腹腔鏡的 肝針生檢出血의 Absorbable Gelatin Sponge止血法에 關한 硏究

Abstract

Needle biopsy of the liver under direct vision of laparoscope if of proved value in the differential diagnosis of various hepatic lesions. But serious complication include uncontrollable hemorrhage from the biopsy site. On the other hand, newly introduced absorbable gelatin sponge, Gelfoam, have been used successfully for support as hemostasis in neurosurgery or vascular surgery. Therefore. The author tried to insert Gelfoam for support as hemostasis into the site of needle biopsy of the liver showing uncontrollable bleeding. For the purpose to evaluate above innovation, experimental and clinical studies were performed as following. In experimental study, needle biopsies of the liver were done on 24 rabbits, selecting the left posterior lobe as the biopsy site which was packed by Gelfoam, and the right anterior lobe as control site. Biopsy was done every 5 minutes interval on 4 rabbits, every 1 hour interval study on another 4 rabbits, and every 1 week interval on 16 rabbits till 4 weeks. As a clinical study, bleeding time, coagulation time, prothrombin time and bleeding time from the biopsy site after aspiration needle biopsy under the direct vision of laparoscope were measured in 6 cases of normal, 22 cases of hepatoma, 17 cases of liver cirrhosis, 10 cases of metastatic cancer, 9 cases of chronic active hepatitis, 2 cases of chronic persistent hepatitis, 2 cases of fatty liver and 1 case of acute viral hepatitis. In another 9 cases of various liver diseases who showed pulsatile or persistent bleeding over 10 minutes from the biopsy site, Gelfoam impaction at the biopsy site under direct vision of laparoscope was done and then measured bleeding time. The results were as follows. 1) In experimental study, tampon effect of Gelfoam was confirmed by collapse of hepatic cell cord around impacted Gelgoam in the biopsy site. 2) The bleeding time from the biopsy site had no direct relationship with the patient’s hemostatic data such as bleeding time, coagulation time and prothrombin time. And there was no significant difference in bleeding time from the biopsy site between normal group and various liver disease group. 3) Gelfoam packing into the biopsy site in 9 cases showing pulsatile or persistent bleeding more than 10 minutes controlled bleeding within 1 minute.