纤维蛋白胶、氰基丙烯酸正丁酯与常规缝线对显微血管吻合口漏血封堵效果比较

doi:10.19438/j.cjoms.2026.04.005

摘要/Abstract

摘要： 目的：建立显微血管吻合口漏血动物模型,评估纤维蛋白胶（fibrin glue,FG）与氰基丙烯酸正丁酯（N-butyl cyanoacrylate,NBCA）封堵吻合口漏血的效果,并比较两者与常规缝线漏血补针在操作时间、通畅率及炎性反应方面的差异。方法：选取健康新西兰大白兔60只,体重（2.8±0.2） kg,雌雄各半。随机分为FG组、NBCA组与对照组,每组20只（雌雄各10只）。建立兔颈动脉端端吻合模型并模拟吻合口漏血。FG组和NBCA组分别采用相应粘接剂封堵漏血,对照组采用常规缝线补针处理。记录各组封堵时间,并于术后即刻及术后4周评估血管通畅率。术后2周和4周取吻合口周围血管组织行HE染色,采用半定量评分法评估炎性反应程度。结果：FG组、NBCA组和对照组的平均封堵时间分别为（87.80±22.02）s、（94.35±19.32）s和（245.70±59.41）s,FG组和NBCA组均显著短于对照组（P<0.05）。3组间即刻及术后4周通畅率差异均无统计学意义（P>0.05）。组织学半定量评分显示,FG组与NBCA组吻合口周围炎性反应较对照组轻,且随时间推移逐渐减轻。结论：FG与NBCA均可用于有效封堵血管吻合口漏血,具有操作简便、封堵迅速及炎性反应较轻等优点,在维持血管通畅性方面与常规缝线法相当,是一种安全可靠的显微血管吻合辅助技术,其中FG因生物相容性佳、在机体中可完全代谢,更具优势。

关键词: 显微血管吻合, 显微外科, 纤维蛋白胶, 氰基丙烯酸正丁酯, 漏血封堵

Abstract: PURPOSE: To establish an animal model of blood leakage at microvascular anastomoses and evaluate the efficacy of fibrin glue (FG) and N-butyl cyanoacrylate (NBCA) in sealing anastomotic leakage. Additionally, to compare these methods with conventional suture repair in terms of operation time, patency rate, and inflammatory response. METHODS: Sixty healthy New Zealand white rabbits, weighing (2.8±0.2) kg with equal numbers of males and females were randomly divided into FG, NBCA and control groups (n=20 each). An end-to-end anastomosis model of the rabbit carotid artery with simulated anastomotic leakage was established. FG and NBCA were used to seal the leakage in the FG and NBCA group, while conventional suture repair was performed in the control group. Sealing time was recorded and vascular patency was evaluated immediately after surgery and at 4 weeks postoperatively. Perivascular tissues were harvested at 2 and 4 weeks for hematoxylin-eosin staining, and inflammatory response was evaluated using a semi-quantitative scoring system. RESULTS: The mean sealing times in the FG, NBCA and control groups were (87.80±22.02) s, (94.35±19.32) s and (245.70±59.41) s, respectively. The sealing times in the FG and NBCA groups were significantly shorter than that in the control group (P<0.05). No significant differences were observed in the immediate patency rate or the patency rate at 4 weeks postoperatively among the three groups (P>0.05). Histological analysis showed that inflammatory reactions around the anastomotic site were milder in the FG and NBCA group than in the control group and gradually decreased over time. CONCLUSIONS: Both FG and NBCA can effectively seal bleeding at the vascular anastomotic site. They provide advantages such as simple operation, rapid sealing and mild inflammatory response, while maintaining vascular patency comparable to conventional suturing techniques. Therefore, they may serve as safe and reliable adjuncts in microvascular anastomosis. FG may have certain advantages because of its good biocompatibility and complete biodegradability in vivo.

Key words: Microvascular anastomosis, Microsurgery, Fibrin glue, N-butyl cyanoacrylate, Leakage sealing

中图分类号:

R782
R615

韩少伟, 李文浩, 李亚辉, 赵雪, 陈传俊. 纤维蛋白胶、氰基丙烯酸正丁酯与常规缝线对显微血管吻合口漏血封堵效果比较[J]. 中国口腔颌面外科杂志, 2026, 24(4): 348-352.

Han Shaowei, Li Wenhao, Li Yahui, Zhao Xue, Chen Chuanjun. Comparison of fibrin glue, N-butyl cyanoacrylate and conventional sutures for sealing bleeding at microvascular anastomotic sites[J]. China J Oral Maxillofac Surg, 2026, 24(4): 348-352.

