Evaluation of a Chitosan Hemostat in a Porcine Laparoscopic Partial Nephrectomy Model: A Pilot Study.
Evaluation of a Chitosan Hemostat in a Porcine Laparoscopic Partial Nephrectomy Model: A Pilot Study.
复制标题
猪腹腔镜肾部分切除术模型中壳聚糖止血剂的评估：初步研究。
DOI：
10.1089/end.2018.0801
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发表时间：
2019
影响因子：
2.7
通讯作者：
Kirsch,WolffM
中科院分区：
文献类型：
--
作者：
Crofton,Andrew;Baldwin,Duane;Alsyouf,Muhannad;Dopp,Matthew;Faaborg,Daniel;Myklak,Kristine;Arenas,Javier;Khater,Nazih;Hudson,Samuel;Oberg,KerbyC;Kirsch,WolffM
背景和目的：腹腔镜肾部分切除术（LPN）理想的止血剂是以低成本提供完全止血和收集系统的封闭。壳聚糖（CS）是一种已确立的局部止血剂，但标准灭菌技术会影响其功能和生物学特性，从而阻止胃肠外使用。本研究旨在表征植入式CS止血剂的安全性和有效性，该止血剂在猪LPNmodel.Methods中采用标准技术（电子束（e-beam）照射）或新技术（非热氮等离子体）灭菌，在6头农场猪上进行腹腔镜部分肾切除术，仅使用CS止血剂（Clo-Sur P. A.D.）电子束（n= 3）或等离子体灭菌（PS）（n= 3）。测量止血所需的止血垫数量、估计失血量、手术时间、肾切除质量和热缺血时间。动物监测14周，并在收获，逆行输尿管肾盂造影和组织学分析performed.Results：完全止血和收集系统密封在两组实现。使用PS止血垫时，止血所需的止血垫（p= 0.056）和失血量（p= 0.096）有减少的趋势，尽管这没有达到统计学显著性。14周内未观察到并发症，大体检查显示植入的CS被包裹在纤维囊内。组织学分析显示愈合的肾切除部位有残留CS和相关慢性炎症、反应性纤维化和异物巨细胞形成。重要的是，邻近的肾组织是完整的，没有残留的实质性炎症或细胞damage.Conclusion：CS垫单独提供安全有效的止血猪LPN模型的活力。与电子束相比，PS可增强止血效果和吸收。
Background and Objective:The ideal hemostatic agent for laparoscopic partial nephrectomy (LPN) would provide complete hemostasis and sealing of the collecting system at a low cost. Chitosan (CS) is an established topical hemostatic agent, but standard sterilization techniques affect its functional and biologic properties, thereby preventing parenteral uses. This study sought to characterize the safety and efficacy of an implanted CS hemostat sterilized with either a standard technique, electron beam (e-beam) irradiation, or a novel technique, nonthermal nitrogen plasma, in a porcine LPN model.Methods:Laparoscopic partial nephrectomies were performed on six farm pigs and hemostasis achieved using only a CS hemostatic agent (Clo-Sur P.A.D.) that was e-beam (n= 3) or plasma sterilized (PS) (n= 3). Number of pads needed to achieve hemostasis, estimated blood loss, operative time, mass of kidney resection, and warm ischemia time were measured. Animals were monitored for 14 weeks and at harvest, retrograde ureteropyelography and histologic analysis were performed.Results:Complete hemostasis and collection system sealing were achieved in both groups. There was a trend toward less pads required for hemostasis (p= 0.056) and reduced blood loss (p= 0.096) with PS pads, although this did not achieve statistical significance. No complications were observed for 14 weeks and gross examination showed the implanted CS was encapsulated in a fibrous capsule. Histologic analysis revealed a healed nephrectomy site with residual CS and associated chronic inflammation, reactive fibrosis, and foreign body giant cell formation. Importantly, the adjacent renal tissue was intact and viable with no residual parenchymal inflammation or cytologic damage.Conclusion:CS pads alone provided safe and effective hemostasis in a porcine LPN model. PS may enhance hemostatic efficacy and resorption compared with e-beam.