Department of Thoracic and Cardiovascular Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan.
Division of Research and Development, Kyoto Medical Planning Co., Ltd., Kyoto, Japan.
Interact Cardiovasc Thorac Surg. 2022 Sep 9;35(4). doi: 10.1093/icvts/ivac196.
Air leakage after lung resection is a common morbidity that may lengthen hospital stay. Applying sealant to a lesion is an effective prophylaxis in clinical practice. This study aimed to examine the effect of a combination of a bioabsorbable polyglycolic acid (PGA) fabric and fibrin glue (FG) on air sealing by measuring the in vitro mechanical strength and degradation of the fabric, and in vivo histological changes after implantation.
A defect was created in the canine left upper lung lobe, and then filled with a fibrinogen solution and covered with a PGA sheet spray-coated with fibrinogen and thrombin. After 1 and 4 weeks, air leakage from the lesion was examined in vivo under airway pressure. Tissue samples were harvested for histological assessment.
The mechanical strength of the PGA fabric remained at 80-90% of the baseline level for 1 week in phosphate-buffered saline, and then rapidly decreased to zero thereafter. Air leakage from the lung defect was prevented by the combination of PGA fabric and FG at 1 and 4 weeks. Histological examinations showed that PGA bundles persisted with a non-specific inflammatory response for 2 weeks and then gradually broke into sparse yarns surrounded by collagen fibres and capillaries by 8 weeks. The lung defect was filled with FG at 1 week and by granulation tissue thereafter.
These results provide evidence for the efficacy of a combination of PGA fabric and FG for the prevention of air leakage in the critical period after lung surgery.
肺切除术后漏气是一种常见的并发症，可能会延长住院时间。在临床实践中，应用密封剂治疗病变是一种有效的预防措施。本研究旨在通过测量织物的体外机械强度和降解以及植入后的体内组织学变化，来检验生物可吸收聚乙二醇酸（PGA）织物和纤维蛋白胶（FG）联合应用对气封的效果。
在犬左侧肺上叶制造一个缺损，然后用纤维蛋白原溶液填充，并覆盖一层喷涂纤维蛋白原和凝血酶的 PGA 片。在 1 周和 4 周后，在气道压力下对病变进行体内漏气检查。采集组织样本进行组织学评估。
PGA 织物在磷酸盐缓冲液中的机械强度在 1 周内保持在基线水平的 80-90%，此后迅速降至零。PGA 织物和 FG 的联合应用可在 1 周和 4 周时防止肺缺损漏气。组织学检查显示 PGA 束在 2 周内持续存在非特异性炎症反应，然后在 8 周时逐渐分解成稀疏的纱线，周围是胶原纤维和毛细血管。肺缺损在 1 周时被 FG 填充，此后被肉芽组织填充。
这些结果为 PGA 织物和 FG 联合应用在肺手术后的关键时期预防漏气提供了证据。
