Low-cost simulator for intra-abdominal bleeding / Simulador de baixo custo para sangramento intra-abdominal

ABSTRACT Background: training in critical surgical situations is crucial for a safe outcome. The use of simulators is well established, although many are quite expensive, requiring the search for financially viable solutions for training centers. Methods: we built a low-cost simulator for intra-abdominal bleeding with inexpensive materials, such as a manikin chest, latex tubes, silicone rubber, and waterproof fabric, seeking to mimic the abdominal viscera and vessels and their anatomical correlations. An IV infusion set allowed simulated blood to flow under pressure, and the blood flowed freely during simulation. After obtaining a functional model, we selected general surgeons to validate the simulator and its use in teaching surgery. We used the content validity index (CVI), with a cutoff of 0.9. Results: the cost of building the prototype was US$71,00 in 2021, accounting for the purchase of the various necessary materials. Twelve raters participated in the validation tests. The results obtained from the feedback survey showed a good evaluation of all items, especially the recognition of the injured vessel, access to the vascular injury, hemostasis by manual compression, and hemostatic suturing. Conclusion: the proposed simulator obtained good results in scenarios of intra-abdominal bleeding from large vessels, as well as for hemostasis by manual compression and suturing. It proved to be a useful tool for training in critical intra- abdominal bleeding situations, while maintaining a low cost of building.

RESUMO Introdução: o treinamento em situações críticas em Cirurgia é determinante para o desfecho seguro. O uso de simuladores é bastante consolidado, embora muitos apresentem custos muito elevados, sendo necessária a busca de soluções financeiramente viáveis para os centros de treinamento. Métodos: construímos um simulador de sangramento intra-abdominal de baixo custo com materiais simples como tronco de manequim, tubos de látex, borracha de silicone e tecido impermeável, buscando representar vísceras abdominais e vasos e suas correlações anatômicas. Um sistema de tubos e equipos de soro permitiu o fluxo, sob pressão, de sangue simulado, que vertia livremente durante a simulação. Após a obtenção de modelo funcional, selecionamos cirurgiões gerais para a validação do simulador e seu uso no ensino de Cirurgia. Utilizamos o Índice de Validação de Concordância (IVC), com corte de 0,9. Resultados: a construção do protótipo resultou em gasto de US$71,00 em valores de 2021, destinados à aquisição dos diversos materiais necessários. Doze avaliadores participaram dos testes de validação. Os resultados obtidos dos questionários demonstraram uma boa avaliação em todos os itens, destacando-se o reconhecimento do vaso traumatizado, o acesso à lesão vascular, o controle hemostático por pressão direta assim como por sutura direta da lesão. Conclusão: o simulador proposto obteve bons resultados em cenários de sangramento abdominal de grandes vasos, assim como o controle hemostático do mesmo por pressão direta e sutura. Mostrou-se ferramenta útil para a adaptação a situações de estresse no treinamento em sangramentos intra-abdominais, além de manter baixo custo de construção.

Hemostatic efficacy of tranexamic acid and ε-aminocaproic acid in hip and knee arthroplasty:a Meta-analysis / 中国骨伤

OBJECTIVE@#To systematically evaluate the hemostatic efficacy of tranexamic acid and ε-aminocaproic acid in total hip arthroplasty (THA) and total knee arthroplasty (TKA).@*METHODS@#Randomized controlled trials (RCT) and retrospective case-control studies about tranexamic acid and ε-aminocaproic acid for the comparison of THA or TKA were searched electronically in PubMed, EMbase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang, VIP from the time of building databases to July 2020. Two investigators carried out literature screening and data extraction according to the inclusion and exclusion criteria respectively. The methodological quality of the included randomized controlled studies was evaluated through the Cochrane Handbook, and the methodological quality of the included retrospective case-control studies was evaluated through the NOS scale. Blood loss, the incidence of thrombosis complications, per capita input of hemoglobin were Meta-analyzed by Review Manager 5.3 software.@*RESULTS@#A total of 6 articles were included, including 4 RCTs and 2 retrospective case-control studies. A total of 3 174 patients, including 1 353 in the tranexamic acid group and 1 821 in the ε-aminocaproic acid group. Meta-analysis results showed that there were no difference statistical significance in blood loss [MD=-88.60, 95%CI(-260.30, 83.10), P=0.31], blood transfusion rate [OR=1.48, 95%CI(0.96, 2.27), P=0.08], thrombotic complications [OR=0.80, 95%CI(0.07, 8.83), P=0.85], per capita hemoglobin input [MD=0.04, 95%CI(-0.02, 0.10), P=0.18] between tranexamic acid group and ε-aminocaproic acid group during THA. While in TKA, the blood loss of the tranexamic acid group was less than that of the ε-aminocaproic acid group [MD=-147.13, 95%CI(-216.52, -77.74), P<0.0001], the difference was statistically significant. The blood transfusion rate [OR=1.30, 95%CI(0.74, 2.28), P=0.37], thrombotic complications [OR=0.95, 95%CI(0.38, 2.36), P=0.92], per capita hemoglobin input [MD=-0.00, 95%CI(-0.05, 0.06), P=0.48], tourniquet time [MD=1.54, 95%CI(-2.07, 5.14), P=0.40] were similar between two groups, the difference was not statistically significant.@*CONCLUSION@#In THA, tranexamic acid and ε-aminocaproic acid have similar hemostatic effects, while in TKA, tranexamic acid can effectively reduce the patient's blood loss and has a better hemostatic effect. Tranexamic acid is recommended as one of the first choice hemostatic drugs for TKA.

