Department of Pediatric Cardiac Surgery, Medical Faculty, RWTH Aachen University, Aachen, Germany.
Ann Thorac Surg. 2013 Jan;95(1):183-8. doi: 10.1016/j.athoracsur.2012.08.057. Epub 2012 Oct 22.
The prevention of the pericardial adhesions largely accountable for the technical difficulty and risk of injury inherent to resternotomy continues to gain in importance with the increasing frequency of reoperations. The hemostatic sponge TachoSil (Nycomed Austria GmbH, Linz, Austria), has shown promising results in adhesion prevention in several regions of the body. This study was designed to evaluate its effectiveness in the prevention of pericardial adhesions in comparison with the Gore-Tex (W. L. Gore and Assoc, Flagstaff, AZ) surgical membrane and a control.
Twenty-four rabbits were distributed into 3 groups: TachoSil, Gore-Tex, or no barrier agent (control). After median sternotomy and pericardiotomy, the cardial surface was exposed to the aggravating effects of room air, irrigation, and gauze abrasion for one hour. A pericardial defect was created and repaired with one of the barrier agents, or left uncovered (control). Resternotomy was performed after 6 months for the evaluation of adhesion formation.
Significantly fewer macroscopic adhesions were observed with TachoSil than Gore-Tex in all regions (p < 0.05) excluding the coronary arteries, where the difference in favor of TachoSil did not achieve significance (0.05< p-value <0.10). TachoSil also demonstrated significantly fewer retrosternal adhesions than the control, as well as a universal non-significant trend of fewer adhesions in all regions. The limited lesions present in the TachoSil group were filmy in nature and removed with blunt dissection relatively easily. No significant differences were found between Gore-Tex and the control. Microscopically, the least pronounced fibrosis formation and inflammatory reaction was detected with TachoSil.
TachoSil is effective in the prevention of pericardial adhesions.
由于再次开胸手术的技术难度和固有损伤风险主要归因于心包粘连的预防，因此，随着再次手术的频率增加，心包粘连的预防变得越来越重要。止血海绵泰科西尔（Nycomed Austria GmbH，奥地利林茨）在身体的多个部位预防粘连方面已显示出良好的效果。本研究旨在评估其与 Gore-Tex（W. L. Gore and Assoc，亚利桑那州弗拉格斯塔夫）外科膜和对照组相比预防心包粘连的效果。
将 24 只兔子随机分为 3 组：TachoSil 组、Gore-Tex 组或无屏障剂（对照组）。胸骨正中切开和心包切开后，心脏表面暴露于室温空气、冲洗和纱布摩擦的加重作用 1 小时。创建心包缺损并用屏障剂之一修复，或不覆盖（对照组）。6 个月后进行再次开胸以评估粘连形成情况。
在所有区域（p < 0.05），包括冠状动脉，TachoSil 观察到的宏观粘连明显少于 Gore-Tex，在这些区域，TachoSil 优势的差异不具有统计学意义（0.05 < p 值 < 0.10）。与对照组相比，TachoSil 也显示出更少的胸骨后粘连，并且在所有区域均具有不显著的趋势，即粘连更少。TachoSil 组的局限性损伤呈薄膜状，用钝性解剖法相对容易去除。Gore-Tex 与对照组之间无显著差异。在显微镜下，TachoSil 组检测到的纤维化形成和炎症反应最不明显。
TachoSil 可有效预防心包粘连。
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