Cardillo Giuseppe, Carleo Francesco, DI Martino Marco, Ciamberlano Bernardo, Ialongo Pasquale, Cusumano Giacomo, Denitza Tinti Maria, Ricci Alberto, Cafarotti Stefano
Unit of Thoracic Surgery, Carlo Forlanini Hospital, Rome, Italy -
Unit of Thoracic Surgery, Carlo Forlanini Hospital, Rome, Italy.
J Cardiovasc Surg (Torino). 2017 Dec;58(6):904-908. doi: 10.23736/S0021-9509.16.09010-8. Epub 2015 Sep 3.
Intraoperative pulmonary artery (PA) bleeding is common during thoracic surgery. We investigated the efficacy of the gelatin matrix-thrombin solution FloSeal (Baxter International, Deerfield, IL, USA) for control of major PA bleeding.
Retrospective data were collected on all intraoperative PA injuries during open or minimally invasive lobectomy or pneumonectomy between January 2000 and January 2014. Patients received either 4/0 prolene sutures (Standard) or the gelatin matrix-thrombin solution, plus sutures as needed (Matrix), with at least 6-month follow-up. Endpoints included time to hemostasis, total blood loss, transfusion and complications.
Of 2809 procedures, 39 (1.4%) had intraoperative PA injury, of which 21 received standard care and 18 the gelatin matrix-thrombin solution. Hemostasis was achieved in all Standard group patients after 2 minutes, and after 5 minutes in Matrix patients. Additional sutures were required in 4 (19.0%) Standard group patients. Three (16.7%) Matrix patients had a second solution application, while 17 (77.8%) received precautionary sutures. Mean blood loss on postoperative day 1 was 836.1±186.1 mL and 957.1±163.0 mL in the Matrix and Standard groups, respectively (P=0.003). Four (22.2%) Matrix patients received postoperative transfusions versus eight (38.0%) Standard patients (P=0.02). Two Standard and no Matrix patients underwent surgical revision. There were no complications and no mortalities.
Our analysis suggests that the gelatin matrix-thrombin solution is safe and effective for the control of major bleeding following intraoperative PA injury, and may improve outcomes. Further prospective studies are required to confirm our findings.
术中肺动脉（PA）出血在胸外科手术中很常见。我们研究了明胶基质-凝血酶溶液FloSeal（美国百特国际公司，伊利诺伊州迪尔菲尔德）控制主要PA出血的疗效。
收集2000年1月至2014年1月期间在开胸或微创肺叶切除术或肺切除术期间所有术中PA损伤的回顾性数据。患者接受4/0普理灵缝线（标准组）或明胶基质-凝血酶溶液，必要时加缝线（基质组），随访至少6个月。观察指标包括止血时间、总失血量、输血情况及并发症。
在2809例手术中，39例（1.4%）发生术中PA损伤，其中21例接受标准治疗，18例接受明胶基质-凝血酶溶液治疗。标准组所有患者在2分钟后止血，基质组患者在5分钟后止血。标准组4例（19.0%）患者需要额外缝合。基质组3例（16.7%）患者再次应用溶液，17例（77.8%）接受预防性缝合。术后第1天，基质组和标准组的平均失血量分别为836.1±186.1 mL和957.1±163.0 mL（P = 0.003）。基质组4例（22.2%）患者术后接受输血，标准组为8例（38.0%）（P = 0.02）。2例标准组患者和0例基质组患者接受了手术翻修。无并发症及死亡病例。
我们的分析表明，明胶基质-凝血酶溶液对控制术中PA损伤后的大出血安全有效，可能改善预后。需要进一步的前瞻性研究来证实我们的发现。