Application of cervical lifting suture in hemostasis of placenta previa with increta and percreta / 中华妇产科杂志

Objective@#To evaluate the effect of cervical lifting suture in treatment of placenta previa with increta and percreta.@*Methods@#From January 2016 to June 2017, 65 cases (0.78%, 65/8 322) were diagnosed placenta previa with increta and percreta by prenatal ultrasonic score system and confirmed by intraoperative findings in the department of obstetrics and gynecology of Peking University Third Hospital. Totally 62 cases (0.75%, 62/8 322) were included, because 3 cases underwent hysterectomy with placenta in situ. According to ultrasonic score system, 62 cases were divided into two groups, score 5-9 group (n=42, 67.7%) and score≥10 group (n=20, 32.3%) , cervical lifting suture techniques were all performed in cesarean sections. Demographic and clinical data were collected and compared.@*Results@#(1) There were no significant differences between two groups in age, gravidity, parity, cesarean section history ratio and gestational week of termination (all P>0.05) . (2) In score≥10 group, the median intraoperative bleeding volume was 4 000 ml (1 200-13 000 ml) , while in score 5-9 group, it was 1 600 ml (700-10 000 ml) , intraoperative blood transfusion volume was 2 000 ml (800-8 800 ml) in score≥10 group, while 1 200 ml (0-8 000 ml) in score 5-9 group. The median operation time was 240 minutes (108-1 200 minutes) in score≥10 group, significantly higher than that in score 5-9 group, which was 135 minutes (69-335 minutes; all P< 0.05). In 8 cases for hysterectomy (12.9%,8/62) , 3 cases in score 5-9 group, 5 cases in score≥10 group. (3) In score≥10 group, the rate of postoperative ICU registration was 80% and mean hospitalization time was (6.3±1.7) days, were significantly different, compared with those in score 5-9 group, which were 26%, (4.9±1.9) days. No serious postpartum complications were found in both groups, and there were no significant differences in Apgar score and weight of newborns (all P>0.05) .@*Conclusion@#Cervical lifting suture in placenta previa with increta and percreta could significantly reduce postpartum hemorrhage and retain uterine.

Blood-saving effect of prophylactic use of tranexamic acid in patients undergoing orthotopic liver transplantation / 中华麻醉学杂志

Objective To evaluate the blood-saving effect of prophylactic use of tranexamic acid in patients undergoing orthotopic liver transplantation.Methods Sixty ASA physical status Ⅰ-Ⅲ patients of both sexes,aged 18-60 yr,weighing 45-80 kg,scheduled for elective orthotopic liver transplantation,were randomly assigned to one of 2 groups (n =30 each) using a random number table:prophylactic use group (group P) and therapeutic use group (group T).Immediately after induction of anesthesia (T1),at 30 min of anhepatic phase (T2),and at 30 min and 2 h of neohepatic phase (T3,4),central venous blood samples were collected to determine plasma fibrinogen concentration (Fib) and platelet count,and the arterial blood samples were obtained to detect thromboelastography (TEG) parameters.In group T,when lysis after 30 min＞7.5％ and Clot Index ≤ 1.0 according to the results of TEG,which indicating that primary hyperfibrinolysis occurred,tranexamic acid 15-20 mng/kg was injected intravenously.In group P,immediately after beginning of skin incision,immediately after occlusion of portal vein,and immediately after portal vein unclamping,tranexamic acid 1 g was injected intravenously,and a single injection of tranexamic acid 15-20 mg/kg was given when primary hyperfibrinolysis occurred.The intraoperative blood loss,fluid input and output and transfusion of blood components were recorded.The duration of stay in ICU,amount of abdominal drainage during stay in ICU,volume of blood transfused within 72 h after operation,and hepatic artery and portal vein thrombosis within 1 week after operation were recorded.Results Compared with group T,the intraoperative blood loss,volume of succinylated gelatin injection transfused,and requirement for platelet and cryoprecipitate were significantly reduced,Angle at T2 and lysis after 30 min at T2,3 and maximum amplitude at T3 were increased,and no significant change was found in the duration of stay in ICU,postoperative amount of abdominal drainage and volume of blood transfused in group P.No patients developed primary hyperfibrinolysis in group P.No hepatic artery and portal vein thrombosis was detected within 1 week after operation in the two groups.Conclusion Prophylactic use of tranexamic acid can effectively prevent hyperfibrinolysis and reduce intraoperative blood loss without increasing the risk of development of thrombosis,and it provides better blood-saving effect than therapeutic use guided by TEG in patients undergoing orthotopic liver transplantation.

