トロンビン注入による前立腺手術の止血

Abstract

前立腺肥大症手術において, 前立腺腺床部分に側孔のあいた特殊バルーンカテーテルを用いて腺床内にトロンビン溶液を注入し止血効果を, 対照の結紮止血群と比較し検討した.1)手術時間, 術中出血量については, 有意にトロンビン止血群が有効であった.2)術後血尿期間は, 逆にトロンビン止血群で延長していた.この原因として, 腺床内の凝血の溶解が考えられたが, 臨床的には全く問題にならなかった.3)低フィブリノーゲン血症, および薬剤の劣悪な保存状態が, 本法の効果を低下させる.この点への配慮が特に大切である

We describe the usefulness of topical application of thrombin as a hemostatic aid in prostatic surgery. We used a specially designed 3-way bag catheter, one way of which opened to the prostatic fossa. After enucleation of the prostate suprapubically, we inserted the bag catheter into the bladder before any hemostatic procedure was performed on the prostatic fossa, inflated the bag, gently pulled down the catheter against the prostatic fossa, and then injected the thrombin solution (5, 000 units/5 cc. X 2) into the fossa. Fifty patients were randomized into two groups; the "thrombin" method group and the hemostatic "ligature" group, and compared. The "thombin" method group showed statistically significant superiority to the "ligature" method group in reduced operation time and operative bloodloss. On the contrary, the duration of postoperative hematuria was longer with the "thrombin" method but not significantly. Even the prolonged duration of hematuria, however, produced no clinical problems. Hypofibrinogenemia and poor conditions of drug storage lowered its efficacy. These points should be remembered when using thrombin.