Masci Emilia, Faillace Giuseppe, Longoni Mauro
Division of General Surgery, Ospedale Edoardo Bassini, ASST Nord Milano, Via Gorki 50, 20092, Cinisello Balsamo, MI, Italy.
BMC Res Notes. 2018 Apr 11;11(1):239. doi: 10.1186/s13104-018-3344-3.
Laparoscopic cholecystectomy is the first-choice treatment for symptomatic cholelithiasis. Though generally safe, this procedure is not without complications, with bleeding the most frequent cause of conversion to open cholecystectomy. Oxidized regenerated cellulose (ORC) added to conventional hemostatic strategies, is widely used to control bleeding during surgery despite limited evidence supporting its use. This retrospective study analyzed patients undergoing laparoscopic cholecystectomy in an Italian center over a 16-month period, between October 2014 and February 2016, who experienced uncontrollable bleeding despite the use of conventional hemostatic strategies, requiring the addition of ORC gauze (Emosist).
Of the 530 patients who underwent laparoscopic cholecystectomy, 24 (4.5%) had uncontrollable bleeding from the liver bed. Of these, 62.5% had acute cholecystitis and 33.3% chronic cholecystitis; 1 patient was diagnosed with gallbladder carcinoma, postoperatively. Most patients had comorbidities, 16.7% had liver cirrhosis, and 37.5% used oral anticoagulants. The application of ORC rapidly controlled bleeding in all patients. Patients were discharged after a mean duration of 2.2 days. ORC was easy to use and well tolerated. Bleeding complications remain a relevant issue in laparoscopic cholecystectomy. ORC was able to promptly stop bleeding not adequately controlled by conventional methods and appears, therefore, to be a useful hemostat.
腹腔镜胆囊切除术是有症状胆结石的首选治疗方法。尽管该手术一般较为安全，但并非没有并发症，出血是转为开腹胆囊切除术最常见的原因。氧化再生纤维素（ORC）添加到传统止血策略中，尽管支持其使用的证据有限，但仍被广泛用于手术期间控制出血。这项回顾性研究分析了2014年10月至2016年2月期间在意大利一家中心接受腹腔镜胆囊切除术的患者，这些患者尽管使用了传统止血策略仍出现无法控制的出血，需要添加ORC纱布（Emosist）。
在530例行腹腔镜胆囊切除术的患者中，24例（4.5%）肝床出现无法控制的出血。其中，62.5%患有急性胆囊炎，33.3%患有慢性胆囊炎；1例患者术后被诊断为胆囊癌。大多数患者有合并症，16.7%有肝硬化，37.5%使用口服抗凝剂。ORC的应用迅速控制了所有患者的出血。患者平均住院2.2天后出院。ORC使用方便且耐受性良好。出血并发症仍是腹腔镜胆囊切除术中的一个重要问题。ORC能够迅速止住传统方法未能充分控制的出血，因此似乎是一种有用的止血剂。
