• 北京大學人民醫(yī)院肝膽外科中心(北京100044);

【摘要】目的  研究部分肝臟切除術(shù)中使用纖維蛋白膠防治術(shù)后出血及膽汁滲漏的效果。方法  制作家兔部分肝臟切除模型，將40只家兔按隨機數(shù)字表法隨機分為假手術(shù)組(n=10)、對照組(n=10)和實驗組(n=20)。其中假手術(shù)組行單純開腹術(shù)，對照組與實驗組行肝臟部分切除術(shù)，對照組采用電刀燒灼肝臟創(chuàng)面，實驗組在燒灼后再在肝臟創(chuàng)面噴灑纖維蛋白膠。術(shù)后觀察動物進食、體重以及不良反應發(fā)生情況，定時記錄腹腔引流量，檢測腹腔引流液中血紅蛋白(hemoglobin，Hg)、白細胞(WBC)、總膽紅素(TBil)以及血中谷丙轉(zhuǎn)氨酶(ALT)、谷草轉(zhuǎn)氨酶(AST)、乳酸脫氫酶(LDH)和TBil的水平。結(jié)果  實驗組平均出血量和手術(shù)時間分別為(16.0±2.7) ml和(23.7±2.9) min，明顯低于對照組的(20.8±3.5) ml和(27.3±2.9) min (P＜0.01)； 實驗組動物的腹腔引流量、引流液中Hg、WBC和TBil水平均隨時間延長而逐漸降低(P＜0.05)，其中實驗組術(shù)后腹腔引流液中Hg水平在術(shù)后第1、2和7 d明顯低于對照組(P＜0.05)，TBil水平在術(shù)后1、2、3、5和7 d均明顯低于對照組(P＜0.05)； 術(shù)后對照組和實驗組的ALT、AST、LDH和TBil水平均顯著高于假手術(shù)組(P＜0.01)，而實驗組的ALT、AST(除第3 d以外)和LDH水平顯著低于對照組(P＜0.05)； 3組動物進食良好，體重增加，無不良反應和死亡發(fā)生。結(jié)論  肝臟部分切除術(shù)中使用纖維蛋白膠對防治術(shù)后創(chuàng)面出血和膽汁滲漏是安全有效的。

引用本文： 王東,彭吉潤,朱繼業(yè),冷希圣. 家兔部分肝臟切除術(shù)中應用纖維蛋白膠防治術(shù)后出血及膽汁滲漏的實驗研究. 中國普外基礎與臨床雜志, 2008, 15(4): 262-265. doi: 復制

