Study of dural suture watertightness: an in vitro comparison of different sealants
Study of dural suture watertightness: an in vitro comparison of different sealants
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DOI：
10.1007/s00701-011-1197-9
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发表时间：
2011-12-01
影响因子：
2.4
通讯作者：
Allain, Jean-Marc
中科院分区：
文献类型：
--
作者：
Chauvet, Dorian;Viet Tran;Allain, Jean-Marc
脑脊液漏是硬膜内手术的主要并发症，尤其是后颅窝和颅底手术。硬脑膜缝合的水密性是一个决定性的问题，神经外科医生经常使用不同的产品来加强他们的硬脑膜闭合。我们设计了一套能够测试脑脊液泄漏压力水平的实验系统，以便在体外比较两种缝线，特别是四种不同的封闭剂。取出25个新鲜的人身体硬脑膜标本，准备在连接液压马达的压力室系统中进行测试。客观记录脑脊液渗漏水平。首先，比较单纯间断缝合和50 mm线状缝合的简单缝合。其次，测试了四种密封剂(两种密封剂/胶，BioglueA(R)，DuraselA(R)；两种止血剂，TachosilA(R)，TissuolA(R))。经配对t检验，间断缝合与流动缝合差异无统计学意义(p=0.079)。所有封闭剂均显著提高了缝合线的水密性。然而，对每种产品的差异均值进行比较，发现差异很大。在我们的实验条件下，一种密封剂(DuraselA(R))和一种止血剂(TachosilA(R))似乎表现出更好的效果。我们观察到了两种不同类型的渗漏：硬脑膜-封闭剂界面处的渗漏和封闭剂本身的渗漏。我们开发了一种能够测试硬脑膜封闭水密性的实验装置。间断缝合似乎与简单缝合没有什么不同。相反，测试的密封胶表现出不同的水密性能。
CSF leakages constitute a major complication of intradural procedures, especially for posterior fossa and skull base surgery. Dural suture watertightness is a decisive issue, and neurosurgeons routinely use different products to reinforce their dural closure. We have designed an experimental system capable of testing CSF leak pressure levels in order to compare two types of sutures in vitro and particularly four different sealants.Twenty-five fresh human cadaveric dural samples were removed and prepared for testing in a pressure chamber system connected to a hydraulic pressure motor. CSF leak levels were objectively registered. First, simple interrupted stitches were compared to running simple closure on 50-mm linear suture. Secondly, four sealants (two sealants/glues, BioglueA (R), DurasealA (R); two haemostatics, TachosilA (R), TissucolA (R)) were tested. Statistical analysis was performed with paired Student's t-test.No significant difference between interrupted closure and running suture was observed (p = 0.079). All sealants increased the watertightness of the suture significatively. However, comparison of the means of the differences for each product revealed large variations. In the conditions of our experiment, one sealant (DurasealA (R)) and one haemostatic (TachosilA (R)) seemed to show better results. We observed two different types of leakage: at the dura-sealant interface and through the sealant itself.We have developed an experimental device capable of testing dural closure watertightness. Interrupted stitch suturing seemed no different from running simple closure. On the contrary, the sealants tested show different watertightness capacities.