Efficacy and safety of hemocoagulase Agkistrodon injection for intraoperative hemostasis:a systematic review and Meta-analysis / 中华普通外科杂志

Objective To systematically evaluate the efficacy and safety of injected hemocoagulase Agkistrodon for intraoperative bleeding.Methods We electronically searched several Chinese database till May 2014 to identify randomized controlled trials (RCTs) about injected hemocoagulase Agkistrodon for operative hemorrhage.The methodological quality of included RCTs was assessed,and the data were extracted by two reviewers independently according to the Cochrane Handbook.The homogeneous RCTs were pooled using RevMan software (Version 5.1.0).Results 2 358 articles were searched initially,and 12 RCTs involving 1 031 patients met the inclusion criteria.The results of Meta-analyses showed that:in the study groups,the average haemostatic time of the wound is shorter [OR =-40.29,95％ CI(-71.13,-9.44),P =0.01],the hemorrhagic volume of the wound [OR =-1.38,95％ CI(-1.90,-0.87),P ＜ 0.000 01],hemorrhagic volume per unit area of the wound [OR =-0.05,95％ CI(-0.06,-0.03),P ＜ 0.00001],introperative hemorrhagic volume and drainage volume on POD1 [OR =-18.52,95％ CI (-25.50,-11.53),P ＜ 0.000 01] are lower than the placebo groups.In all studies,no difference was found in the variation of hemostatic function,liver and renal function and drug-induced adverse events.Conclusions The injection of hemocoagulase Agkistrodon can significantly reduce the average haemostatic time of the wound,the hemorrhagic volume of the wound,overall introperative hemorrhagic volume and drainage volume on POD1,and does not affect the hemostatic function,liver and renal function and not increase the incidence of adverse effects or postoperative complications.

Value of temporary ballon occlusion of abdominal aorta in prevention of bleeding during cesarean section ;in women with pernicious placenta previa and placenta accreta / 中华围产医学杂志

Objective To study the operative technique and effect of temporary balloon occlusion of the abdominal aorta for preventing intraoperative bleeding during cesarean for patients with pernicious placenta previa and placenta accreta. Methods Retrospective analysis was conducted on the intraoperative situation of forty-one cases and information of follow-up twenty-nine cases, which were pernicious placenta previa and placenta accreta and delivered in the First Affiliated Hospital of Zhengzhou University from May 1, 2013 to June 30, 2014. Diagnosis was confirmed by line of color Doppler ultrasound and MRI for all patients before operations. An interventional physician performed right femoral artery puncture and preset the abdominal aortic balloon catheter in the digital subtraction angiography operation room before cesarean. At the same time of fetal delivery, 10 ml normal saline was injected into the balloon immediately, which results in filling of the balloon and blocking of the aorta. According to the area and depth of placenta implantation and implantation or penetration of the posterior bladder wall, placenta separation, partial resection of the uterine wall and partial bladder resection and repair were performed correspondingly. Meanwhile, saline in the balloon was pumped out gradually until empty. Condition of placenta implantation, blood loss and blood transfusion volume during the operation, intraoperative and postoperative complications, the duration and dose of fetal radiation exposure, and Apgar score of neonates were analyzed. Results Among the 41 cases, penetrative placenta and implanted placenta were observed in five cases and 36 cases, respectively. The latter 36 cases including 28 cases of bladder posterior wall accreta and eight cases of bladder posterior wall penetration. For all cases, the average operation time was (68.5±15.3) min, the mean blood loss in the operation was (1 058±960) ml, among which eight received blood transfusion with an average of (600±400) ml, and the mean hospital stay was (8.2±2.3) d. Uteruses were reserved in all cases. The mean duration and dose of fetal radiation exposure was (8.1±3.6) s and (5.2±2.9) mGy, and the Apgar score of neonates was 8.7±0.5 at 1 min and 9.5±0.3 at 5 min, respectively. The patients were followed up until October 31, 2014. Among them, six were lost, six were still in puerperium, 18 were breast-feeding, and the menses of 11 had returned. Conclusion Preset abdominal aortic balloon catheter in pernicious placenta previa and placenta accrete patients might effectively reduce the blood loss during cesarean section as well as the risk of hysterectomy through temporary occlusion of the abdominal aorta.

The study of laparoscopic ovarian cystectomy in sequential hemostasis affect ovarian function / 中国基层医药

Objective To explore the laparoscopic ovarian cystectomy in sequential hemostasis for female patients with ovarian function .Methods 76 cases of patients with unilateral or bilateral ovarian cyst of our hospital from September 2011 to September 2012 were selected ,who were divided into the observation group and control group in accordance with the order of treatment .The observation group was 38 patients,intraoperative hemostasis were used sequential processing on bleeding wounds;The control group was 38 patients,intraoperative were used bipolar electro-coagulation treatment on bleeding wound to stop bleeding .Two groups were given the same preoperative nursing inter-vention,the two groups were observed and compared preoperative serum estradiol , luteinizing hormone and follicle-stimulating hormone and other hormone levels .Operative time were compared,respectively,1,4 months after surgery for hormone levels monitored.Results The mean operative time was (58.0 ±8.1) min in the observation group,(61.0 ±5.4)min in the control group,the two groups showed no significant difference (t =1.32,P>0.05);the observation group were preoperative serum estrogen diol (E2)values(131.4 ±9.6)poml/L,luteinizing hormone(LH) was (5.8 ±1.7)IU/L,follicle-stimulating hormone(FSH)(7.8 ±1.9)IU/L,were E2 preoperative value(128.3 ± 10.1)poml/L,LH value(5.8 ±2.2) IU/L,FSH(6.0 ±1.3) IU/L,the two groups showed no significant difference (t=1.34,0.82,1.02,all P>0.05);groups of patients after one month E2,FSH levels were decreased compared with the preoperative,with significant difference(the observation group,t=4.31,4.10,the control group t=4.18,4.15,all P<0.05);4 months after E2 levels were lower than that of the control group (t=5.22,P<0.05),LF,FSH levels were significantly higher than the observation group (t=4.20,5.09,all P<0.05).Conclusion Laparoscopic ovarian cystectomy in sequential method can effectively maintain hemostatic levels of sex hormones, the normal physiological function of ovarian protection for the effective way to stop bleeding ,which is worthy of further clinical practice .

