Late complications of gelatin-resorcin-formalin glue in the repair of acute type A aortic dissection
Late complications of gelatin-resorcin-formalin glue in the repair of acute type A aortic dissection
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DOI：
10.1016/j.athoracsur.2007.01.025
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发表时间：
2007-05-01
影响因子：
4.6
通讯作者：
Sawa, Yoshiki
中科院分区：
文献类型：
--
作者：
Hata, Hiroki;Takano, Hiroshi;Sawa, Yoshiki
背景在急性A型主动脉夹层的手术治疗中，明胶-间苯二酚-福尔马林胶通常被应用，其疗效已有报道。然而，也报告了一些可能与这种胶水相关的晚期并发症。本文总结了急性A型主动脉夹层及吻合口晚期并发症的治疗经验。1994年10月至2005年8月，68例急性A型主动脉夹层患者接受急诊手术。其中56例（82.4%）患者在远端和近端吻合口的一个或两个部位使用明胶-间苯二酚-福尔马林胶。术后30天内死亡8例（11.8%），其中2例术前已存在脑并发症，5例晚期死亡，死亡原因与心脏事件无关。5名患者在吻合部位发生了主动脉假性动脉瘤，并接受了晚期再次手术。所有这些患者在之前的手术中均使用明胶-间苯二酚-福尔马林胶进行了治疗。再次手术后切除的主动脉壁的组织学检查显示组织坏死、严重的局部炎症和胶应用部位的陈旧血栓机化。使用明胶-间苯二酚-福尔马林胶后可能发生晚期并发症，具有一定的风险，表明其对主动脉组织的毒性。因此，严格要求正确使用这种胶水并密切随访患者。
Background. During surgical treatment for acute type A aortic dissection, gelatin-resorcin-formalin glue is generally applied and its efficacy has been reported. However, some late complications that are potentially associated with this glue have also been reported. In the present study, we reviewed our experiences of treatment for acute type A aortic dissection and late complications that occurred in the anastomotic site, which needed a reoperation.Methods. From October 1994 to August 2005, 68 patients underwent emergency surgery for acute type A aortic dissection. Gelatin-resorcin-formalin glue was applied to 56 (82.4%) of these patients at one or both of the distal and proximal anastomosis sites.Results. Eight (11.8%) patients died in hospital within 30 days after the operation, among which two patients already had cerebral complications prior to the surgery.There were five late deaths from causes unrelated to cardiac events. Five patients developed an aortic pseudoaneurysm at the anastomotic site and underwent a late reoperation. All of these patients had been treated with gelatin-resorcin-formalin glue during the previous operation. Histologic examination of the resected aortic wall after the reoperation revealed tissue necrosis, severe local inflammation, and organization of old thrombi at the site of the glue application.Conclusions. Late complications after the use of gelatin-resorcin-formalin glue may occur with a certain amount of risk, suggesting its toxicity for aortic tissue. Therefore, proper use of this glue and close follow-up of the patients are strictly required.