Department of Surgery, Faculty of Medicine, Clinic for Generalund Visceral Surgery, University of Freiburg Medical Center, Hugstetter Straße 55, D-79106 Freiburg, Germany.
J Hepatobiliary Pancreat Sci. 2019 Mar;26(3):96-103. doi: 10.1002/jhbp.604. Epub 2019 Feb 10.
Bio-absorbable sealants are widely used to reduce the rate and severity of postoperative pancreatic fistulas after distal pancreatectomy. However, numerous clinical trials have failed to demonstrate their clinical benefit. We therefore investigated stability and bio-compatibility of absorbable sealants in vitro and in vivo.
In vitro, polymerized compounds were incubated in pancreatic juice before their stability was tested. In vivo, two compounds were used to seal the pancreatic stump after distal pancreatectomy in nine pigs. Burst pressure of the pancreatic stump, surgical outcome, histology of the pancreatic stump, systemic inflammation, and drain fluid was examined.
Products based on fibrin or collagen were unstable in the presence of active pancreatic enzymes and completely dissolved within 2 h. Sealants using chemical cross-linking of proteins showed improved stability for 7 days. In vivo, application of polyethylenglycol-based sealant leads to complete closure of the pancreatic duct after 5 days, while a glutaraldehyde-based sealant prevented physiological closure of the pancreatic main duct.
Many compounds used clinically to reinforce the pancreatic stump after distal pancreatectomy are inadequate due to instability in the presence of pancreatic enzymes. While selected bio-absorbable sealants inhibited the natural healing of the pancreatic stump, polyethylenglycol-based sealants should be tested in further clinical trials.
生物可吸收密封剂被广泛用于降低远端胰腺手术后胰瘘的发生率和严重程度。然而，许多临床试验未能证明其临床获益。因此，我们研究了可吸收密封剂在体外和体内的稳定性和生物相容性。
在体外，聚合化合物在胰液中孵育，然后测试其稳定性。在体内，在 9 头猪的远端胰腺手术后，两种化合物被用于密封胰腺残端。检测胰腺残端的爆裂压、手术结果、胰腺残端的组织学、全身炎症和引流液。
基于纤维蛋白或胶原蛋白的产品在有活性的胰腺酶存在下不稳定，在 2 小时内完全溶解。使用蛋白质化学交联的密封剂在 7 天内显示出更好的稳定性。在体内，使用聚乙二醇基密封剂可在 5 天后完全封闭胰管，而戊二醛基密封剂可防止主胰管的生理性关闭。
许多临床上用于加固远端胰腺手术后胰腺残端的化合物由于在存在胰腺酶时不稳定而不足。虽然一些选择的生物可吸收密封剂抑制了胰腺残端的自然愈合，但应在进一步的临床试验中测试聚乙二醇基密封剂。