The effect of intrauterine packing with gauze for hemostasis of uterine atony during operation / 中国基层医药

Objective To investigate hemostatic effect of uterine tamponade in dealing with postpartum hem -orrhage due to uterine inertia during caesarean section .Methods 72 patients treated with conservative treatment due to bleeding uterine contraction weakness during cesarean section were chosen ,who were dealed with sterile gauze close packing of uterine bleeding ( uterine packing group ) .43 patients underwent conservative therapy of uterine contraction weakness resulted in postpartum hemorrhage were selected to carry out B -Lynch suture hemostasis ( B-Lynch suture group).Bleeding volume,operation time,bleeding efficiency of two groups were calculated .Results The uterine packing group had shorter operation time ,less bleeding,immediate hemostasis rate.The B-Lynch suture group had a tad longer operation time , bleeding more , immediate hemostasis rate low , low efficiency .Immediate hemostasis rate (95%VS 82%)between two groups had statistically significant (χ2 =4.02,P0.05).Conclusion Uterine packing for postpartum hemorrhage due to uterine inertia during caesarean section has simple operation ,rapid,hemostatic effect,postoperative body without foreign body removal.

Impact on ovarian reserve function by different homostasis methods during laparoscopic cystectomy in treatment of ovarian endometrioma / 中华妇产科杂志

Objective To investigate the impact on ovarian reserve function by different hemostasis methods during laparoscopic surgery in treatment of ovarian endometrioma.Methods From September 2008 to February 2010,162 cases with ovarian endometrioma undergoing laparoscopic surgery in Shandong Provincial Hospital were enrolled in this study.At the 3rd day of the menstrual cycle before surgery and the 1 st,3rd,6th and 12th cycle after surgery,serum FSH and anti-mullerian hormone(AMH) and ultrasound basal antral follicle count (AFC) and peak systolic velocity (PSV) were examined and compared.Based on hemostasis method,those patients were divided into 3 groups,including 54 cases in bipolar hemostasis,54 cases in ultrasonic scalpel hemostasis and suture after excision of endometrioma.Results (1) Before surgery:no significant different factors among three groups before surgery were observed,including age,size of endometrioma,the level of FSH,AMH,AFC,PSV (P ＞ 0.05).(2) Ovarian reserve function after surgery:①FSH:at the 1st,3rd,6th and 12th month follow-up,the FSH in the bipolar group was (11.7 ±4.0),(9.9 ± 4.0),(9.5 ± 4.3),(9.5 ± 3.9) U/L,and the FSH in ultrasonic scalpel group was (11.4 ±4.3),(9.7 ± 4.0),(9.2 ± 3.7),(9.9 ± 4.6) U/L,were significantly higher than (9.3 ± 3.8),(6.7 ±3.0),(6.5 ± 3.2),(6.4 ± 2.2) U/L in suture group respectively (all P ＜ 0.05).()AMH:at the 1 st,3rd,6th and 12th month follow-up,the AMH in the bipolar group was (1.8 ±0.9),(1.8 ± 1.0),(1.9 ±1.0),(2.0 ± 1.0) μg/L,and the AMH in the ultrasonic scalpel group was (1.6 ±± 0.8),(1.8 ± 1.0),(2.0 ± 1.1),(2.1 ± 1.0) μg/L,which were significantly lower than (2.8 ± 1.7),(2.9 ± 1.6),(3.0 ±1.3),(3.2 ± 1.5) μg/L in suture group,respectively (all P ＜ 0.05).③AFC:there was no significant difference of APC among the three groups in the 1st month after surgery.However,at the 3rd,6th and 12th month follow-up,the AFC of 4.8 ± 1.4,5.9 ± 1.5,6.1 ± 1.5 in the suture group was significant higher than 3.7 ± 1.4,4.1 ± 1.4,4.0 ± 1.5 in bipolar group and 3.6 ± 1.3,4.0 ± 1.1,3.9 ± 1.5 in ultrasonic group,respectively (all P ＜ 0.05).④PSV:at the 1 st,3rd,6th and 12th month follow-up,the PSV of the bipolar group(7.9 ±3.5),(8.1 ±3.3),(8.4 ±3.1),(8.6±3.0) cm/s in bipolar group and (8.1 ±3.5),(8.0 ± 3.0),(7.9 ± 3.2),(8.0 ± 2.9) cm/s in ultrasonic group were significant lower than (10.9 ± 3.3),(12.0 ± 3.2),(11.8 ± 3.0),(12.1 ± 4.1) cm/s in suture group,respectively.(allP＜0.05).Conclusions Bipolar or ultrasonic scalpel hemostasis during laparoscopic excision of ovarian endometrioma is associated with a significant reduction in ovarian reserve.Electrocoagulation of the ovarian tissue should be avoided.

