Head of the Department of Hospital Surgery Named After N.S. Makokhi, Russian Federation, Omsk State Medical University of the Ministry of Health of Russia, Lenin's st. 12., Omsk, 644099, Russia.
Russian Federation, Nizhnevartovsk County Clinical Hospital, Lenin's st. 18, Khanty-Mansi Autonomous Area, Nizhnevartovsk, 628614, Russia.
Hernia. 2021 Apr;25(2):441-448. doi: 10.1007/s10029-020-02251-1. Epub 2020 Jun 18.
The purpose of the study is to compare the results of single-blind a randomized controlled trial on the use of the local hemostatic agent Haemoblock and ultrasound monitoring of postoperative wounds in patients after the large incisional hernias repair.
The study represented a single-blind randomized controlled trial. The total number of patients was 66. Group with Haemoblock (A) and the Group without Haemoblock (B) included 33 patients each. Operation-sublay retromuscular repair with mesh prolene implant. We applied Haemoblock 15 ml retromuscularly and 15 ml subcutaneousely in group A. Wounds were drained by vacuum suction drainage. Postoperatively - ultrasound monitoring of postoperative wounds.
Median of follow-up was 33 days. Significant differences were obtained in the duration of wound draining, 2.6 ± 0.6 days in group A versus 4.1 ± 0.9 days in group B (p = 0.002). In group A, the levels of C-reactive protein and albumin were less in the separated discharge, as well as its total amount. During the first 12 days, a significantly lower volume of fluid collections was detected in patients of group A than in patients of group B. We noted a more rapid subsidence of exudative processes in postoperative wounds in patients from group A. The number of punctures was significantly higher in group B (0.8 ± 1.0 vs. 0.2 ± 0.4, respectively, p = 0.003). The total number of puncture interventions in group A was six in six patients, versus 27 in 14 patients in group B (p = 0.000).
The use of the local hemostatic agent Haemoblock can reduce the duration of the postoperative wound draining, shorten the period of inflammatory exudative processes in the postoperative wound, significantly reduce the number of puncture interventions for the postoperative wound, reduce the risk of the seromas formation and surgical site infections (SSI) associated with seroma, reduce the severity of pain and the need for analgesics.
本研究旨在比较局部止血剂 Haemoblock 和术后伤口超声监测在大型切口疝修补术后患者中的应用的单盲随机对照试验结果。
该研究为单盲随机对照试验。总共有 66 名患者。使用 Haemoblock 的组（A 组）和不使用 Haemoblock 的组（B 组）各有 33 名患者。采用网片 prolene 植入物的手术皮下肌后修复。A 组在肌后和皮下分别使用 15ml Haemoblock。伤口采用真空抽吸引流。术后对术后伤口进行超声监测。
中位随访时间为 33 天。在引流时间方面，A 组为 2.6±0.6 天，B 组为 4.1±0.9 天，差异有统计学意义（p=0.002）。在 A 组，分离排出物中的 C 反应蛋白和白蛋白水平以及其总量较低。在第 12 天之前，A 组患者的积液量明显低于 B 组患者。我们注意到 A 组患者术后伤口渗出过程的消退速度更快。B 组的穿刺次数明显更高（分别为 0.8±1.0 次与 0.2±0.4 次，p=0.003）。A 组共进行了 6 次穿刺干预，而 B 组则有 14 名患者进行了 27 次穿刺干预（p=0.000）。
使用局部止血剂 Haemoblock 可以减少术后伤口引流的时间，缩短术后伤口炎症渗出过程的时间，显著减少术后伤口穿刺干预的次数，降低与血清肿相关的血清肿和手术部位感染（SSI）的风险，减轻疼痛程度和对镇痛剂的需求。
