Evidence for the Rapidly Renal Reconstruction by Fibrin Sealant Aided with Dexon™ Mesh in Experimental Partial Nephrectomy

• Main Authors: Pai-Fu Wang, 王百孚
• Other Authors: Allen W. Chiu
• Format: Others
• Language: zh-TW
• Published: 2007
• Online Access: http://ndltd.ncl.edu.tw/handle/82180020716235229707

碩士 === 長榮大學 === 醫學研究所 === 95 === More renal tumors were incidentally found because of the broad employment of screening image modality. They are more frequently indicated for partial nephrectomy with the characteristics of early stages and small sizes, such as small renal incidentalomas, peripheral or exophytic renal tumors. Some experts even developed laparoscopic partial nephrectomy which has been gradually accepted in the past decade. However, hemostasis and repair of renal tissue had always been the drawbacks. Better techniques for bleeding control and renal reconstruction are imperative before this procedure can get more popularity. To break through its technical difficulties, we used an in vivo partial nephrectomy model to evaluate the clinical efficacy and histochemical impact in a new technique of renal repair with fibrin sealant and Dexon mesh. Ten groups of Sprague-Dawley rats (n=3) underwent bilateral partial nephrectomy sequentially on day 1 to 7, 14, 21 and 30. Renal repair was accomplished by suturing technique on one side as the control groups, and fibrin sealant with Dexon™ mesh on the other side as the experimental groups. The time of renal reconstruction was recorded respectively and compared. Histological evaluation was carried out by hematoxylin and eosin staining. Immunohistochemical analysis was performed to evaluate the expression of transforming growth factor-β1 (Tgf-β1) and Ki67 proteins. Isolated renal tissue studies included Western blot analysis for the protein expression of Tgf-β1, and the mRNA expression of Tgf-β1 by reverse transcription-polymerase chain reaction (RT-PCR) and semi-quantitation. In comparison with suturing technique, renal repair with fibrin sealant and Dexon™ mesh was much faster (27.2 versus 114.3 seconds, p < 0.0001). There was also significant attenuation of acute inflammatory response in the fibrin-Dexon™ group. The scores of inflammatory cells were lower than in the suture group (1.4 v.s 1.6). The Ki67 proliferative index showed no increase in the fibrin-Dexon™ group but increased up to 30% in the suture group. The serial change of Tgf-β1 mRNA (p=0.042) and protein (p=0.050) expression appeared significantly lower in fibrin-Dexon™ group. Based on the data in our study, we obtained the following conclusion. The fibrin sealant and Dexon™ mesh significantly simplified the procedure by reducing the time of renal reconstruction. Fibrin sealant aided with Dexon™ mesh can diminish the acute inflammatory response by avoiding the damage from suturing manner and offer convincing effect in renal repair as duplicating the suturing technique. This new method can be regarded as an alternative for renal repair in partial nephrectomy. Key words: partial nephrectomy, fibrin sealant, Dexon™ mesh.