Clinical research on bilateral arcuate artery suture hemostasis of corpus uteri for postpartum hemorrhage due to uterine inertia during caesarean section / 中华妇产科杂志

Objectives To investigate the effect of bilateral arcuate artery suture hemostasis of corpus uteri (haemostasia) for postpartum hemorrhage due to uterine inertia during caesarean section,and to explore the change of blood vessels and blood flow of the uterus after surgery.Methods From May 2009 to Dec.2011,the 212 patients in No.202 People's Liberation Army Hospital received bilateral arcuate artery suture hemostasis of corpus uteri for postpartum hemorrhage due to uterine inertia during caesarean section.Among them,127 patients who failed to respond to conservative management and received haemostasia were defined as the ‘ haemostasia' group.23 patients who received the suture after they failed to respond to conservative management and other conventional surgical hemostasis were defined as the ‘ other +haemostasia' group.62 patients who received the suture simultaneously with conservative management were defined as the ‘ drug + haemostasia' group.The suture was done by the following steps:(1) The uterus should be exteriorised,and the fundus of uterus should be towards the head.(2)Transfix the anterior and posterior wall of corpus uteri with big blunt round needle and absorbable suture.The entry point was 2 cm above the uterine incision and 2 cm to lateral border of corpus uteri.The suture spanned the fundus of uterus,and was stretched tightly in front of the fundus,then tied knots were made.Bleeding volume,prompt hemostatic rate,effect rate,total effect rate and operation time were recorded.The resistance index (RI) of uterine artery,systolic/ diastolic blood pressure (S/D),the visualization ratio of uterine artery and the mean value of artery diameter were obtained through color Doppler ultrasonography and enhancement CT 6-12 months after the surgery.Results (1) In the ‘ drug + haemostasia' group,the bleeding volume was (532 ±28) ml.The operation time was (34 ± 3) min,and the prompt hemostatic rate was 97％.While the ‘ haemostasia' group had more bleeding volume,longer operation time and lower prompt hemostatic rate than the ‘ drug + haemostasia' group,with no statistically significant difference (P ＞ 0.05).In ‘ other + haemostasia' group,the bleeding volume was (1379 ± 95) ml.The operation time was (79 ± 15) min,and the prompt hemostatic rate was 78％.The differences were significant when compared to the other groups (P ＜ 0.01).There was no statistically significant difference on total effect rate among the three groups (P ＞ 0.05).(2) There was no statistically significant difference on the RI and S/D of bilateral uterine artery among all the groups 6-12 months after the surgery.(3)The visualization ratio of left uterine artery of the ‘ other + haemostasia' group was lower (87％) than the ‘ haemostasia' group (97％) and the ‘ drug +haemostasia' group (95％,P ＜ 0.05).There was no statistically significant difference between the ‘ haemostasia' group and the ‘ drug + haemostasia' group on the visualization ratio of bilateral uterine artery and the mean value of bilateral uterine artery diameter (P ＞ 0.05).Conclusions The bilateral arcuate artery suture hemostasis of corpus uteri is a simple,rapid,effective and safe method to control postpartum hemorrhage due to uterine inertia during caesarean section.The ovary and uterine blood flow are not affected after the surgery.

Clinic analysis of presacral venous plexus bleeding in pelvic operation / 国际外科学杂志

Objective To investigate the methods of prevention and treatment of presacral venous plexus bleeding in pelvic operation.Methods The clinical data of 8 cases of presacral venous plexus bleeding in pelvic operation from 1998 to 2013 were analyzed.Results All 8 cases succeeded in controlling bleeding,The amount of bleeding was 1 000-4 000 mL,the average amount is 2 600 mL.Conclusions The key to prevention of presacral venous plexus bleeding was thorough familiar with pelvic anatomy and a dexterous technique of careful dissection.Massive hemorrhage occurred direct electric coagulation hemostasis was available,the method was simple.

The effect of different hepatic vascular exclusion on prognosis of patients undergoing hemihepatectomy / 中华普通外科杂志

Objective To assess the effect of three different liver vascular exclusions on prognosis of patients undergoing hemihepatectomy.Methods Clinical data of 216 patients undergoing hemihepatectomy were analyzed retrospectively.Ninety-eight out of 216 patients received Pringle maneuver during hepatectomy in group A,71 patients of selective liver inflow and outflow vascular exclusions in group B,47 patients using liver hanging maneuver combining with selective liver inflow and outflow vascular exclusions were in group C.Results There was no difference in operation time between the three groups ( t =0.72,0.83,and 0.67,P ＞ 0.05 ).The intraoperative blood loss and transfusion in group B and C were less than that in group A (t =3.72,3.83 and 4.11,4.07,P ＜0.05).Serum albumin level on day 1 and day 3 in group B and C were higher than that in group A (t =3.65,3.77,and 3.90,3.74,P ＜0.05 ).Serum total bilirubin level on day 3 and 5 in group B and C were lower than that in group A ( t =4.13,5.01,and 4.09,3.99,P ＜0.05).Serum alanine aminotransferase on day 1,3 and 5 in group B and C were lower than that in group A ( t =5.36,6.14,and 5.70,7.01,and 4.94,3.98,P ＜ 0.05 ).Postoperative complication rate in group A was higher than that in group B and C ( x2 =13.71 and 23.56,P ＜ 0.05 ).The 3-year survival rate of patients with malignant tumor in the three groups were not significantly different (t =2.38,P ＞ 0.05 ).Conclusions Intraoperative blood loss and transfusion and postoperative complication rate can be reduced,and liver injury can be diminished in hemihepatectomy using selective liver inflow and outflow vascular exclusion alone and or in combination with a liver hanging maneuver.

