Fu Aile Medical Glue (FAL) and its application

Release date: 2006-05-29

Fu Aile Medical Glue (FAL) and its application Tian Xia Lu Yongshun [Keywords] Medical Glue Medical Glue Therapy [Abstract] This article outlines the definition, classification, standards, development history of medical glue, development status at home and abroad, especially The biological properties of FAL medical glue; FAL (NOCA + NBCA) improve the purity of the monomer, optimize the comprehensive performance of medical glue, equipped with a variety of suitable tools, so that medical glue has become a must in many departments, developed into medical glue Therapeutics. Introduced the indications, operational points and effects of FAL in general surgery, laparoscopic, extra-neuronal, cardiothoracic, maternity, urology, orthopedics, oral, otolaryngology, burn surgery and other departmental operations. Glue Overview 1.1 Definition of Medical Glue Medical Glue is a biomedical special functional adhesive. In addition to its usual bonding function and mechanical function, it should also have biomedical functions. It is used internationally to manufacture and human physiological environment (human tissue and Medical supplies that are in contact with blood, etc. are collectively referred to as biomedical engineering materials. In China, as a Class III medical device management. 1.2 Medical adhesive classification and standard basis 2005 China Medical Medical regulations and supervision guidelines, medical glue is classified as Class III 6865-3 in the medical device classification, including medical α-cyanoacrylate, and the FYEL medical glue standard YZB/Country 0941-2003 is listed as the only one in the country. Approved medical glue testing standards.1.3 Brief history and current status of medical adhesive development In the surgical operation, antibacterial and hemostasis are the foundation. The repair, sewing and tying of the living tissue are the two most basic operations. This method is not only cumbersome and laborious. And it is easy to cause bleeding and new damage, bringing more pain to the patient; for large areas of bleeding that can not find bleeding points, doctors feel helpless. If glue can be used instead of or partially to replace suture, it is a revolution in surgery to stop bleeding of small blood vessels or to seal the serosal surface of the cancer. For nearly a hundred years, people have been looking for an ideal medical treatment. Glue, and made unremitting efforts.
Thousands of adhesives have been developed so far, but few are suitable for medical use and are eliminated by strict medical indicators.
In 1959, the Eastman 910 (α-cyanoacrylate) instant bond produced by Eastman Kodak Company of the United States attracted the medical community. Since 1960, Nathan et al first used it for arterial anastomosis [1]. In 1972, the FDA approved (alpha-isobutyl cyanoacrylate) medical treatment and then stopped [2], until 2003, when Johnson & Johnson applied to China. FDA-approved 2-OCA (2-Octyl Cyanoacrylate), entered the Peking Union Medical College Hospital in 2004, but was expensive and limited to epidermal applications. Cold down [3]
In 1963, the Japanese Ministry of Health and Welfare approved 「A "Sankyo" (α-cyanoacrylate B / n-butyl ester) as a dental glue and surgical glue. Histoacry Blau (n-butyl cyanoacrylate) was produced by B. Braun in Germany. It was sold at 375 yuan/0.5ml in 1994. In 2000, Meyer-H????k in Germany? The company imports EPIGLU human tissue adhesive (α-cyanoacrylate) into China, and the price is high.
<661>(I-Isobutyl cyanoacrylate) (IBCA) produced in Gai County, Liaoning Province, China, in 1966, in 1999, Yongkang County, Henan Province, Beijing, the emergence of the instant Kang medical glue (Kamper) Feng), Yichang (Shengkang) medical adhesives and other products, the main glue is (IBCA).
