进展期胃癌术中低渗温热腹腔化疗联合生物蛋白胶缓释氟尿嘧啶植入的临床研究

目的分析进展期胃癌术中腹腔内植入生物蛋白胶缓释氟尿嘧啶的安全性和治疗价值。方法对96例胃癌患者进行随机分组研究,比较三组资料的安全性指标和1、3、5年生存率、复发、转移率。结果三组资料在腹腔化疗的安全性方面均无显著性差异;治疗组术后复发率(15.15%)低于对照组A(36.36%)和对照组B(40.44%),差异有显著性意义(P<0.05)。治疗组术后1、3、5年生存率分别为86.56%、62.32%和54.17%,而对照组A术后1、3、5年生存率分别为83.98%、39.39%、30.30%,对照组B术后1、3、5年生存率分别为81.45%、29.33%、26.35%。三组1年生存率比较差异无统计学意义,而3、5年生存率比较,治疗组明显优于对照组A和对照组B(P<0.05)。结论进展期胃癌术中低渗温热腹腔化疗联合生物蛋白胶缓释氟尿嘧啶植入,安全性好,可明显降低复发率,提高患者生存率。     

以生物蛋白胶为载体配合丝裂霉素缓释化疗腹腔恶性肿瘤的临床研究

目的　探讨以生物蛋白胶为载体配合丝裂霉素缓释化疗辅助治疗腹腔恶性肿瘤的有效性和安全性。方法　将 5 3例腹腔恶性肿瘤患者随机分为实验组 (n =2 7) ,对照组 (n =2 6) ,术后实验组将生物蛋白胶溶解丝裂霉素喷洒在腹腔及瘤床周围 ,对照组未使用 ,比较实验组与对照组的疗效差异。结果　术后实验组和对照组患者化疗不良反应的发生率分别为 5 4.2 % ,61.5 % ,两组无显著差异 (P >0 .0 5 )。术后 1年 ,对照组生存率为 5 0 % ,实验组生存率为 77.8% ,两组有统计学差异 (P <0 .0 5 )。结论　以生物蛋白胶为载体配合丝裂霉素术后腹腔缓释化疗能够延长病人的生存期 ,安全有效。     

生物蛋白胶封堵术治疗高位肛瘘的围手术期护理

目的探讨应用生物蛋白胶封堵术治疗高位肛瘘围手术期护理。方法对20例实施生物蛋白胶封堵术治疗高位肛瘘患者的护理进行和总结。结果手术配合精心护理,瘘管闭合良好,无复发及无假性愈合。结论充分术前准备,术后做好病情观察、特殊的换药方法及加强饮食和康复指导,对巩固手术的治疗效果起着重要的作用。     

生物蛋白胶封堵术治疗高位肛瘘的临床研究

目的探讨生物蛋白胶封堵术治疗高位肛瘘的临床应用。方法将我科2010年3月至2011年4月期间60例高位肛瘘,随机分为治疗组和对照组各30例。治疗组采用生物蛋白胶封堵术,对照组采用肛瘘切除术,比较两组术后创面愈合时间、创面换药疼痛、肛管压力测定。结果治疗组术后疼痛及创面愈合时间均比对照组低（P〈0．05）;复发率的差异无统计学意义（P〉0．05）;术后肛管静息压比较,差异有统计学意义（P〈0．05）。结论生物蛋白胶封堵术治疗高位肛瘘有较好的效果,能缩短伤口愈合时间,减轻术后换药疼痛,保护肛管静息压。     

医用生物蛋白胶治疗骶管囊肿

目的：评价医用生物蛋白胶治疗骶管囊肿的疗效。方法：19例骶管囊肿患者，男7例，女12例；年龄19—68岁，平均48．4岁；病程2周-7个月。囊肿部位9例在S1平面，4例在S1-S2平面，5例在S2平面，1例在S1-S3平面。11例采用囊肿壁大部切除，8例采用囊肿壁部分切除。之后均采用医用生物蛋白胶（FG胶）局部喷涂治疗。结果：19例平均随访21.3个月（13-30个月），临床症状完全消失18例，1例术后仍有解尿无力，2周后恢复。术后12个月复查MRI均无复发。结论：医用生物蛋白胶治疗骶管囊肿，操作简单、安全，效果好。术后患者症状消失快、恢复快、效果满意，是治疗骶管囊肿的一种有效可行的方法。     

