Houston K A, Rotstein O D
Department of Surgery, University of Toronto, Ontario, Canada.
Arch Surg. 1988 Feb;123(2):230-4. doi: 10.1001/archsurg.1988.01400260118015.
The use of fibrin sealant has been advocated to enhance the healing of high-risk intestinal anastomoses. Colonic anastomoses were performed in 162 rats randomly assigned to four groups: control animals with or without fibrin sealant applied to the anastomosis and steroid-treated animals with or without fibrin sealant. At five days postoperatively, the use of steroids alone significantly reduced the anastomotic bursting pressure (ABP) and enhanced abscess and adhesion formation. The addition of fibrin sealant to the anastomosis in steroid-treated animals did not improve ABP and, in fact, further increased abscess formation. In control animals, the use of fibrin sealant also reduced ABP and enhanced abscess and adhesion formation. By ten days, there was no difference in ABP among the groups, and the rate of abscess formation was reduced in all groups. These findings indicated that short-term treatment with steroids delayed colonic anastomotic healing. Fibrin sealant did not enhance the integrity of these high-risk anastomoses. The present data do not support the use of fibrin sealant in high-risk colonic anastomoses.
有人主张使用纤维蛋白密封剂来促进高危肠道吻合口的愈合。对162只大鼠进行结肠吻合术，并随机分为四组：吻合口应用或未应用纤维蛋白密封剂的对照动物，以及应用或未应用纤维蛋白密封剂的类固醇治疗动物。术后五天，单独使用类固醇显著降低了吻合口破裂压力（ABP），并增加了脓肿和粘连的形成。在接受类固醇治疗的动物中，吻合口添加纤维蛋白密封剂并未改善ABP，事实上，还进一步增加了脓肿的形成。在对照动物中，使用纤维蛋白密封剂也降低了ABP，并增加了脓肿和粘连的形成。到十天时，各组之间的ABP没有差异，所有组的脓肿形成率均降低。这些发现表明，短期使用类固醇会延迟结肠吻合口的愈合。纤维蛋白密封剂并未增强这些高危吻合口的完整性。目前的数据不支持在高危结肠吻合术中使用纤维蛋白密封剂。
