Mayol Julio M, Zapata Carolina
Hospital Clinico San Carlos, Universidad Complutense de Madrid Madrid, Spain.
Surg Technol Int. 2013 Sep;23:23-8.
Different hemostatic methods are available for mild to moderate intraoperative bleeding during open and laparoscopic abdomino-pelvic surgery, but topical hemostats have gained popularity. We sought to review evidence on the use of a gelatin-thrombin matrix (FloSeal®) in elective abdominal and pelvic surgery. A systematic search of PubMed, EMBASE, and Cochrane databases was conducted. The primary endpoints were intraoperative bleeding and number of transfusions. Secondary endpoints included operative time, postoperative complications, re-operation for bleeding, mortality, and duration of hospitalization. Of five controlled trials, only three were prospective, randomized-controlled studies. The first, in open myomectomy, showed that hemostatic matrix dramatically reduced intraoperative bleeding and transfusion rates compared with conventional hemostatic measures. Hemostatic matrix also reduced postoperative stay. Similar results were obtained in a trial comparing FloSeal versus infrared-sapphire coagulator during open renal tumor enucleation. In the third, FloSeal was equally as effective as conventional suture methods in preventing staple-line bleeding after sleeve gastrectomy. Data were not pooled because of the heterogeneity in design. There is insufficient evidence that FloSeal provides better results than conventional hemostasis in abdominal and pelvic surgery, except for open myomectomy. Well-designed randomized trials are needed to evaluate the use of gelatin-thrombin matrix in elective abdomino-pelvic surgery outcomes.
对于开放性和腹腔镜下腹部盆腔手术中轻度至中度的术中出血，有多种止血方法可供选择，但局部止血剂越来越受欢迎。我们试图回顾关于在择期腹部和盆腔手术中使用明胶-凝血酶基质（FloSeal®）的证据。我们对PubMed、EMBASE和Cochrane数据库进行了系统检索。主要终点是术中出血和输血次数。次要终点包括手术时间、术后并发症、因出血再次手术、死亡率和住院时间。在五项对照试验中，只有三项是前瞻性随机对照研究。第一项研究是在开放性子宫肌瘤切除术中进行的，结果表明与传统止血措施相比，止血基质显著减少了术中出血和输血率。止血基质还缩短了术后住院时间。在一项比较FloSeal与红外蓝宝石凝血器在开放性肾肿瘤剜除术中应用的试验中也得到了类似结果。在第三项研究中，FloSeal在预防袖状胃切除术后吻合口出血方面与传统缝合方法效果相当。由于设计的异质性，未对数据进行汇总。除了开放性子宫肌瘤切除术外，没有足够的证据表明FloSeal在腹部和盆腔手术中比传统止血方法效果更好。需要设计良好的随机试验来评估明胶-凝血酶基质在择期腹部盆腔手术中的应用效果。
