Naganuma Masaaki, Akiyama Masatoshi, Takaya Hiroki, Sakuma Kei, Kumagai Kiichiro, Kawamoto Shunsuke, Adachi Osamu, Saiki Yoshikatsu
Division of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryomachi, Aoba-ku, Sendai, 980-8574, Japan.
Gen Thorac Cardiovasc Surg. 2020 Jan;68(1):18-23. doi: 10.1007/s11748-019-01155-x. Epub 2019 Jun 8.
Fibrin glue is used to reinforce anastomosis in aortic surgery. There has not yet been a consensus on how it should be applied optimally. This study aimed to define the optimal condition of applying fibrin glue.
In experiment 1, we determined the optimal condition for spraying fibrin glue using an expanded polytetrafluoroethylene graft within a needle hole. The length and area of the fibrin cap within the hole were measured. In experiment 2, methods for applying fibrinogen were assessed by comparing brushing and spraying. In experiment 3, swine aorta segments sutured with a Dacron graft were divided into the following three groups: nothing was applied; fibrinogen was sprayed and rubbed using brush. The aorta was clamped and blood was infused from an occlusion catheter inserted into the graft. The pressure at the first appearance of blood leak was recorded.
In experiment 1, among the four groups divided by the pressure and distance of spraying, the fibrin cap area in the group with 0.075 MPa and 2-cm spray distance was significantly larger than that in the group with 0.15 MPa and 2 cm (P < 0.01). In experiment 2, the fibrin cap area in the brushing group was significantly larger than that in the spraying group (P < 0.05). In experiment 3, the capacity to resist endoluminal pressure was higher in the brushing and combined spraying group compared with that in the sequential combined spraying group (P < 0.01).
The brush and spray methods showed excellent hemostatic outcomes.
纤维蛋白胶用于强化主动脉手术中的吻合口。关于如何最佳应用纤维蛋白胶尚未达成共识。本研究旨在确定应用纤维蛋白胶的最佳条件。
在实验1中，我们使用针孔内的膨体聚四氟乙烯移植物确定喷涂纤维蛋白胶的最佳条件。测量孔内纤维蛋白帽的长度和面积。在实验2中，通过比较涂抹和喷涂评估应用纤维蛋白原的方法。在实验3中，将用涤纶移植物缝合的猪主动脉段分为以下三组：不做任何处理；喷涂纤维蛋白原并用刷子摩擦。夹闭主动脉，并通过插入移植物的闭塞导管注入血液。记录首次出现血液渗漏时的压力。
在实验1中，按喷涂压力和距离划分的四组中，0.075 MPa和2 cm喷涂距离组的纤维蛋白帽面积显著大于0.15 MPa和2 cm组（P < 0.01）。在实验2中，涂抹组的纤维蛋白帽面积显著大于喷涂组（P < 0.05）。在实验3中，与顺序联合喷涂组相比，涂抹和联合喷涂组抵抗腔内压力的能力更高（P < 0.01）。
涂抹和喷涂方法显示出优异的止血效果。
