微孔多聚糖止血球在腹腔镜脾切除术中的应用

Application of microporous polysaccharide hemospheres in laparoscopic splenectomy

目的探讨微孔多聚糖止血球(microporous polysaccharide hemospheres,MPH)在腹腔镜脾切除术(laparoscopic splenectomy,LS)的止血效果。方法2005年12月至2008年5月期间,临床确诊为特发性血小板减少性紫癜且有脾切除手术指征的患者50例,随机分成医用生物蛋白胶组(FG组,25例)和MPH组(25例),由同一主刀医生进行LS,两组术中分别常规用5mlFG或1gMPH喷洒于脾蒂断面钉合线及脾窝创面。记录术中出血量、喷洒FG或MPH后渗血停止的时间,测定术后24、48h引流液量。统计方法采用x2检验和Studentt检验。结果两组患者的一般资料(性别、年龄、术前血小板计数)均无显著性差异。FG组和MPH组术中出血量分别为(90.8±85.8)ml和(82.2±101.0)ml(t=0.325,P=0.747),喷洒FG或MPH后创面渗血停止时间分别为(2.1±1.8)min和(1.2±0.8)min(t=2.470,P=0.017),术后24h引流量分别为(85.9±45.7)ml和(52.3±37.9)ml(t=2.833,P=0.007),术后48h引流量分别为(37.6±18.8)ml和(22.4±17.7)ml(t=2.948,P=0.005)。FG组术后1例疑胰尾损伤,保守治疗成功。余两组患者均未出现严重并发症。结论微孔多聚糖止血球在腹腔镜脾切除术中具有快速、可靠的止血作用,其效果优于医用生物蛋白胶。

Objective To investigate the hemostatic effect of microporous polysaccharide hemospheres （MPH） in laparoseopic splenectomy（LS）. Methods 50 cases of clinical diagnosed idiopathic thromboeytopenic purpura（ITP） who were available for surgical therapy were randomly divided into two groups and underwent LS by the same surgeon during December 2005 and May 2008. 5 ml of fibrin glue（FG） was regularly sprayed to the staple site of splenic pedicle and splenic pouch in FG treated group （FG group, 25 cases）. 1 gram of MPH was regularly applied in MPH treated group（MPH group, 25 cases）. Estimated volume of blood loss and hemostatic time after applying FG or MPH were recorded. Estimated volume of 24,48 hours drainage postoperatively were mesured consequently. Chi square test and Student＇s t-test was used for statistical analysis. Results There was no significant difference in sex ratio, age and preoperative blood platelet count in two groups. The estimated volume ofintraoperative blood loss were （90.8±85.8） ml in FG group and （82.2±101.0） ml in MPH group（t=0.325, P=0.747）. The hemostatic time of operative section after applying FG or MPH was （2.1±1.8） rain and （1.2±0.8） min, respectively（t=2.470, P =0.017）. Estimated volume of 24 hours drainage postoperatively were （85.9±45.7） ml and （52.3±37.9） ml, respectively（t=2.833, P=0.007）.Estimated volume of 48 hours drainage postoperatively were （37.6±18.8） ml and （22.4±17.7） ml, respectively （t =2.948, P=0.005）. 1 Case was diagnosed as injury of pancreas tail and recovered with conservative treat- ment. No serious complications happened in the other cases. Conclusion MPH provides rapid and effective hemostasis in LS. The hemostatic efficacy of MPH is better than FG.