Objective
To investigate the hemostasis of thermosensitive chitosan hemostatic film.
Methods
Fifty adult Sprague Dawley rats, male or female and weighing 190-210 g, were made the models of liver injury. The models were randomly divided into 5 groups (n=10) depending on different hemostatic materials. The incision of the liver was covered with the hemostatic materials of 2.0 cm × 1.0 cm × 0.5 cm in size: thermosensitive chitosan hemostatic film (group A), chitosan hemostatic film (group B), cellulose hemostatic cotton (group C), gelatin sponge (group D), and no treatment (group E), respectively. The bleeding time and bleeding amount were recorded. After 4 weeks, the incisions of the liver were observed with HE staining.
Results
Gross observation showed better hemostatic effect and faster hemostatic time in groups A, B, and C; group D had weaker hemostatic effect and slower hemostatic time; group E had no hemostatic effect. The bleeding time and bleeding amount of groups A, B, C, and D were significantly lower than those of group E (P lt; 0.05). The bleeding time and bleeding amount of groups A, B, and C were significantly lower than those of group D (P lt; 0.05), but no significant difference was found among groups A, B, and C (P gt; 0.05). The liver cells of group A had milder edema and ballooning degeneration than other 4 groups through histological observation.
Conclusion
The thermosensitive chitosan hemostatic film has good hemostasis effect on the liver incision of rats.
Objective To investigate and evaluate prevention and treatment of seroma by transposition of tissue flaps and Arista hemostatic powder after regional lymph node resection in patients with malignant tumors. Methods Twelve patients (6 males, 6 females; aged 31-81 years, with metastatic tumors underwent prevention and treatment of seroma with the tissue flaps and Arista hemostatic powder spray after regional lymph node resection. The metastatic tumors involved the axilla in 1 patient with breast carcinoma, the iliac and inguinal regions in 2 patients with carcinomas of theuterine cervix and the rectum, and the inguinal region in 9 patients, including4 patients with malignant fibrous histiocytoma（3 in the thigh, 1 in the leg）,2 patients with squamous carcinomas in the leg, 1 patient with synovial sarcomain the knee, 1 patient with epithelioid sarcoma in the leg, and 1 patient with malignant melanoma in the foot. As for the lymph node removal therapy. 1 patientunderwent axillary lymph node removal, 2 palients underwent lymph node removal in theiliac and inguinal regions, and 9 patients underwent lymph node removal inthe inguinal region. Meanwhile, of the 12 patients, 6 patients underwent transpostion of sartourius flaps with Arista hemostatic powder, 3 patients underwent transposition of the rectus abdominis myocutaneous flaps (including 2 patients treatedwith Arista spray befor the wound closure and 1 patient treated by transposition of local skin flaps with Arista spray used again),and 3 patients underwent only the suturing of the wounds combined with Arista. At the same time, of the 12 patients,only 4 patient underwent the transplantation of artificial blood vessels. Results The follow-up for 2-10 months after operation revealed that 10 patients, who had received the transposition of tissue flaps and the spray of Arista hemostatic powder, had the first intention of the incision heal with seroma cured. Nine patients were given a preventive use of Arista hemostaticpowder and therefore no seroma developed. The combined use of the transpositionof tissue flaps and Arista hemostatic powder spray achieved a success rate of 100% in the prevention or treatment of seroma. However, 1 patient developed microcirculation disturbance 24 hours after operation and underwent disarticulation of the hip; 1 patient developed pelvic cavity hydrops and died 10 months after operation. Conclusion The combined use of transposition of tissue flaps and Arista hemostatic powder spray can effectively prevent or treat seroma after regional lymph node removal in a patient with malignant tumor.
ObjectiveTo systematically review the influence on ovarian reserve function by different hemostatic methods during laparoscopic cystectomy in treatment of ovarian endometrioma (OE).
MethodsDatabases including The Cochrane Library, PubMed, EMbase, CNKI, CBM and WanFang Data were electronically searched, to collect relevant randomized controlled trials (RCTs) about laparoscopic electro coagulation vs. microscopically suture for OE from 1990 to Mar, 2014. Meanwhile, references of included studies were also retrieved manually. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and assessed the risk of bias of included studies. Then RevMan 5.2 software was used for meta-analysis.
ResultsA total of 16 RCTs involving 1 236 patients were finally included. The results of meta-analysis showed that the luteinizing hormone (LH) levels after 1 month, 2 months, 6 months and 12 months and estradiol (E2) levels after 2 months, 6 months had no significant differences between the two groups and the E2 level after 12 month of the suture group was significantly lower than that of the electro coagulation group. The levels of follicle stimulating hormone (FSH), LH, E2, antral follicle count (AFC), mean ovarian stromal peak systolic blood flow velocity (PSV) and anti-Mullerian hormone (AMH) in the suture group were significantly superior to those in the electro coagulation group at other follow-up time.
ConclusionCurrent evidence suggests that in treatment of ovarian endometriotic cyst by laparoscopic cystectomy, compared with electro coagulation hemostasis, suture hemostasis has less influence on ovarian reserve function. Due to limited quality and quantity of included studies, more high quality studies are needed to verify the above conclusion.
ObjectiveTo review trauma-induced coagulopathy and use of tranexamic acid in patients with traumatic hemorrhage.
MethodsThe relevant literatures about the definition and pathogenesis of trauma-induced coagulopathy, and the use of tranexamic acid in patients with traumatic hemorrhage were reviewed.
