100 g for 9 min. The PRP obtained was activated by addition of autologous thrombin and calcium chloride to form a matrix of fibrin (PRFM) thick. The patient presented important air leak after middle lobe wedge resection for solitary lung lesion with standard open decortication for important pleural adhesions post pleuritis. On postoperative day XIII the patient developed a thoracic empyema and consequently underwent a antibiotic pleural irrigation through the chest drainage based on the microbiological analysis of the pleural fluid. After a week we obtained the resolution of the empyema but a residual space remained and air leak persisted. We treated the patient with autologous platelet gel. We administer 7.5 mL of the autologous platelet gel across the chest drainage ever 72 hours for 3 times. After the third application we had the closure of the cavity and the cessation of air leak. Autologous platelet gel is easy to use, safe and inexpensive. It can be considered a valid therapeutic option in selected patients with a alveolar fistula and a lung partial re-expansion. The product consist of a significant amount of cellular components with healing anti-inflammatory an proregenerative properities that permit the body to heal tissue wounds faster and more efficiently. A sterile pleural cavity is fundamental conditions for the final success of the procedure.
术后肺泡瘘合并胸腔是胸外科严重的并发症及治疗挑战。本研究旨在评估自体血小板凝胶治疗肺泡瘘合并胸腔的疗效。我们使用自体血小板凝胶治疗了1例肺切除术后持续性肺泡瘘患者，该凝胶是在免疫血液学与输血科制备的一种细胞成分。血小板凝胶-富血小板血浆（PRP）是一种由自体血小板制成的生物材料，从患者少量血液中提取，以1100g离心9分钟。获得的PRP通过添加自体凝血酶和氯化钙激活，形成浓稠的纤维蛋白基质（PRFM）。该患者因孤立性肺病变行中叶楔形切除术后出现严重漏气，因胸膜炎后严重胸膜粘连行标准开放性胸膜剥脱术。术后第13天，患者发生胸腔积脓，随后根据胸腔积液的微生物分析结果，通过胸腔引流进行抗生素胸腔冲洗。一周后胸腔积脓消退，但仍有残余腔隙且漏气持续存在。我们用自体血小板凝胶治疗该患者。每72小时通过胸腔引流注入7.5mL自体血小板凝胶，共3次。第三次注入后，腔隙闭合，漏气停止。自体血小板凝胶使用方便、安全且价格低廉。对于选定的肺泡瘘和肺部分复张患者，可将其视为一种有效的治疗选择。该产品含有大量具有愈合、抗炎和促再生特性的细胞成分，可使机体更快、更有效地愈合组织伤口。无菌胸腔是该手术最终成功的基本条件。
