Tsilimigras Diamantis I, Antonopoulou Aspasia, Ntanasis-Stathopoulos Ioannis, Patrini Davide, Papagiannopoulos Kostas, Lawrence David, Panagiotopoulos Nikolaos
Department of Thoracic Surgery, University College London Hospitals (UCLH), London, UK.
School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
J Thorac Dis. 2017 Mar;9(3):568-576. doi: 10.21037/jtd.2017.02.57.
BioGlue is a commonly used sealant in thoracic surgery. Prolonged air leak and presence of bronchopleural fistulae (BPF) are often encountered in clinical practice. We therefore, investigated the role and the efficacy of BioGlue in these scenarios.
A systematic review was conducted by searching Medline [1966-2016] and Cochrane Central Register of Controlled Trials (CENTRAL) [1999-2016] along with reference lists of the included studies. Included studies reported on thoracic surgery operations and use of BioGlue in thoracic surgical procedures, whereas excluded studies met at least one of the following criteria: non-English language studies, non-human population, studies on surgical specialties other than Thoracic surgery, reviews and meta-analyses and sealants other than BioGlue.
Twelve studies with a total number of 194 patients were included. Amongst them, 178 were treated for alveolar air leaks (AAL), 14 for BPF and 2 for lymphatic leaks. BioGlue was utilized at the time of initial operation in 172 (96.7%) patients for AAL, while at secondary intervention in 13 (92.9%) for BPF and 1 (50%) for lymphatic leak. In terms of AAL, only 2 out of 4 studies showed statistically significant reduction in duration of air leak, duration of intercostal drainage and length of stay (LOS) when BioGlue was applied. No complications were encountered after using BioGlue in sealing BPF, apart from the re-application of BioGlue in 3 cases.
Although BioGlue has been shown to be efficient in treating AAL, it should be used with caution against BPF, despite encouraging preliminary results. Potential adverse effects must always be taken into consideration. Future randomized controlled trials are warranted in an attempt to establish its benefit in current clinical practice.
生物胶是胸外科常用的密封剂。临床实践中经常遇到长时间漏气和支气管胸膜瘘（BPF）的情况。因此，我们研究了生物胶在这些情况下的作用和疗效。
通过检索Medline[1966 - 2016]和Cochrane对照试验中心注册库（CENTRAL）[1999 - 2016]以及纳入研究的参考文献列表进行系统评价。纳入的研究报告了胸外科手术以及生物胶在胸外科手术中的应用，而排除的研究至少符合以下标准之一：非英语语言研究、非人类群体、胸外科以外其他外科专业的研究、综述和荟萃分析以及除生物胶以外的密封剂。
纳入12项研究，共194例患者。其中，178例接受肺泡漏气（AAL）治疗，14例接受BPF治疗，2例接受淋巴漏治疗。172例（96.7%）AAL患者在初次手术时使用生物胶，13例（92.9%）BPF患者在二次干预时使用生物胶，1例（50%）淋巴漏患者使用生物胶。在AAL方面，4项研究中只有2项显示应用生物胶后漏气持续时间、肋间引流持续时间和住院时间（LOS）有统计学显著降低。使用生物胶密封BPF后，除3例再次应用生物胶外，未出现并发症。
尽管生物胶已被证明在治疗AAL方面有效，但尽管有令人鼓舞的初步结果，在治疗BPF时仍应谨慎使用。必须始终考虑潜在的不良反应。未来有必要进行随机对照试验，以确定其在当前临床实践中的益处。