ResultsTraumatic-induced coagulopathy was a coagulation disorder in the early stage after injury, which was associated with the anticoagu-lation and increasing activity of fibrinolysis. Tranexamic acid as an anti-fibrinolytic drug, it had a good result in clinical application, which could reduce the mortality due to bleeding in use within 3 h after injury, the effect was the best in use within 1 h after injury, but it had no benefit or even would increase the mortality due to hemorrhage in use >3 h after injury. There was no standardized dosage of tranexamic acid, but the volumes of blood loss and blood transfusion had no difference under the different dosages. However, high dosage or long-term use of tranexamic acid might increase the risk of the thrombosis or epilepsy.
ConclusionEmergency traumatic patients face a series of death threats related trauma. Appropriate and timely hemostasis is important for prognosis. Early, short-term, and appropriate dosage of tranexamic acid could obviously reduce mortality and adverse events, but its timing and dosages need to be further optimized.
Three different methods of electrocautery were used to study the effects of electrocoagu-lation on limbs and intraabdominal blood vessel of 6 rabbits. These methods are non-touching, touching and segmental electrocoagulation. The results show that all three methods can satisfactorily stop bleeding of the blood vessel which is smaller than 1. 5mm in diameter. For arteries with the diameter 1.5～2.0mm. the effect of segment electrocoagulation is better than the other methods because it has a long burn end after cautery.
OBJECTIVE: To validate the hemostatic properties of collagen sponge made in China. METHODS: The experimental model of superficial cut of liver was established in 20 Sprague-Dawley adult rats, which were divided into two groups randomly. Collagen sponge or gelatin sponge was used to cover the cut respectively. Hemostatic result was observed. Afterwards, standard liver trauma model by resection left front liver lobe was made, wound was treated with collagen sponge or gelatin sponge respectively. Hemostatic result was observed. Concurrent hemostatic time and bleeding amount were noted. At 7, 14 and 20 days after operation, intra-abdominal adhension, infection and healing state of liver were observed by exploratory laparotomy. The histological changes of regenerate liver tissue were observed by microscopy. RESULTS: Collagen sponge adhered to wound well. Concurrent hemostatic time and bleeding amount in collagen sponge group were superior to those of gelatin sponge (P lt; 0.05). The histological examination showed that collagen sponge was absorbed and degraded rapidly, regenerative hepatocytes could be induced. CONCLUSION: Collagen sponge has fine hemostatic properties and can induce regeneration of hepatocytes effectively. It is worth popularizing for its convenience in clinical application and its properties of rapid degradation and absorption.
ObjectiveTo evaluate the safety, efficacy, and cost-effectiveness of different uses of oxidized regenerated cellulose (ORC) in video-assisted thoracoscopic surgery (VATS) for lung cancer resection to provide a reference for the selection, clinical use, and rational utilization of absorbable hemostatic materials. MethodsA retrospective analysis of relevant data from inpatients who underwent VATS for lung cancer resection at a tertiary hospital from July 2019 to January 2020 and from July 2020 to December 2020 was conducted. Patients were divided into two groups based on the use of ORC: 1) combined use group (ORC and collagen sponge) and 2) sole-use group (ORC). Safety, efficacy, and economic outcome indicators were compared between the two groups. ResultsThe main analysis included a total of 904 patients, with 466 in the combined use group and 438 in the sole-use group. Compared to the combined use group, the sole-use group had a significantly longer hospital stay, used fewer hemostatic drugs, had a lower average cost of hemostatic materials, and a lower median total hospitalization cost (P<0.05). No statistically significant difference was found between the two groups in terms of intraoperative blood loss volume, massive blood loss rate, perioperative transfusion rate, reoperation rate, postoperative 48-hour drainage volume, bloody drainage fluid rate, or postoperative laboratory test indicators. ConclusionThere was no significant difference in the safety or efficacy of VATS for lung cancer resection between the sole use of ORC and the combined use of ORC, but the sole use of ORC was associated with a lower cost of hemostatic materials and a lower total hospitalization cost. The sole use of hemostatic gauze in VATS for lung cancer resection may be a more cost-effective choice.
ObjectiveTo systematically review the hemostatic effect of traditional class Ⅲ hemostatic powder and aggregate absorbable hemostat in surgeries. MethodsThe PubMed, Embase, CENTRAL, CNKI, VIP and WanFang Data databases were electronically searched to collect controlled studies related to the objectives from inception to September 18th, 2023. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed by using RevMan 5.3 software. ResultsA total of 7 randomized controlled trials, 5 cohort studies and 9 animal experiments were included. The results of analysis showed that the group with traditional class Ⅲ hemostatic powder or aggregate absorbable hemostat had a higher hemostatic success rate and shorter hemostatic time than those with no hemostatic material in animal surgeries. And the group with aggregate absorbable hemostat had a higher 10 min hemostatic success rate than those with traditional hemostatic measures. The application of traditional class Ⅲ hemostatic powder in human cardiothoracic surgeries shortened the hemostatic time and reduced drainage after surgeries, but caused more blood loss during knee arthroplasties. Aggregate absorbable hemostat caused less blood loss than traditional hemostatic measures in human hip arthroplasties, and the 5 min and 10 min success rates of aggregate absorbable hemostat group were not worse than those of hemostatic gauze. ConclusionCurrent evidence shows that the hemostatic effect of both traditional class Ⅲ hemostatic powder and aggregate absorbable hemostat are better than that of no hemostatic material in animal and human surgery, but the comparison results between the two and with other hemostatic measures are still not clear. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