O reparo de lesão esplênica por laparoscopia: o uso da cola de fibrina em porcos heparinizados / The laparoscopy splenic injury repair: the use of fibrin glue in a heparinized porcine model

PURPOSE: To investigate the effectiveness of fibrin glue (laparoscopic via) into promote the hemostasis of a spleen injury on a heparinized porcine model. METHODS: Eighteen Landrace porcine were submitted to laparoscopic spleen injury and randomly distributed: GHA (heparin plus adhesive), GH (heparin without adhesive) and GS (Sham - without heparin or adhesive). Ten minutes before the surgical procedures a single IV dose (200UI/kg) of heparin sodium was administrated only to groups GHA and GH. In the GHA, adhesive was applied after the mechanical injury and recorded the time until the polymerization and clot formation. RESULTS: No significant differences occurred among the groups (Fisher test) considering the weight and surgery time. The blood amount in the abdominal cavity on GH was significantly higher in comparison to the sham group and especially with the GHA (p<0.004). No significant differences were observed in the body temperature, heart rate, cardiac output, means arterial pressure, pulmonary artery pressure during the experiment. The activated partial thromboplastin time (APTT) was lower in the GHA in comparison to GH (p<0.003). CONCLUSION: The fibrin biological adhesive applied by laparoscopy is effective for hemostasis of minor spleen injury in a porcine model under the effect of anticoagulant drug.

OBJETIVO: Investigar a eficácia da cola de fibrina (via laparoscópica) na hemostasia de uma lesão no baço de porco heparinizado. MÉTODOS: Dezoito suínos Landrace foram submetidos a lesão do baço e distribuídos aleatoriamente: GHA (heparina adesivo), GH (heparina sem adesivo) e GS (Sham - sem heparina ou adesivo). Dez minutos antes dos procedimentos uma dose única (200UI/kg) de heparina sódica (EV) foi administrada nos grupos GHA e GH. A fibrina (GHA) foi aplicada após a lesão e registrado o tempo até a polimerização e formação do coágulo. RESULTADOS: Não houve diferenças significativas entre os grupos (teste de Fisher), considerando o peso e o tempo de cirurgia. A quantidade de sangue na cavidade abdominal de GH foi significativamente maior em comparação ao GS e, especialmente, com o GHA (p<0,004). Não foram observadas diferenças significativas na temperatura corporal, frequência cardíaca, débito cardíaco, pressão arterial ou pressão da artéria pulmonar durante o experimento (20 minutos). O tempo de tromboplastina parcial ativada (TTPA) foi menor no GHA em relação ao GH (p<0,003). CONCLUSÃO: A cola de fibrina biológica aplicada por laparoscopia é eficaz para a hemostasia de lesões no baço menor em um modelo suíno sob o efeito de drogas anticoagulantes.

Control of hemorrhage during the operation of old pelvic fractures by temporary balloon occlusion of the common iliac artery / 中华骨科杂志

ObjectiveTo discuss the clinical application of the temporary balloon occlusion of the common iliac artery in the control of hemorrhage in the operations of the old pelvic fractures.Methods From January 2006 to June 2009,twelve patients (10 males,2 females; mean age 33.9 years) with old pelvic fractures of Tile C type were treated operatively.Three cases were treated with external fixator.Operative treatments were delayed for the treatment of the life-threatening visceral injuries in six nonunions and three malunions.A balloon catheter was placed through intravascular intervention in the common iliac artery of the affected side.The balloon catheter was infolded when the osteotomy was performed and the operations were undertaken under temporary and total occlusion of the common iliac artery.Osteotomies and internal fixations were performed in 12 cases.Decompressions of lumbosacral trunk were undertaken in 4 cases complicated with injuries of sciatic nerve.ResultsThe mean time of operations was 290 min(range,210-367min).The mean time of occlusions was 65 min (range,45-90 min).The loss of blood ranged from 700 ml to 2800 ml,with an average of 1833 ml.All cases were followed up for 12-48 months,with an average of 35 months.The mean time of bone healing was 20.6 weeks (range,16-24 weeks).No thrombosis of the common iliac artery and deep venous thrombosis of the lower extremity or ischemic necrosis happened.In the four cases complicated with injuries of sciatic nerve,three recovered partly and could walk with a crutch and one recovered completely and could walk normally.Two cases limped and other six cases could walk normally.ConclusionThe effect of temporary balloon catheter occlusion of common iliac artery is reliable.It drastically reduces hemorrhage during the operation and avoid the complications of selective arterial embolism and ligation and makes the operations of the old pelvic fractures more safer.

