Application of fibrin glue sealant after hepatectomy does not seem justified - Results of a randomized study in 300 patients
Application of fibrin glue sealant after hepatectomy does not seem justified - Results of a randomized study in 300 patients
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DOI：
10.1097/01.sla.0000245846.37046.57
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发表时间：
2007-04-01
影响因子：
9
通讯作者：
Serrano, Teresa
中科院分区：
文献类型：
--
作者：
Figueras, Juan;Llado, Laura;Serrano, Teresa
目的：评价肝切除术后应用纤维蛋白胶封闭剂的疗效、出血量、胆漏、并发症及术后演变。然而，关于它在肝脏手术中的应用的试验仍然有限，而且方法学质量很差。研究对象和方法：总共300名接受肝切除的患者被随机分为纤维蛋白胶涂抹组和对照组。对引流特点、引流情况及术后并发症进行评估。结果：两组患者术后输血量分别为0.15±0.66vs.0.17±0.63PRCU(P=0.7234)，需要输血者分别为18%vs.12%(P=0.20)。总引流量(1180 2528对960+/-1253毫升)或术后引流天数(7.9+/-5对7.1+/-4.7)无差异。纤维蛋白胶组和对照组的胆瘘发生率相似(10%比11%)。两组间术后并发症发生率差异无统计学意义(23%比23%；P=1)。结论：纤维蛋白封闭剂在肝脏表面的应用似乎不合理。失血量、输血量、胆瘘发生率和预后与未使用纤维蛋白胶的患者相似。因此，停止常规使用纤维蛋白密封剂将显著节省成本。
Objective: To evaluate the efficacy, amount of hemorrhage, biliary leakage, complications, and postoperative evolution after fibrin glue sealant application in patients undergoing liver resection.Summary Background Data: Fibrin sealants have become popular as a means of improving perioperative hemostasis and reducing biliary leakage after liver surgery. However, trials regarding its use in liver surgery remain limited and of poor methodologic qualityPatients and Methods: A total of 300 patients undergoing hepatic resection were randomly assigned to fibrin glue application or control groups. Characteristics and debit of drainage and postoperative complications were evaluated. The amount of blood loss, measurements of hematologic parameters liver test, and postoperative evolution (particularly involving biliary fistula and morbidity) was also recorded.Results: Postoperatively, no differences were observed in the amount of transfusion (0.15 +/- 0.66 vs. 0.17 +/- 0.63 PRCU; P = 0.7234) or in the patients that required transfusion (18% vs. 12%; P = 0.2), respectively, for the fibrin glue or control group. There were no differences in overall drainage volumes (1180 2528 vs. 960 +/- 1253 mL) or in days of postoperative drainage (7.9 +/- 5 vs. 7.1 +/- 4.7). Incidence of biliary fistula was similar in the fibrin glue and control groups, (10% vs. 11%). There were no differences regarding postoperative morbidity between groups (23% vs. 23%; P = 1).Conclusions: Application of fibrin sealant in the raw surface of the liver does not seem justified. Blood loss, transfusion, incidence of biliary fistula, and outcome are comparable to patients without fibrin glue. Therefore, discontinuation of routine use of fibrin sealant would result in significant cost saving.