腹腔镜手术中应用医用生物蛋白胶辅助治疗的体会

目的:探讨医用生物蛋白胶(b iom ed ical fibrin sealant,BFS)在腹腔镜手术中的应用优势及前景。方法:在1 215例腹腔镜手术中应用医用生物蛋白胶。结果:所有病例均手术顺利,术后恢复良好。无胆囊床创面渗出、肠吻合口漏、阑尾残端漏等并发症出现。结论:医用生物蛋白胶在各种腹腔镜手术中可以有效的减少创面的渗血,预防小胆管的微小漏和肠吻合口的“针孔漏”;促进组织愈合,为腹腔镜手术提供有效的安全保障,同时减少腹腔粘连,促进恢复,缩短住院时间。     

生物蛋白胶二期封堵术治疗高位肛周脓肿的临床应用

目的探讨生物蛋白胶二期封堵术治疗高位肛周脓肿的临床应用。方法回顾分析我科2006年5月至2007年12月,采用生物蛋白胶二期封堵术治疗高位肛周脓肿12例临床病例。结果术后超过半年随访,12例无复发。结论生物蛋白胶二期封堵术治疗高位肛周脓肿有较好的效果,能缩短伤口愈合时间,减轻术后换药疼痛,为高位肛周脓肿的治疗开辟了一条新的途径。     

急性炎症期腹腔镜胆囊切除术中生物蛋白胶的应用

目的探讨医用生物蛋白胶对减少急性胆囊炎LC术后胆囊床创面渗漏的价值。方法2005年1月至2008年12月随机选取生物蛋白胶治疗组36例患者和42例对照组患者。通过比较术中止血时间、术后腹腔引流量及引流时间、胆漏情况、住院时间等5项指标来说明其有效性。结果除胆漏外,治疗组与对照组差异无统计学意义。结论急性炎症期LC医用生物蛋白胶能有效减少创面出血和渗漏,同时缩短住院时间,减少住院费用。     

海马拔毒散合生物蛋白胶治疗褥疮20例

褥疮又名“席疮” ,因久着席褥生疮而名 ,多见于昏迷、半身不遂或下肢瘫痪等病人 ,好发于易受压迫及摩擦部位。由于长期卧床不起 ,久病气血亏虚。复因局部受压 ,血液循环差 ,局部营养不良而引起局部溃烂、坏死。作者在临床上运用海马拔毒散合医用生物蛋白胶 (广州倍特生物技术有限公司生产 )治疗观察 2 0例 ,效果满意。1　临床资料2 0例中男 13例 ,女 7例 ;年龄 5 0～ 78岁 ,平均6 2 3岁。病史 5～ 6 7ｄ ,平均 4 1ｄ。表面结痂而痂下积脓者 8例。褥疮单发于骶尾部者 3例 ,单发于两髋部者 1例 ,足跟部者 1例 ,发生于上述部位两处或两处以上…     

医用生物蛋白胶在消化道外瘘治疗中的应用

目的 探索一种促进消化道外瘘瘘管尽快闭合的填堵治疗新方法。方法 对28例不同部位、不同类型的消化道外瘘患者，采用自行设计的导管系统．选择不同口径的双腔输送管，沿瘘管缓慢插入，待输送管顶端距瘘口约1cm时，将配制好的蛋白胶，经双腔输送管缓慢推入，边推注边缓慢退出导管，使内瘘口及整个瘘管被蛋白胶完全填堵。结果 导管系统的输送管插入瘘管均顺利。28例瘘管填堵过程中均无特殊不良反应。其中17例经1次填堵，1周左右瘘管自行愈合；11例经2-3次填堵后，2周左右瘘管愈合，填堵效果均满意。25例术后随访3～6个月，瘘口均愈合良好，无消化液再漏出，顺利恢复正常饮食。结论 医用生物蛋白胶在消化道外瘘治疗中具有满意的填堵效果，为消化道外瘘的治疗开辟了一条新的途径。     

Fibrin glue in the management of anal fistulae

OBJECTIVE: Fibrin glue has been used as a sphincter sparing approach for the treatment of anal fistulae for two decades. However, there is uncertainty about its short and long-term efficacy. The objective of this review was to ascertain the role of fibrin glue in the management of anal fistulae, including assessment of recurrence rates, continence disturbance and other complications. METHODS: We searched Medline (January 1966 to February 2004), the Cochrane database, and EMBASE using the terms anal fistulae, fistula-in-ano, and fibrin glue. Relevant papers from the reference lists of these articles and from the authors' personal collections were also reviewed. A systematic review of all articles relating to the use of fibrin glue in the treatment of anal fistulae was performed. This included 19 studies. Reviewers performed data extraction independently. Outcomes evaluated included recurrence rates, continence disturbance, septic complications, adverse drug reactions, and duration of follow-up. Heterogeneity of the clinical trials made direct comparisons difficult and meta-analysis impossible. RESULTS: The success rates reported in published studies range from 0% to 100%. Differences in patient selection (including fistula aetiology and type), treatment protocols, and follow-up duration may contribute to such diverse results. CONCLUSIONS: Fibrin glue is simple to use, has a minimal morbidity and should not affect later treatment options in the event of its failure. It is therefore theoretically attractive as a first line treatment in the management of those types of anal fistula in which it has been shown to work. However, further research into 'biological' glues is merited and these subject to randomised controlled study.     

