Release date: 2007-09-12
Healing effect of Fuai Le gel on hepatectomy section Inner Mongolia Baotou Central Hospital General Surgery (014040) Li Mingzhang邬 Haifeng Yao Bihui [Keywords] Liver resection; oozing; medical adhesive medical glue has been widely used in the surgical field Pay attention to it, and its effect is positively evaluated. However, domestic reports of hemostasis for liver resection sections are rare. How to reduce oozing and bile leakage in the liver resection section has very important clinical significance, which can help reduce postoperative complications and accelerate patient recovery. On the basis of our successful experience in spleen preservation, our department used a Fuai Le gel spray closure for 24 cases of hepatic resection of different etiology during 2001-2004. It is summarized as follows. Clinical data General information: There were 24 patients in this group, including 18 males and 6 females, aged 21-68 years, with a median age of 49 years. There were 14 cases of primary liver tumor, 5 cases of hepatic cavernous hemangioma, 4 cases of traumatic partial hepatectomy, and 1 case of amebic liver abscess. The estimated area of ​​the liver section is 62-140 cm2. Methods: The liver lesions were removed according to the conventional method. The liver blood flow was not blocked at the first hepatic gate. The hepatic section bleeding point was electrocoagulated to stop bleeding. The pipes were sutured or ligated. After confirming the absence of active bleeding and obvious biliary leakage, dry the section with dry gauze to protect the surrounding organs, and spray the closed liver section with Fu Aile Medical Glue (produced by Beijing Fu Aile Technology Development Co., Ltd. with a special sprayer). A protective film is formed on the cross section after 3 to 6 seconds. The amount of glue is 2 to 4 ml. The pedicled membrane can also be attached to the liver section according to the situation. Double-tube drainage was placed in the operation area to observe the amount of drainage exudate containing oozing blood. Hemostasis drugs are no longer used after surgery. 3. RESULTS: The amount of blood infiltrated on the first day after surgery was (80±21.6) ml, decreased to (35±6.5) ml on the second day, and then decreased to (10±35) ml on the third day, and no bile leakage occurred. Only one case of subgingival effusion appeared, and the symptoms improved after adjusting the drainage tube, and gradually recovered. There were no reoperations to stop bleeding and perioperative death in the whole group. The average length of hospital stay was (11 ± 3) days. No fever reaction and allergic reaction. Discussion The liver has a rich blood supply, and the bile duct is widely distributed. Postoperative liver section oozing and leaking bile has always been a difficult problem for trapping liver resection. Abdominal hemorrhage and bile leakage are likely to cause infection, which is directly related to the therapeutic effect and prognosis. Therefore, it is very important to properly treat the liver section during surgery to stop bleeding and avoid bile leakage. The birth of medical glue and its wide application in the field of surgery has a milestone in the development of the foreign sciences [1], adding a powerful weapon for the treatment of diseases. We have achieved successful experience in the application of spleen trauma and spleen [2]. The third generation of Fuaile Medical Glue is a high-purity α-cyanoacrylic acid high-carbon n-alkyl ester, which has good histocompatibility and non-toxicity. After a small amount of water or blood is encountered in the liver section, it rapidly solidifies to form a film that closely binds to the cross-sectional structure. It not only has a good protective effect on the liver section, but also does not affect the combination of the omentum flap and the section to establish blood supply. The spray method can be used to uniformly form the film to avoid waste, and does not cause unevenness and difficulty in application. We understand that Fu Aile Medical Glue has a short curing time. The liver section should be dried as much as possible before spraying. The surrounding tissue should be isolated with a dry dressing when spraying. The nozzle should be about 10cm away from the liver section, and the spray should be kept even. After the cover film is formed, it is lightly wiped with a dry dressing, and the liquid is repeatedly sprayed. It is necessary to place double tube drainage to observe the amount of bloody exudate. With the traditional conventional liver section treatment method, it is often seen that the amount of oozing blood in the peritoneal drainage is as high as several hundred milliliters, and sometimes it is necessary to stop bleeding again. In a few cases, bile leakage occurs, and the blood is severely endangered. After the closure of the liver section with Fu Aile gel, the amount of oozing blood was significantly reduced at 1, 2, and 3 days after surgery, without increasing the heat source reaction and other adverse reactions; and the pedicled reticle flap was closely attached to the liver section, effectively Prevent the accumulation of fluid under the valve. The pressure-sensitive gelatin sponge on the cross-section after spraying can achieve hemostasis. In short, the use of Fu Aile medical glue spray section in the treatment of liver cut surface can effectively reduce postoperative oozing and bile leakage, reduce complications and shorten recovery period. At the same time, the operation is simple, safe and has promotional value. References [1] Xia Suisheng, the hallmark of the progress of modern clinical general surgery [J]. Journal of Clinical Surgery, 1998, 6 (1): 1-2 [2] Yan Yanlei, Li Mingzhang, Hu Jiang, et al. Simultaneous spleen arteriovenous Ligation and treatment of severe traumatic splenic rupture in animals and clinical application [J]. Chinese Journal of General Surgery Basic and Clinical, 1998,5 (5): 292-293. [Author] Li Mingzhang (1962-), male, chief physician. Reprinted from the Journal of Clinical Surgery, Vol. 13, No. 9, 2005
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