Treatment of massive bleeding after pelvic fracture with temporary occlusion of abdominal aorta / 中华骨科杂志

Objective To explore the efficacy of temporary occlusion of abdominal aorta in the treatment of massive bleeding after pelvic fracture.Methods From May 2003 to May 2010,temporary occlusion of abdominal aorta was performed for 23 patients with massive bleeding after pelvic fracture.There are 15 male and 8 female patients with a mean age of 32 years (range,17-62 years).The mechanisms of injury included traffic accidents in 17 cases,falls in 4,engine injury in 1 and crash injury in 1 case.According to AO classification,4 cases were of type B2,4 of type B3,2 of type B3,1 of type C1,4 of type C2,and 12 of type C3.After aorta occlusion,the internal iliac vessel was ligated and the bleeding sites were tamponed.The fractures of pelvis were reduced.External fixation was used in 17 cases and screws and plates were used to fixation in 6 cases.Results All cases were rescued successfully.The average volume of blood transfusion was 4000 ml (range,1500-8500 ml).Intraoperative self-blood transfusion was performed in 14 patients.The average volume of self-blood transfusion was 1500 ml (range,700-5000 ml).Twenty-one patients were followed;the duration of follow-up was 26 months (range,5-36 months).The functional results were excellent in 11 cases,good in 4,fair in 3 and poor in 2 according to Majeed scores system.Complications included 2 cases of infection,1 of lower limb deep venous thrombosis,1 of malreduction of sacroiliac joint,and 1 of malunion of pelvic fracture.No complication was found due to the aorta occlusion or the internal iliac vessel ligation.Conclusion Temporary occlusion of abdominal aorta was an efficient and quick method in the treatment of massive bleeding after pelvic fracture.

Clinical study of super-early operation combined with traditional Chuanxiongqin on treatment of hypertensive intracerebral hemorrhage / 中国基层医药

Objective To explore an effective treatment for hypertensive intracerebral hemorrhage.Methods By the method of random and control,patients with hypertensive intracerebral hemorrhage were randomly divided into two groups:the treatment group(32 patients)was treated with integrated traditional Chinese and western medicine therapy,including super-early operation,conventional western medicine and Chuanxiongqin injection treatment.The control group(40 patients)was treated with operation and conventional western medicine treatment.The effect was evaluated on 28 th day after treatment.Results The effect of the treatment group was superior to that of the control group(χ~2=4.15,3.26,P＜0.05).The treatment group had lower mortality rate(χ~2=8.04,P＜0.05)and lower morbidity of complications(pulmonary infection:6/16 cases,χ~2=11.37,P=0.01;upper-congestive hemorrhage:8/16 cases,χ~2=4.10,P=0.04)statistical data indicated that there was significant difference between treatment group and control group.Conclusion Super-early operation with traditional Chinese medicine in treatment of hypertensive intracerebral henorrhage has a better effect than the treatment without traditional Chinese medicine.

Hemostasia hepática utilizando eletrocautério seco ou emplastrado com lidocaína ou neomicina ou glicerina ou vaselina, em coelho / Liver hemostasis using a dry eletrocautery or greased with lidocaine or neomycin or glycerin or vaseline, in rabbit

OBJETIVO: Avaliar a hemostasia e a cicatrização hepática após hepatectomia segmentar, utilizando eletrocautério seco, ou emplastrado com: gel de lidocaína, pomada de neomicina, loção de glicerina e pomada de vaselina. MÉTODOS: Coelhos foram submetidos à hepatectomia parcial e distribuídos em seis grupos (n=10): Grupo 1: sem tratamento; Grupo 2: tratamento com eletrocautério seco; Grupo 3: emplastrado com gel de lidocaína; Grupo 4: pomada de neomicina; Grupo 5: loção de glicerina; Grupo 6: pomada de vaselina. Foram mensurados o peso do fígado ressecado, o volume de sangramento e o tempo dispendido para hemostasia. Cinco coelhos de cada grupo foram reoperados após 24 horas, e cinco após sete dias, para biópsia da ferida hepática e exploração da cavidade abdominal. Eritrograma e marcadores de função e lesão hepática foram avaliados no pré-operatório e antes das reoperações. RESULTADO: O gel de lidocaína e a loção de glicerina reduziram o volume do sangramento e o tempo de hemostasia, além de conduzirem a energia térmica do eletrocautério, provocando degeneração hidrópica celular após 24 horas e necrose após sete dias, com profundidade maior no tecido hepático. Todas as substâncias elevaram as aminotransferases. Esses valores normalizaram-se em até sete dias. CONCLUSÃO: O eletrocautério emplastrado com gel de lidocaína e a loção de glicerina foram os métodos mais eficazes na hemostasia do parênquima hepático de coelhos.

