Vakalopoulos Konstantinos A, Wu Zhouqiao, Kroese Leonard F, Jeekel Johannes, Kleinrensink Gert-Jan, Dodou Dimitra, Lam King H, Lange Johan F
Department of Surgery, Erasmus University Medical Center, Room Ee-173, Postbus 2040, 3000 CA Rotterdam, The Netherlands.
Department of Surgery, Erasmus University Medical Center, Room Ee-173, Postbus 2040, 3000 CA Rotterdam, The Netherlands.
Am J Surg. 2017 Jan;213(1):151-158. doi: 10.1016/j.amjsurg.2016.05.009. Epub 2016 Jun 16.
Tissue adhesives (TAs) in gastrointestinal surgery are gradually gaining acceptance. Before implementation as colonic sealants, an evaluation of the sealing capability of a TA when in contact with fecal matter, as in a leaking anastomosis, is needed. In this study, we used clinically available TAs for the sutureless closure of colonic defects evaluating mechanical strength and tissue healing.
A total of 160 rats were divided into 8 groups. Two .5-cm incisions were created, one in the proximal and another in the distal colon. Incisions were sealed with a TA: Histoacryl Flex, Bioglue, Dermabond, Tissucol, Duraseal Xact, gelatin-resorcinol-formaldehyde or Glubran 2. A control group was included in which the colonic defects were not sealed. Follow-up time was 3 or 10 days. Clinical complication rate, bursting pressure, and histopathologic analysis was included.
Leakage rates in the TA groups were highest for Duraseal Xact, Bioglue, and gelatin-resorcinol-formaldehyde at 3 and 10 days. The cyanoacrylates Glubran 2, Histoacryl Flex, and Omnex, and the fibrin glue Tissucol showed the lowest overall clinical complication rates while maintaining the highest bursting pressure at day 10. Histoacryl Flex exhibited significantly higher collagen formation at day 10 than the other TAs.
This experimental model evaluates the protective effect of a TA seal on a leaking colonic defect. We found large differences in leakage rates and inertness of the tested TAs. The cyanoacrylates Histoacryl Flex, Omnex, and Glubran 2 as well as the fibrin glue Tissucol demonstrated the lowest leakage rates and the most inert histopathologic profile while maintaining high mechanical strength.
组织粘合剂（TAs）在胃肠外科手术中逐渐得到认可。在作为结肠密封剂应用之前，需要评估TA在与粪便接触时（如吻合口漏的情况）的密封能力。在本研究中，我们使用临床可用的TAs对结肠缺损进行无缝合闭合，评估其机械强度和组织愈合情况。
总共160只大鼠被分为8组。在近端结肠和远端结肠各制造一个0.5厘米的切口。切口用一种TA进行密封：Histoacryl Flex、生物胶、皮肤粘合剂、纤维蛋白胶、Duraseal Xact、明胶 - 间苯二酚 - 甲醛或Glubran 2。设立一个对照组，其中结肠缺损未进行密封。随访时间为3天或10天。包括临床并发症发生率、破裂压力和组织病理学分析。
在3天和10天时，Duraseal Xact、生物胶和明胶 - 间苯二酚 - 甲醛的TA组渗漏率最高。氰基丙烯酸酯类的Glubran 2、Histoacryl Flex和Omnex以及纤维蛋白胶Tissucol总体临床并发症发生率最低，同时在第10天时保持最高的破裂压力。在第10天时，Histoacryl Flex的胶原蛋白形成明显高于其他TAs。
该实验模型评估了TA密封对结肠缺损渗漏的保护作用。我们发现所测试的TAs在渗漏率和惰性方面存在很大差异。氰基丙烯酸酯类的Histoacryl Flex、Omnex和Glubran 2以及纤维蛋白胶Tissucol在保持高机械强度的同时，渗漏率最低，组织病理学表现最惰性。