1. 19 　 de Virgilio C, Elbassir M, Hidalgo A, et al. Fibrin glue reduces the severity of intra-abdominal adhesions in a rat model [ J ] . Am J Surg, 1999; 178(6) ∶ 577.
2. 　王海東, 鄭進方, 邢貽雷, 等. 纖維蛋白膠在普外科手術(shù)的應用——附153例臨床分析 [J]. 中國微創(chuàng)外科雜志, 2001; 6(3)∶133.
3. 　Cothren CC, McIntyre RC Jr, Johnson S, et al. Management of low-output pancreatic fistulas with fibrin glue [J]. Am J Surg, 2004; 188(1)∶89.
4. 　Schenk WG 3rd, Burks SG, Gagne PJ, et al. Fibrin sealant improves hemostasis in peripheral vascular surgery: a randomized prospective trial [J]. Ann Surg, 2003; 237(6)∶871.
5. 　尚培中, 李德炳, 劉景章, 等. 改良套疊式胰空腸吻合術(shù)應用石蕊試紙和纖維蛋白膠預防胰漏47例體會 [J]. 中國普外基礎與臨床雜志, 2006; 13(2)∶219.
6. 　許邦文, 周寧新, 霍宗紅. 吸收性止血綾在擇期肝部分切除術(shù)中的應用 [J]. 中國普外基礎與臨床雜志, 2002; 9(4)∶276.
7. 　Kraus TW, Mehrabi A, Schemmer P, et al. Scientific evidence for application of topical hemostats, tissue glues, and sealants in hepatobiliary surgery [J]. J Am Coll Surg, 2005; 200(3)∶418.
8. 　Ederle A, Scattolini C, Bulighin G, et al. Does the combination of a human fibrin sealant with ranitidine accelerate the healing of duodenal ulcer? [J]. Ital J Gastroenterol, 1991; 23(6)∶354.
9. 　　Canonico S, Sciaudone G, Pacifico F, et al. Inguinal hernia repair in patients with coagulation problems: prevention of postoperative bleeding with human fibrin glue [J]. Surgery, 1999; 125(3)∶315.
10. 　Davidson BR, Burnett S, Javed MS, et al. Experimental study of a novel fibrin sealant for achieving haemostasis following partial hepatectomy [J]. Br J Surg, 2000; 87(6)∶790.
11. 　詹利永, 王敏, 陸伯豪, 等. 醫(yī)用膠減少胃癌術(shù)后腹腔滲出的隨機對照研究 [J]. 中華胃腸外科雜志, 2005; 8（1）∶43.
12. 　張獻義, 劉寧青, 呂鵬飛, 等. 醫(yī)用生物蛋白膠在甲狀腺手術(shù)中的應用 [J]. 中華普通外科雜志, 2004; 19(8)∶511.
13. 　楊子彬. 生物止血材料——纖維蛋白膠臨床應用進展 [J]. 世界醫(yī)療器械, 2001; 7(2)∶24.
14. 　Schwartz M, Madariaga J, Hirose R, et al. Comparison of a new fibrin sealant with standard topical hemostatic agents [J]. Arch Surg, 2004; 139(11)∶1148.
15. 　　Capussotti L, Ferrero A, Viganò L, et al. Bile leakage and liver resection: Where is the risk? [J]. Arch Surg, 2006; 141(7)∶690.
16. 　　Eder F, Meyer F, Nestler G, et al. Sealing of the hepatic resection area using fibrin glue reduces significant amount of postoperative drain fluid [J]. World J Gastroenterol, 2005; 11(38)∶5984.
17. 　Hayashibe A, Sakamoto K, Shinbo M, et al. New method for prevention of bile leakage after hepatic resection [J]. J Surg Oncol, 2006; 94(1)∶57.
18. 　　Figueras J, Llado L, Miro M, et al. Application of fibrin glue sealant after hepatectomy does not seem justified: results of a randomized study in 300 patients [J]. Ann Surg, 2007; 245(4)∶536.
19. 　蘇怡, 候延文, 高珉之. 纖維蛋白膠生物性能的研究 [J]. 預防醫(yī)學情報雜志, 2001; 17(6)∶433.
  1. 1. 19 　 de Virgilio C, Elbassir M, Hidalgo A, et al. Fibrin glue reduces the severity of intra-abdominal adhesions in a rat model [ J ] . Am J Surg, 1999; 178(6) ∶ 577.
  2. 2. 　王海東, 鄭進方, 邢貽雷, 等. 纖維蛋白膠在普外科手術(shù)的應用——附153例臨床分析 [J]. 中國微創(chuàng)外科雜志, 2001; 6(3)∶133.
  3. 3. 　Cothren CC, McIntyre RC Jr, Johnson S, et al. Management of low-output pancreatic fistulas with fibrin glue [J]. Am J Surg, 2004; 188(1)∶89.
  4. 4. 　Schenk WG 3rd, Burks SG, Gagne PJ, et al. Fibrin sealant improves hemostasis in peripheral vascular surgery: a randomized prospective trial [J]. Ann Surg, 2003; 237(6)∶871.
  5. 5. 　尚培中, 李德炳, 劉景章, 等. 改良套疊式胰空腸吻合術(shù)應用石蕊試紙和纖維蛋白膠預防胰漏47例體會 [J]. 中國普外基礎與臨床雜志, 2006; 13(2)∶219.
  6. 6. 　許邦文, 周寧新, 霍宗紅. 吸收性止血綾在擇期肝部分切除術(shù)中的應用 [J]. 中國普外基礎與臨床雜志, 2002; 9(4)∶276.
  7. 7. 　Kraus TW, Mehrabi A, Schemmer P, et al. Scientific evidence for application of topical hemostats, tissue glues, and sealants in hepatobiliary surgery [J]. J Am Coll Surg, 2005; 200(3)∶418.
  8. 8. 　Ederle A, Scattolini C, Bulighin G, et al. Does the combination of a human fibrin sealant with ranitidine accelerate the healing of duodenal ulcer? [J]. Ital J Gastroenterol, 1991; 23(6)∶354.
  9. 9. 　　Canonico S, Sciaudone G, Pacifico F, et al. Inguinal hernia repair in patients with coagulation problems: prevention of postoperative bleeding with human fibrin glue [J]. Surgery, 1999; 125(3)∶315.
  10. 10. 　Davidson BR, Burnett S, Javed MS, et al. Experimental study of a novel fibrin sealant for achieving haemostasis following partial hepatectomy [J]. Br J Surg, 2000; 87(6)∶790.
  11. 11. 　詹利永, 王敏, 陸伯豪, 等. 醫(yī)用膠減少胃癌術(shù)后腹腔滲出的隨機對照研究 [J]. 中華胃腸外科雜志, 2005; 8（1）∶43.
  12. 12. 　張獻義, 劉寧青, 呂鵬飛, 等. 醫(yī)用生物蛋白膠在甲狀腺手術(shù)中的應用 [J]. 中華普通外科雜志, 2004; 19(8)∶511.
  13. 13. 　楊子彬. 生物止血材料——纖維蛋白膠臨床應用進展 [J]. 世界醫(yī)療器械, 2001; 7(2)∶24.
  14. 14. 　Schwartz M, Madariaga J, Hirose R, et al. Comparison of a new fibrin sealant with standard topical hemostatic agents [J]. Arch Surg, 2004; 139(11)∶1148.
  15. 15. 　　Capussotti L, Ferrero A, Viganò L, et al. Bile leakage and liver resection: Where is the risk? [J]. Arch Surg, 2006; 141(7)∶690.
  16. 16. 　　Eder F, Meyer F, Nestler G, et al. Sealing of the hepatic resection area using fibrin glue reduces significant amount of postoperative drain fluid [J]. World J Gastroenterol, 2005; 11(38)∶5984.
  17. 17. 　Hayashibe A, Sakamoto K, Shinbo M, et al. New method for prevention of bile leakage after hepatic resection [J]. J Surg Oncol, 2006; 94(1)∶57.
  18. 18. 　　Figueras J, Llado L, Miro M, et al. Application of fibrin glue sealant after hepatectomy does not seem justified: results of a randomized study in 300 patients [J]. Ann Surg, 2007; 245(4)∶536.
  19. 19. 　蘇怡, 候延文, 高珉之. 纖維蛋白膠生物性能的研究 [J]. 預防醫(yī)學情報雜志, 2001; 17(6)∶433.