OBJECTIVE: To assess the hemostasis and healing of the hepatic parenchyma after segmental hepatectomy, using a dry electrocautery or an electrocautery greased with lidocaine gel, neomycin pomade, glycerin lotion, or a vaseline pomade. METHODS: Rabbits were submitted to partial hepatectomy and divided into six groups of 10 animals each: Group 1: untreated; Group 2: treated with a dry electrocautery; Group 3: treated with an electrocautery greased with lidocaine gel; Group 4: with neomycin pomade; Group 5: with glycerine lotion; Group 6: with vaseline pomade. Resected liver weight, bleeding volume and time spent to achieve hemostasis were determined. Five rabbits from each group were re-operated upon after 24 hours and five after 7 days in order to obtain a biopsy of the hepatic wound and to explore he abdominal cavity. Red blood cell levels and markers of hepatic function and injury were determined before surgery and before re-operation. RESULTS: Lidocaine gel and glycerine lotion reduced the bleeding volume and the time to achieve hemostasis and conducted the thermal energy of the electrocautery, causing hydropic cell degeneration after 24 hours and deeper necrosis of hepatic tissue after 7 days. All substances increased the aminotransferase concentrations. These values returned to normal after a maximum of seven days. CONCLUSION: The electrocautery coated with lidocaine gel and glycerine lotion were the most effective methods for the hemostasis of hepatic parenchyma.

Uso tópico da adrenalina em diferentes concentrações na cirurgia endoscópica nasal / Topical use of adrenaline in different concentrations for endoscopic sinus surgery

A concentração ideal de adrenalina tópica a promover hemostasia adequada sem toxicidade ainda é motivo de controvérsia. OBJETIVO: Comparar soluções tópicas de adrenalina em diferentes concentrações. DESENHO DO ESTUDO: Prospectivo, duplo-cego, seleção aleatória. MATERIAIS E MÉTODOS: 49 pacientes submetidos à cirurgia endoscópica nasal, divididos em 3 grupos usando exclusivamente adrenalina tópica, nas concentrações de 1:2000, 1:10.000 e 1:50.000. Comparou-se o tempo operatório, o sangramento, as concentrações plasmáticas de adrenalina e noradrenalina e a variação dos parâmetros cardiovasculares. RESULTADOS: O tempo operatório por procedimento foi menor no grupo que utilizou adrenalina 1:2000, assim como o sangramento (p < 0,0001). As concentrações plasmáticas de adrenalina subiram em todos os 3 grupos, porém mais no grupo que utilizou adrenalina 1:2000. Houve uma tendência de aumento dos níveis tensionais nos pacientes que usaram adrenalina 1:2000 e 1:10.000, com maior ocorrência de picos hipertensivos. Discussão: Os benefícios do uso da solução de adrenalina mais concentrada foram evidentes, principalmente em relação ao sangramento. A tendência de aumento dos níveis tensionais pode ter ocorrido por não termos utilizado técnica anestésica intravenosa exclusiva. CONCLUSÃO: Analisando os prós e contras, sugerimos o uso de solução de adrenalina tópica 1:2000; mais pesquisas que corroborem nossos achados são necessárias.

The ideal adrenaline concentration remains unknown. AIM: Compare topical adrenaline solutions in different concentrations. STUDY DESIGN: Prospective, double blind, randomized trial. PATIENTS AND METHODS: 49 patients divided in 3 groups underwent endoscopic sinus surgery, using only topical solutions of adrenaline in different concentrations (1:2,000, 1:10,000 and 1:50,000). We compared the duration of surgery, intra-operative bleeding, plasmatic levels of catecholamines, hemodynamic parameters and changes in heart rhythm. RESULTS: Surgery time was shorter in the group using adrenaline 1:2,000, which also showed less bleeding in all evaluations (objective and subjective - p < 0.0001). Plasmatic levels of epinephrine rose in all groups, more sharply in the 1:2,000 group. There was a trend towards elevation of blood pressure in the groups using adrenaline 1:2,000 and 1:10,000, with a greater occurrence of hypertensive peaks. DISCUSSION: We found a very significance bleeding difference favoring the 1:2,000. The blood pressure elevation in the 1:2,000 and 1:10,000 groups was progressive but very slow throughout the procedure, which could be associated with the anesthesia technique. CONCLUSION: We favor the use of topical adrenalin 1:2,000 due to a clear superiority in hemostasis. Further investigation is needed to corroborate our findings.

Cirugía maxilofacial ambulatoria en pacientes con riesgo hemostático

Se presenta un método de acción para exodoncia y cirugía bucal mediana en personas con riesgo hemostático, para lo cual se analizaron 68 intervenciones en 57 pacientes: 49 con trastornos anticoagulantes crónicos y 8 con algún tipo de hemopatía, que fueron realizadas en todos los casos con aplicación de trombina en el alvéolo o superficie alveolar. En más de la mitad de los pacientes medicados con anticoagulantes, éstos se suspendieron antes y después del acto quirúrgico, con hemostasia posoperatoria similar a la obtenida en aquéllos que continuaron recibiéndolos. La mayor parte de los períodos posoperatorios evolucionaron satisfactoriamente y sólo un bajo porcentaje presentó sangrados leves, resueltos casi en su totalidad con medidas locales y ambulatoriamente. No se encontró relación alguna entre la complejidad y el resultado hemostático alcanzado.

An action method is presented for exodontia and mean oral surgery in persons at haemostatic risk, for that reason, we analyse 68 procedures in 57 patients. 49 presenting with chronic anticoagulant disorders and 8 some type of hemopathy, performed in all cases with application of thrombin into alveolus or alveolar surface. In more than half of patients given anticoagulants, theses were discontinuated before and after surgical procedure. Most of postoperative periods evolved satisfactorily and only a low percentage showed light bleedings, overcomed in almost as a whole using local and ambulatory measures. There wasn´t any relation between complexity and the haemostatic result obtained.