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可吸收性粉末止血剂在微创胸外科手术中的应用

Absorbable Powder Haemostat Use in Minimally Invasive Thoracic Surgery.

作者信息

Ricciardi Sara, Patel Akshay Jatin, Alunni Fegatelli Danilo, Volpi Sara, Femia Federico, Petrella Lea, Bille Andrea, Cardillo Giuseppe

机构信息

San Camillo Forlanini Hospital, Circonvallazione Gianicolense 87, 00186 Rome, Italy.

Guy's and St Thomas' NHS Foundation Trust, London SE1 7EH, UK.

出版信息

J Clin Med. 2024 Dec 27;14(1):85. doi: 10.3390/jcm14010085.

Abstract

: Significant intraoperative and postoperative blood loss are rare but possibly life-threatening complications after lung resection surgery either during open or minimally invasive procedures. Microporous Polysaccharide Haemospheres (ARISTA™AH) have demonstrated time-efficient haemostasis, lower postoperative blood volumes and a lower blood transfusion requirement, without any identified adverse events across other specialities. The primary aim of our study was to evaluate the impact of ARISTA™AH on short-term postoperative outcomes in thoracic surgery. Our secondary aim was to compare ARISTA™AH with other commonly used haemostatic agents. : We retrospectively reviewed a prospectively collected database of consecutive early-stage lung cancer patients surgically treated in two European centres (October 2020-December 2022). Exclusion criteria included open surgery, patients with coagulopathy/anticoagulant medication, major intraoperative bleeding, non-anatomical lung resection and age <18 years. The cohort was divided into five groups according to the haemostatic agent that was used. Propensity score matching was used to estimate the effect of ARISTA™AH on various intra- and postoperative parameters (continuous and binary outcome modelling). : A total of 482 patients (M/F:223/259; VATS 97/RATS 385) with a mean age of 68.9 (±10.6) years were analysed. In 253 cases, ARISTA™AH was intraoperatively used to control bleeding. This cohort of patients had a significant reduction in total drain volume by 135 mls (standard error 53.9; = 0.012). The use of ARISTA™AH did reduce the average length of a hospital stay (-1.47 days) and the duration of chest drainage (-0.596 days), albeit not significantly. In the ARISTA™AH group, we observed no postoperative bleeding, no blood transfusion requirement, no 30-day mortality and no requirement for redo surgery. The use of ARISTA™AH significantly reduced the odds of postoperative complications, as well as the need for transfusion and redo surgery. : Our data showed that Microporous Polysaccharide Haemospheres are a safe and effective haemostatic device. Their use has a positive effect on the short-term postoperative outcomes of patients surgically treated for early-stage lung cancer.

摘要

在开胸或微创手术的肺切除手术后,术中及术后大量失血虽罕见,但可能是危及生命的并发症。微孔多糖微球(ARISTA™AH)已证明具有高效止血、降低术后失血量及减少输血需求的作用,且在其他专科未发现任何不良事件。本研究的主要目的是评估ARISTA™AH对胸外科术后短期结局的影响。次要目的是将ARISTA™AH与其他常用止血剂进行比较。

我们回顾性分析了两个欧洲中心前瞻性收集的连续早期肺癌手术患者数据库(2020年10月至2022年12月)。排除标准包括开胸手术、有凝血功能障碍/服用抗凝药物的患者、术中大出血、非解剖性肺切除以及年龄<18岁。根据所使用的止血剂将队列分为五组。采用倾向评分匹配法来评估ARISTA™AH对各种术中及术后参数的影响(连续和二元结局模型)。

共分析了482例患者(男/女:223/259;电视辅助胸腔镜手术97例/机器人辅助胸腔镜手术385例),平均年龄68.9(±10.6)岁。253例患者术中使用ARISTA™AH控制出血。该组患者总引流量显著减少135毫升(标准误53.9;P = 0.012)。使用ARISTA™AH确实缩短了平均住院时间(-1.47天)和胸腔引流时间(-0.596天),尽管差异不显著。在ARISTA™AH组,未观察到术后出血、输血需求、30天死亡率及再次手术需求。使用ARISTA™AH显著降低了术后并发症的几率以及输血和再次手术的需求。

我们的数据表明,微孔多糖微球是一种安全有效的止血装置。其使用对早期肺癌手术患者的术后短期结局有积极影响。

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