Bures Maximilian, Zardo Patrick, Länger Florian, Zhang Ruoyu
Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
Department of Cardiac and Thoracic Surgery, Otto-von-Guericke University Magdeburg, Magdeburg, Germany.
J Cardiothorac Surg. 2016 Oct 21;11(1):149. doi: 10.1186/s13019-016-0544-6.
Albumin-glutaraldehyde glue has gained widespread acceptance for treatment of alveolar air leaks (AAL) in thoracic surgery. As liquid run-off during application is detrimental to its sealing efficacy, we developed a modified technique and assessed it in vitro.
Caudal lobes of freshly excised swine lungs (n = 20) were intubated and ventilated. A standardized focal superficial parenchymal defect (40 × 25 mm) was created on the inflated lung. AAL was assessed under exposure to increasing inspired tidal volume (TVi). Lung lobes were randomly selected and subjected to either a standard sealing suggested by the manufacturer (control group) or a modified technique relying on placement of a square silicone frame around the lesion site (study group). AAL was subsequently assessed until burst failure occurred and the occuring lesions length was recorded on the inflated lung to evaluate elasticity of underlying tissue.
Superficial parenchymal defects resulted in AAL increasing with ascending TVi. AAL prior to sealant application was comparable in both groups. An application error occurred once in our control group. At TVi = 400, 500, 600 and 700 ml, the albumin-glutaraldehyde glue achieved complete sealing in 10, 10, 9 and 8 lungs respectively in our study group, as opposed to 9, 7, 6 and 4 lobes in the control group. The required mean burst pressure was significantly higher in our study group (41.0 ± 1.0 vs. 37.5 ± 4.2 cmHO, p = 0.0195), but there was no difference in expansion of covered defect between both groups (1.0 ± 0.4 vs. 1.5 ± 1.7 mm, p = 0.3772).
Our tests suggest that frame-assisted sealant application might prevent glue run-off and thus improves its sealing efficacy. We encourage further investigation of this technique in well-designed, controlled clinical trials.
白蛋白-戊二醛胶水在胸外科治疗肺泡漏气（AAL）方面已得到广泛认可。由于应用过程中的液体流失会损害其密封效果，我们开发了一种改良技术并在体外进行了评估。
对新鲜切除的猪肺（n = 20）的尾叶进行插管和通气。在充气肺上制造一个标准化的局灶性浅表实质缺损（40×25mm）。在逐渐增加的吸入潮气量（TVi）暴露下评估AAL。随机选择肺叶，采用制造商建议的标准密封方法（对照组）或依靠在病变部位周围放置方形硅胶框架的改良技术（研究组）。随后评估AAL，直到发生破裂失败，并在充气肺上记录出现的病变长度，以评估下层组织的弹性。
浅表实质缺损导致AAL随TVi升高而增加。两组在应用密封剂前的AAL相当。我们的对照组发生了一次应用错误。在TVi = 400、500、600和700ml时，研究组中白蛋白-戊二醛胶水分别在10、10、9和8个肺中实现了完全密封，而对照组分别为9、7、6和4个肺叶。我们研究组所需的平均破裂压力明显更高（41.0±1.0 vs. 37.5±4.2 cmHO，p = 0.0195），但两组之间覆盖缺损的扩展没有差异（1.0±0.4 vs. 1.5±1.7mm，p = 0.3772）。
我们的测试表明，框架辅助密封剂应用可能会防止胶水流失，从而提高其密封效果。我们鼓励在精心设计的对照临床试验中对该技术进行进一步研究。