In 1971, Shaanxi Province first created <504>(N-BCA) (n-butyl cyanoacrylate) produced by Shanghai Xinyi Pharmaceutical Co., Ltd. for the sterilization of fallopian tube. Clinically proven <504> there is too fast polymerization for doctors to operate. In the 1974 National Family Planning Work Conference, Lin Jiamei and Lin Qiaozhi proposed that they must be modified before they can enter the human body. 1978 1 In the Xi'an Chemical Research Institute, I was fortunate to host the female sterilization tamponade and the subsequent men's and women's sterilization and blocking agents. The six-five scientific research projects have been reviewed by a large number of English, Japanese, Russian and German materials. That is, the performance of the lower ester (501) can be changed with the high carbon ester (506). Can it be changed with N-octyl-α-Cyanoacrylate (N-OCYL) (N-octyl-α-Cyanoacrylate) Performance of 504). After more than 200 synthetic tests, <508> monomers with purity of only 92% (through infrared, nuclear magnetic, elemental analysis) were developed, and after 84 screenings, the tubal sterilization was developed in 1978. Agent, referred to as J-2 glue [4.5]. On the basis of the success of animal experiments, it entered the clinical. Male J-3 glue [6.7].. From 1980 to 1983, the Fourth Military Medical University, Wuhan Tongji Medical College, Tianjin Labor Health Research Institute, in the absence of any reference materials for modern toxicological tests, completed acute poisoning, The results of subacute, chromosomal aberration, carcinogenesis, triad (mutagenic, teratogenic, carcinogenic) and reproduction were all negative. The bacteriostatic test was carried out by the Second Affiliated Hospital of Xi'an Medical College (Staphylococcus aureus, Staphylococcus aureus) , four-cocci, hemolytic streptococcus, streptococcus mutans, pneumococci, Escherichia coli, proteus, Bacillus subtilis, Pseudomonas aeruginosa, yeast, etc.) form a bacteriostatic zone against 11 kinds of bacteria. On the basis of the experimental test, in Xi'an Medical University First Affiliated Hospital, Xi'an First, Second, Fourth, Central Hospital, Siji Hospital, Tangdu Hospital, Stomatological Hospital, Wuhan Tongji Medical College Organ Research Institute, Suzhou University One hospital, Shenzhen hospital, Shenyang Chinese Medical University First Hospital, Tianjin Pulmonary Hospital, Dalian Friendship Hospital, Fujian Nanping Municipal Hospital, Shandong Qilu Hospital, Shanghai Renji Hospital, Baotou Central Hospital, Under the assistance and participation of hundreds of doctors led by the famous organ transplant scientist Professor Xia Suisheng in the hospitals of Anyang City Hospital and Xinmi Anorectal Disease Research Institute, we developed the following in the 10 years (1978-1988): J-2 Glue, J-3 glue, developed CD glue, ZT glue, V-1 glue, V-2 glue, TH glue, ophthalmic glue, OB glue, BC glue, spray PW glue, EC glue, F-TH glue, D -TH glue, ZM glue, Xenon glue and other <508> series of medical glue. Entered into clinical clinical departments of about 1 million cases, only J-3 glue in 100 cities and counties in Shaanxi Province reached 100,000 cases. [8.9], 1988- In 1989, we held two sessions of medical glue seminars in Xi'an, which is a new milestone in the application of medical adhesives in China. It has been fully infiltrated into various fields of clinical practice. In 1991, the medical adhesive research laboratory moved south to Shenzhen and Guangzhou (1993). The realization of the transformation of scientific research results in enterprises. (1993-1996) held 3-4 sessions in Guangzhou. Five seminars received 625 papers. Some hospitals have used medical glue as a surgical routine. Glue [10]. In 1994, the series of medical glue passed the national production appraisal, and the medical α-cyanoacrylate was included in the 1997 edition of the National Medical Device Classification Catalogue Class III 6865-3. It is said that 504 monomer is used as the first generation of medical glue, and 508 is the main glue of the series as the second generation of medical glue. In 2002, in Beijing Zhongguancun High-tech Park, we have developed the spray-type Fu Aile medical glue. The third generation of medical glue. 2005 Fu Aile medical glue standard: YZB / country 0941-2003 has been listed as the country's only recognized medical glue testing standards [11] clinical needs and the creative application of doctors, the formation of medical glue treatment Learning [12] 2. Fu Aile Medical Glue (FAL) 2.1 FAL optimized composition (developing a monomer with a purity of >99%) to improve the overall performance of the adhesive [33-37]