Spontaneous pneumothorax and Fibrin glue sealant during thoracoscopy

The prophylactic treatment of the application of fibrin glue to the pulmonary surface during thoracoscopy in idiopathic spontaneous pneumothorax resulted in rapid and total pulmonary expansion in 33 of 35 patients. The 2 failures were due to apical cysts larger than 2 cm. The successfully treated patients were hospitalized for a median of 4 days (range 2–12). No complications were observed. All regained full working capacity within 1 month of discharge. Post-treatment X-ray examination of the chest was uniformly normal. During an observation time ranging from 7–24 months (median 12 months), 3 recurrences (9%) were seen at 7, 12, and 16 months, respectively. The treatment seems (1) to reduce the need for thoracotomy (2) to be associated with a high success rate, short and long-term, (3) to minimize the duration of hospital stay and (4) not to disturb the normal pleuro-pulmonary anatomy.     

Fibrin glue for securing the mesh in laparoscopic totally extraperitoneal inguinal hernia repair

Background Anchoring the mesh in laparoscopic totally extraperitoneal groin hernia repair (TEP) with human fibrin glue has theoretical advantages. However, these have been supported and reported previously only in animal studies. Before the initiation of large patient trials, the authors wanted to confirm the feasibility, assess the costs, and rule out any flagrant short- and long-term adverse effects of fibrin glue usage in a small series of patients. Methods Nine consecutive TEP repairs with fibrin glue mesh fixation were performed. The perioperative and postoperative outcomes at 1, 16, and 40 months were compared with those for a control group of 96 stapled repairs. Results Gluing was easy and is less expensive than stapling. No fibrin glue–related adverse effects were found. The overall outcome was similar to that for stapled repairs, with no indication that the glued repairs were inferior. Conclusions Fibrin glue seems to be a reasonable, feasible, and maybe even competitive alternative to the standard tissue-penetrating mesh fixation. The results of this study justify launching larger trials. Presented at the 11th International Congress of the European Association for Endoscopic Surgery (EAES), Glasgow, Scotland, 15–18 June 2003, and as an updated version at the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) meeting, Denver, CO, USA, 31 March 31–3 April 2004.     

Fibrin glue injection method with diluted thrombin for refractory postoperative digestive fistula

Background

The injection of the biological adhesive fibrin glue is often performed to treat postoperative digestive fistulas. However, it is not always effective especially in case of complex fistulas with large cavities, because the fibrin glue will coagulate before the mixed solutions fill the cavity, creating dead space. We report the results of fibrin glue injection with diluted thrombin solution.

Methods

We studied the tensile strength and coagulation time of the resulting fibrin glue at each dilution of the thrombin solution. Based on in vitro study, 18 patients who had developed postoperative digestive fistula were treated by fibrin glue injection with diluted thrombin solution.

Results

In vitro study proved that the dilution of thrombin prolonged the coagulation time of the fibrin glue to more than 1 minute with almost no change to the tensile strength of the glue until a certain dilution was reached. The fistulas of 16 patients were successfully closed.

Conclusions

Our simple method of fibrin glue injection is useful for refractory postoperative digestive fistula, even in cases of complex fistula with large cavities.     

The Use of Fibrin Glue in the Treatment of Fistula-In-Ano: A Prospective Study

Purpose This prospective study was done to analyze the efficacy of commercial fibrin glue application in the healing of patients with fistulas-in-ano. Methods This clinical trial of 36 patients was performed during the period from November 2003 to May 2004. Thirty men and six women were treated for a fistula-in-ano with commercial fibrin glue application. None of the patients had undergone prior attempts to correct fistulas-in-ano surgically. All patients received preoperative mechanical bowel preparation and prophylactic intravenous antibiotics. In the operating room, the patients underwent an anorectal examination under spinal anesthesia. The external and internal fistula tract openings were then identified. The fistula tract was curetted. Fibrin glue was injected into the external fistula opening until fibrin glue could be seen coming from the internal opening. No dressing was applied over the external opening. Thereafter, the patient was discharged. A 1-week course of oral antibiotics was prescribed. The patients were followed up for 70 weeks with a mean of 54 weeks (range 40–70 weeks). Results The cause of the fistula-in-ano was cryptoglandular in all patients. The overall initial success rate was 77.8% (28/36). No complications were encountered related to the application. Two patients underwent a reapplication with fibrin glue and the fistulas of these patients were all closed. The overall success rate was 83.3% (30/36). Conclusion Fibrin glue application was thus found to be an easy, safe, effective, and useful alternative treatment in the management of fistulas-in-ano. However, our findings need substantiation by increasing the number of patients and prolonging the follow-up duration, as well as carrying out comparative studies.     

