Köckerling F, Schneider C, Reymond M A, Hohenberger W
Chirurgische Klinik mit Poliklinik, Universität Erlangen-Nürnberg.
Zentralbl Chir. 1997;122(5):405-8.
The inflammatory pericholecystic reaction to acute or subacute cholecystitis results in the involvement in the inflammatory process of connective tissue within the liver bed, with subsequent neovascularization. The inflamed wall of the gallbladder and the surrounding connective tissue also involved in the inflammatory process become fused together thus preventing dissection in this plane. As a result, the gallbladder affected by acute cholecystitis frequently has to be dissected directly out of the liver parenchyma. The resulting diffuse parenchymal bleeding proves difficult to control by cauterization. In addition, there is a danger of postoperative bile leakage occurring. Today, the use of fibrin sealing is accepted practice in the treatment of oozing haemorrhage from the resection surface of the liver following resective surgery, and for the prevention of postoperative biliary fistulae. Using special application systems, the two-component fibrin sealing can now also be employed under video-endoscopic control. Through direct application of the adhesive to the parenchyma in the liver bed using a flexible catheter, diffuse oozing bleeds can be effectively arrested. In addition, coagulation-related parenchymal necroses associated with the development of biliary fistulae can be avoided. The technique of video-endoscopic controlled fibrin sealing is an important method of preventing and controlling complications arising during video-endoscopic surgery.
急性或亚急性胆囊炎的炎性胆囊周围反应会导致肝床内的结缔组织卷入炎症过程，并随后出现新生血管形成。发炎的胆囊壁和参与炎症过程的周围结缔组织会融合在一起，从而阻止在此平面进行分离。因此，患有急性胆囊炎的胆囊常常必须直接从肝实质中剥离出来。由此产生的弥漫性实质出血很难通过烧灼来控制。此外，还存在术后胆漏的风险。如今，纤维蛋白封闭术在治疗切除性手术后肝脏切除表面的渗血以及预防术后胆瘘方面已被广泛应用。使用特殊的应用系统，现在也可以在视频内镜控制下使用双组分纤维蛋白封闭剂。通过使用柔性导管将粘合剂直接应用于肝床的实质，可以有效止住弥漫性渗血。此外，还可以避免与胆瘘形成相关的凝血性实质坏死。视频内镜控制下的纤维蛋白封闭术是预防和控制视频内镜手术中出现并发症的重要方法。
