外用冻干人纤维蛋白原粘合剂在规则性肝切除肝断面的应用  

The External Use of Freeze-dried Human Fibrinogen Glue on Liver Sections of Regular Hepatectomy

作　　者：李伟[1] 辛国军[2] 田宇剑[1] 吴胜[1] 李建平 LI Wei;XIN Guo-jun;TIAN Yu-jian;WU Sheng;LI Jian-ping(Department of Hepatobiliary Surgery, the 904th Hospital of Joint Logistic Support of Chinese People's Liberation Army ( Wuxi Taihu Hospital),Wuxi 214044,Jiangsu,China;Department of Hepatobiliary Surgery,Ningxia Hui Autonomous Region People's Hospital,Yinchuan 750001,Ningxia,China;Department of Hepatobiliary and Pancreatic Surgery,the Third Affiliated Hospital of Nantong University,the Third People's Hospital of Wuxi,Wuxi 214044,Jiangsu,China)

机构地区：[1]1中国人民解放军联勤保障部队第904医院(无锡市太湖医院)肝胆外科,江苏无锡214044 [2]宁夏回族自治区人民医院肝胆外科,宁夏银川750001 [3]南通大学第三附属医院无锡市第三人民医院肝胆胰中心,江苏无锡214044

出　　处：《中国现代手术学杂志》2019年第2期94-96,共3页Chinese Journal of Modern Operative Surgery

摘　　要：目的探讨外用冻干人纤维蛋白原粘合剂(护固莱士)在规则性肝切除肝断面的应用价值。方法本研究病例来自中国人民解放军联勤保障部队第 904 医院肝胆外科及宁夏回族自治区人民医院肝胆外科,收集 2016 年 1 月至 2017 年 12 月期间,在这两所医院住院行规则性肝切除的患者,共计 218 例,将其随机分成两组,对照组肝断面行常规结扎或电凝止血,观察组在此基础上使用外用冻干人纤维蛋白原粘合剂喷洒创面,术后均常规放置腹腔引流管,对比分析两组患者在术后 3 d 的引流量、术后拔管时间,术后出血、胆汁漏、腹腔感染等方面的情况。结果术后第 1 d,两组腹腔引流量无统计学差异( P>0.05),手术后第 2、3 d 的引流量观察组明显减少( P<0.05),且拔管时间较早( P<0.05)。与对照组相比,观察组患者术后出血及胆汁漏发生率低,有统计学意义( P<0.05);在腹腔感染方面,两组相比无统计学差异( P>0.05)。结论在对肝断面主要血管、胆管有效处理的基础上,配合使用外用冻干人纤维蛋白原粘合剂喷洒,可减少术后小血管出血及毛细胆汁漏的发生,且不增加术后腹腔感染的发生,术后引流管拔管时间早,值得临床进一步推广使用。Objective To investigate the clinical results of the external use of freeze-dried human fibrinogen glue on liver sections of regular hepatectomy. Methods The regular hepatectomy cases from the 904th Hospital of Joint Logistic Support of Chinese People's Liberation Army and Ningxia Hui Autonomous Region People's Hospital from January 2016 to December 2017 were enrolled. A total of 218 cases were divided into two groups randomly. The control group underwent routine liver section ligation or coagulation. And on the basis of the above operations,the observation group used the freeze-dried human fibrinogen glue to be sprayed on liver sections.Results There was no difference of the abdominal drainage volume on the first day after operation ( P>0.05).But it decreases obviously on the second and the third day in the observation group ( P<0.05),and resulted in less abdominal drainage time( P<0.05). Compared with the control group,the postoperative bleeding volume and bile leakage volume in the observation group were less than that of the control group ( P<0.05). There was no significant difference in the abdominal infection rate between the two groups ( P >0.05). Conclusion On the basis of effective treatment of the blood vessels and bile ducts on the liver section,the use of freeze-dried human fibrinogen glue can reduce postoperative bleeding and bile leakage with no increase of the incidence of postoperative abdominal infection. It is worthy of further clinical application.

关 键 词：人纤维蛋白原粘合剂 外用 规则性肝切除 肝断面 

分 类 号：R657.3[医药卫生—外科学] R973.1[医药卫生—临床医学]