The use of sprayed fibrin glue for face lifts

Summary The use of a fibrin and thrombin tissue glue administered in aerosol form has been evaluated in 65 patients undergoing a face lift. In 55 cases the glue was applied to the undermined areas bilaterally, and appeared to decrease postoperative oedema and bruising. In a further 10 cases the adhesive was used on one side only. In 5 of these patients there was no difference between the two sides, while in 5 cases the glued side was judged superior. With this technique drains and dressings are not necessary in the postoperative period and patients find this especially convenient.     

Long-term assessment of the treatment of recurrent tracheoesophageal fistula with fibrin glue associated with diathermy

Purpose

Recurrent tracheoesophageal fistula (RTF) is a serious common complication of the surgical treatment of esophageal atresia. We report the results of our technique of bronchoscopic treatment of RTF with fibrin glue (Tissucol), with a follow-up of over 1 decade.

Methods

A retrospective review between 1993 and 2004 was conducted, including all patients diagnosed with RTF and treated bronchoscopically with Tissucol, with over 1 year of follow-up. The procedure was implemented under general anesthesia using a rigid neonatal bronchoscope. A magnification chamber and previous diathermia using a urethral catheter were used in the latter 4 patients. The fibrin glue was injected through a clear catheter. The number of endoscopic sessions per patient was limited to 3.

Results

Seven patients were treated, with evidence of fistular closure in 6 (85%). One patient with satisfactory results, but a follow-up of 4 months, was not included. The age at bronchoscopy ranged from 14 to 20 days (mean, 16.7 days), and a total of 12 sessions were required (mean, 1.7). In the latter 4 patients, diathermia was associated with good results in all and a lower number of sessions (mean, 1.5). All patients were evaluated clinically and radiologically, and a control endoscopy was performed in 4 patients. The follow-up lasted from 2 to 11 years (mean, 7.4 years).

Conclusions

Because we started to use Tissucol (1994), other authors have reported successful isolated cases, but a relatively large series and a long-term follow-up were lacking. We consider that the success of the procedure depends on several technical factors such as an early diagnosis, before epithelium is formed in the fistula, and the use of initial diathermia, associated in the latter 4 patients. The results obtained with 85% success with a follow-up over 1 year show that the fibrin adhesive is the reference substance for the treatment of RTF; we recommend its endoscopic application associated with diathermia as initial measure.     

Cartilage chips synthesized with fibrin glue in rhinoplasty

A new type of cartilage graft that is synthesized from cartilage fragments minced by our instrument and mixed with fibrin glue is described. This new material is useful when particular grafts are required in primary or secondary rhinoplasty.     

Minimal suture blepharoplasty: Closure of incisions with autologous fibrin glue

Blepharoplasty incisions can be closed safely with autologous fibrin glue. The fibrinogen, prepared either from a whole-blood or plasmapheresis source, is mixed with commercially available thrombin to form a seal that is both hemostatic and adhesive. The complication rate is low and primarily due to technical factors in the initial cases. 'When compared with standard suture techniques, the incidence of minor problems such as milia formation was much lower. In select cases, the technique of using fibrin glue and a minimal number of sutures may be useful as an alternative method of would closure in blepharoplasty patients.Presented at the annual meeting of the American Society of Aesthetic Plastic Surgery, April 30, 1990, New York, NY, USA     

Influence of fibrin glue on seroma formation after breast surgery

BACKGROUND: This study was designed to determine the effectiveness of Hemaseel APR fibrin sealant versus conventional drain placement in the prevention of seromas after breast procedures. METHODS: A prospective, randomized, controlled study of subjects who were randomized into control (drain) and experimental (fibrin) groups was conducted. RESULTS: Analysis of 82 patients showed similarly matched groups. Seroma formation rate was 45.5% in the control group and 36.8% in the fibrin glue group (P = 0.43). The rate of wound complications was similar. Aspirate volumes were significantly greater in the fibrin glue group. Drain placement saved patients >366 US dollars over fibrin glue. CONCLUSIONS: Although use of fibrin sealant resulted in a nonsignificant decrease in seroma formation rate compared with that of drain placement, the higher cost involved, cumbersome technique, and higher aspirate volumes tend to indicate that there is no advantage to using fibrin glue over drain placement with the technique described.