纤维蛋白粘合剂在腹腔镜肝囊肿开窗引流术中的应用

Application of biomedical fibrin glue in laparoscopic fenestration of hepatic cyst

目的研究在腹腔镜肝囊肿开窗引流术中应用纤维蛋白粘合剂的价值。方法前瞻性选择2012年1月至2018年6月中山大学附属第八医院行腹腔镜肝囊肿开窗引流术患者60例,随机分为试验组和对照组,各30例。对照组常规行腹腔镜肝囊肿开窗引流术,试验组完成同样术式后,在囊肿残腔和囊壁切缘残端处喷涂纤维蛋白粘合剂,比较两组手术时间、出血量、拔管时间、禁食时间、住院天数、总费用、并发症发生率以及术后1、2d血清C反应蛋白(CRP)水平、白细胞计数(WBC)和丙氨酸氨基转移酶(ALT)水平。结果(1)与对照组相比,试验组患者术后的手术时间、术中出血量、拔管时间、禁食时间显著减少,住院天数更短,总费用更少,差异均有统计学意义(t=7.943、11.932、25.676、18.821、15.823、3.458,均P<0.001)。(2)试验组患者术后1、2d时CRP、WBC以及ALT水平均显著低于对照组(F=52.278、46.386、77.924,均P<0.001)。(3)试验组患者无胆漏、腹水发生,复发1例;对照组患者发生胆漏2例,腹水2例,复发3例。试验组的术后总并发症发生率显著低于对照组,差异有统计学意义(3.33%vs23.33%,χ^2=5.192,P=0.023)。结论腹腔镜肝囊肿开窗引流术中应用纤维蛋白粘合剂,对于封闭创面、促进组织愈合、预防胆漏及腹水等方面起到显著疗效,且无明显不良反应,值得推广。

Objective To investigate the feasibility of biomedical fibrin glue in laparoscopic fenestration of hepatic cyst.Methods From January 2012 to June 2018,sixty patients with hepatic cyst undergoing laparoscopic fenestration and drainage in the Eighth Affiliated Hospital of Sun Yat-sen University were prospectively selected.They were randomly divided into the treatment group (sprayed with fibrin adhesive at the residual cavity of cyst and the residual end of the incision margin of cyst wall) and the control group (treated with laparoscopic fenestration and drainage of hepatic cysts),with 30 cases in each group.The operation time,blood loss,extubation time,fasting time,hospitalization days, total expenses,complications rate and serum level of C-reactive protein (CRP),white blood cell count (WBC) and alanine aminotransferase (ALT) during postoperative 1 and 2 days were compared between the two groups.Results (1) Compared with the control group,the operation time,intraoperative bleeding volume,extubation time and fasting time in the treatment group were significantly reduced,with shorter hospitalization days and less total costs,and the differences were statistically significant (t=7.943,11.932, 25.676,18.821,15.823,3.458,all P<0.001).(2) CRP,WBC and ALT levels of the treatment group were significantly lower than those of the control group at 1 and 2 d after operation (F=52.278,46.386,77.924,all P<0.001).(3) There were no bile leakage or ascites and recurrence in 1 patient of the treatment group.In the control group,bile leakage occurred in 2 cases,ascites in 2 cases and recurrence in 3 cases.The incidence of total complications in the treatment group was significantly lower than that in the control group (3.33% vs 23.33%,χ^2=5.192,P=0.023).Conclusion The application of biomedical fibrin glue in laparoscopic fenestration of hepatic cyst has a significant effect on closing wounds,promoting tissue healing,preventing bile leakage and ascites,and has no obvious adverse reactions,which is worthy of promotion.