Martorana Eugenio, Ghaith Ahmed, Micali Salvatore, Pirola Giacomo Maria, De Carne Cosimo, Fidanza Francesco, Bianchi Giampaolo
Department of Urology, University of Modena and Reggio Emilia, Modena, Italy.
Urol Int. 2016;96(3):274-9. doi: 10.1159/000444304. Epub 2016 Feb 19.
Perioperative bleeding is a potential complication of robot-assisted laparoscopic radical prostatectomy (RALP) that may worsen outcomes. The role of local hemostatic materials in RALP has not been adequately assessed. We evaluated the hemostatic impact of FloSeal (Baxter International Inc., Fremont, Calif., USA) in RALP.
A retrospective analysis was performed of 392 consecutive patients with prostate cancer who underwent RALP at our institution between February 2008 and July 2014. The patients were divided into 2 consecutive homogenous groups based on the use of FloSeal. Group A included 200 patients who underwent RALP between February 2008 and May 2011, with hemostasis performed using only traditional techniques. Group B included the remaining 192 patients, who underwent RALP between June 2011 and July 2014 and received FloSeal 5 ml after traditional hemostatic methods. We compared the blood transfusion rate, the differences between immediate postoperative hemoglobin (Hb) and mean postoperative day 1 (POD1) Hb levels, difference between POD1 and least Hb levels and difference between immediate postoperative Hb and least Hb levels.
The intraoperative use of FloSeal significantly decreased the blood transfusions rate, from 8.5 to 2.1% (p = 0.004). FloSeal was also associated with significant improvements in the difference between the immediate postoperative Hb and POD1 Hb levels (p = 0.03), mean POD1 Hb and least Hb (p = 0.01) and mean immediate postoperative Hb and least Hb levels (p = 0.034).
In this study, the use of FloSeal improves hemostatic outcomes in patients undergoing RALP compared with traditional hemostatic techniques, without increase of cost.
围手术期出血是机器人辅助腹腔镜根治性前列腺切除术（RALP）的一种潜在并发症，可能会使手术结果恶化。局部止血材料在RALP中的作用尚未得到充分评估。我们评估了FloSeal（美国加利福尼亚州弗里蒙特市百特国际公司）在RALP中的止血效果。
对2008年2月至2014年7月在我院接受RALP的392例连续性前列腺癌患者进行回顾性分析。根据是否使用FloSeal将患者分为2个连续的同质组。A组包括200例在2008年2月至2011年5月期间接受RALP的患者，仅采用传统技术进行止血。B组包括其余192例患者，他们在2011年6月至2014年7月期间接受RALP，并在传统止血方法后使用5毫升FloSeal。我们比较了输血率、术后即刻血红蛋白（Hb）与术后第1天（POD1）Hb水平的差异、POD1与最低Hb水平的差异以及术后即刻Hb与最低Hb水平的差异。
术中使用FloSeal显著降低了输血率，从8.5%降至2.1%（p = 0.004）。FloSeal还与术后即刻Hb与POD1 Hb水平的差异（p = 0.03）、平均POD1 Hb与最低Hb水平的差异（p = 0.01）以及术后即刻平均Hb与最低Hb水平的差异（p = 0.034）的显著改善相关。
在本研究中，与传统止血技术相比，使用FloSeal可改善接受RALP患者的止血效果，且不增加成本。