参考文献

[1] Ferreira RS Jr, de Barros LC, Abbade LPF, et al. Heterologous fibrin sealant derived from snake venom: from bench to bedside- an overview[J]. J Venom Anim Toxins Incl Trop Dis, 2017, 23: 21.
[2] Meneses E, Boneva D, McKenney M, et al. Massive transfusion protocol in adult trauma population[J]. Am J Emerg Med, 2020, 38(12): 2661-2666.
[3] Daud A, Kaur B, McClure GR, et al. Fibrin and thrombin sealants in vascular and cardiac surgery: a systematic review and meta-analysis[J]. Eur J Vasc Endovasc Surg, 2020, 60(3): 469-478.
[4] Fonouni H, Kashfi A, Majlesara A, et al.Analysis of the hemostatic potential of modern topical sealants on arterial and venous anastomoses: an experimental porcine study[J]. J Mater Sci Mater Med, 2017, 28(9): 134.
[5] 赵玉婵, 周启荣, 李启泉, 等. 微血管无缝线吻合技术的研究进展和应用前景[J]. 创伤外科杂志, 2024, 26(6): 461-465.
Zhao YC, Zhou QR, Li QQ, et al.Research progress of sutureless microvascular anastomosis[J]. Journal of Traumatic Surgery, 2024, 26(6): 461-465.
[6] Ozkan O, Ozgentas HE.Open guide suture technique for safe microvascular anastomosis[J]. Ann Plast Surg, 2005, 55(3): 289-291.
[7] Sergeant P, Kocharian R, Patel B, et al.Needle-to-suture ratio, as well as suture material, impacts needle-hole bleeding in vascular anastomoses[J]. Interact Cardiovasc Thorac Surg, 2016, 22(6): 813-816.
[8] Kapischke M, Gerhard D, Pries A.Sutureless open vascular anastomosis connector: an experimental study[J]. Vascular, 2017, 25(1): 101-104.
[9] Ribaud JG, He K, Madira S, et al.Sutureless vascular anastomotic approaches and their potential impacts[J]. Bioact Mater, 2024, 38: 73-94.
[10] Ma G, Kucey A, Tyagi SC, et al. The role of sealants for achieving anastomotic hemostasis in vascular surgery[J]. Cochrane Database Syst Rev, 2024, 5(5): CD13421.
[11] Spotnitz WD, Prabhu R.Fibrin sealant tissue adhesive-review and update[J]. J Long Term Eff Med Implants, 2005, 15(3): 245-270.
[12] Beudert M, Gutmann M, Lühmann T, et al.Fibrin sealants: challenges and solutions[J]. ACS Biomater Sci Eng, 2022, 8(6): 2220-2231.
[13] Karpenko AA, Cheban AV, Rabtsun AA, et al.Fibrin sealant TISSEEL Lyo as a haemostatic agent in vascular surgery: results of randomized, controlled, patient-blinded, multicentre clinical study in the Russian population[J]. Sci Prog, 2023, 106(3): 332153330.
[14] Patrone R, Granata V, Belli A, et al.The safety and efficacy of Glubran 2 as biliostatic agent in liver resection[J]. Infect Agent Cancer, 2021, 16(1): 19.
[15] Sohn JJ, Gruber TM, Zahorsky-Reeves JL, et al.Comparison of 2-ethyl-cyanoacrylate and 2-butyl-cyanoacrylate for use on the calvaria of CD1 mice[J]. J Am Assoc Lab Anim Sci, 2016, 55(2): 199-203.
[16] 胡业帅, 钱海, 刘方军, 等. 采用大鼠颈动脉进行显微血管吻合技术训练的可行性研究[J]. 临床神经外科杂志, 2020, 17(2): 188-191.
Hu YS, Qian H, Liu FJ, et al.Value of end-to-end rat carotid artery anastomosis in microtechnique training for beginners[J]. Journal of Clinical Neurosurgery, 2020, 17(2): 188-191.
[17] Anderson JM, Rodriguez A, Chang DT.Foreign body reaction to biomaterials[J]. Semin Immunol, 2008, 20(2): 86-100.
[18] Alghoul MS, Gordon CR, Yetman R, et al.From simple interrupted to complex spiral: a systematic review of various suture techniques for microvascular anastomoses[J]. Microsurgery, 2011, 31(1): 72-80.
[19] Adam D, Broderick D, Kyzas P, et al.Microvascular anastomotic coupler devices versus hand-sewn technique for arterial anastomosis: a systematic review[J]. Br J Oral Maxillofac Surg, 2021, 59(5): 524-533.
[20] Sert G, Aksoyler D, Kara M, et al.Comparison of total anastomosis time between four different combinations of suturing and knot tying techniques in microsurgical anastomosis[J]. J Plast Surg Hand Surg, 2023, 57(1-6): 240-246.
[21] Frountzas M, Pergialioti V, Stergios K, et al.The effect of TISSEEL^TM on confined bowel perforation: an experimental study[J]. Eur Surg Res, 2021, 62(3): 151-160.
[22] Dai L, Gao M, Gu C, et al.Perivenous application of cyanoacrylate tissue sealants reduces intimal and medial thickening of the vein graft and inflammatory responses in a rabbit model of carotid artery bypass grafting[J]. Eur J Cardiothorac Surg, 2016, 49(2): 675-681.
[23] Pascual G, Sotomayor S, Rodríguez M, et al.Cytotoxicity of cyanoacrylate-based tissue adhesives and short-term preclinical in vivo biocompatibility in abdominal hernia repair[J]. PLoS One, 2016, 11(6): e157920.
[24] Levicheva EA, Linkova DD, Farafontova EA, et al.Fibrin glues: proteins, mechanism of action, classification, and application[J]. Int J Mol Sci, 2025, 27(1): 447.
[25] Boursier M, Bayon Y, Negrell C, et al.Biocompatible glues: recent progress and emerging frontiers in surgical adhesion[J]. Polymers (Basel), 2025, 17(13): 1749.