FAL consists of high purity n-octyl cyanoacrylate (N-OCA) and n-butyl cyanoacrylate (N-BCA). Removes 502, DTDP, plexiglass, etc. from the second generation of medical adhesive formulations. Freon and other additives and formula specifications up to 17 seeds are too complicated. FAL curing time is 2-6S (to get operation), good diffusion and sealing performance, good toughness of polymer film, 180 degree non-breaking, low heat of polymerization, high bonding strength, etc., meet the clinical requirements. 2.2 FAL perfect aseptic support Tools and specifications have developed handy glue tools (all patented) [33-37], spray freely, according to different clinical requirements, doctors can choose the corresponding specifications and models, ending the era of rubber coating with tweezers. Closed hemostatic spray can be freely available in a variety of specifications and clinical free choice Fule Medical plastic (FAL) specifications model specifications ml0.51.01.01.01.0 1.51.5 model smear spray-A spray-B spray-C cavity mirror-A cavity mirror- A spray-B matching tool sealing EO sterilization suction bottle coating glue stick suction bottle coating glue stick spray bottle 2.5cm nozzle suction bottle coating glue stick spray bottle flat nozzle suction bottle coating glue stick spray bottle 8.3cm Nozzle suction bottle glue stick spray bottle mirror endoscope suction bottle glue stick spray bottle bottle mirror nozzle suction bottle glue stick spray bottle flat nozzle 8.3cm nozzle for small incision bonding broken bone fixed point Bleeding closure small wound surface spray closure hemostasis large wound surface spray closure hemostasis deep wound surface spray closure hemostasis laparoscopic small wound closure hemostasis laparoscopic wound closure hemostasis large + deep wound spray closure hemostatic dual-use tool features: 1 suction bottle overall Smooth, the glue mouth is properly ensured to use a drop of glue; 2 dexterous glue sticks, the size of each head has its own 3 spray bottles can be sprayed all over, without any propellant 4 deep selection steering 360 degree nozzle 5 equipped Glue device for minimally invasive laparoscopic surgery. 2.3 Biological properties of FAL FAL completed 17 biological tests, more than 10 million clinical cases, followed up for more than 30 years, no adverse reactions were found. FAL spray film was absorbed in the body for 2-4 weeks and excreted by breathing feces. "Skin rubber" completed 6 tests [3], instant Kang glue completed 3 tests. Test items Fu Aile medical glue N-OCA + N-BCA US skin rubber 2-OCA instant Kang medical glue I-BCA cells Toxic negative negative negative intradermal sputum negative negative negative skin sensitization negative negative negative acute systemic toxicity negative negative hemolytic negative pyrogen negative mutation (Ames) negative teratogenic negative carcinogenic (long-term toxicity) negative implant negative negative degradation degradation The human body is non-toxic and harmless, low molecular weight is absorbed by the human body, and it is excluded. Intraocular eye stimuli negative negative cancer-causing negative chromosome aberration negative breeding negative white mice two generations no teratogenic sub-viral negative antibacterial against 11 kinds of bacteria forming antibacterial zone 3. FAL Clinical application [13-32] (For details, please refer to the instruction manual or application report)
Because FAL improves the purity of the monomer and optimizes the comprehensive performance of the medical glue, it is equipped with various applicable tools, making the medical glue become a must-have item in many departments, and has developed into medical gel therapy. The following is the general FAL, laparoscopic, nerve For external, cardiothoracic, maternity, urology, orthopedics, oral, otolaryngology, burns, etc., the application site, operation points and effects are introduced. The functional points of the application of the department are detailed in the FAL papers. Incision 2 Thyroid incision 3 Liver and spleen cut surface 4 Severe spleen trauma 5 Gallbladder resection surface 6 Liver abscess (cyst hydatid cyst) Cyst cavity 7 Acne treatment 8 Cancer serous surface 9 Esophagogastric anastomosis 10 Anal fistula plug 11. Main pancreatic duct embolization 12 Acne resection routinely hemostasis sutured the skin, tightly apply the glue edge glue on the glue stick to spread the gauze to dry the wound surface, immediately spray the glue, and then cover the large omentum with the omentum and then stick it on the spleen with gauze. Dip the gallbladder bed, spray FAL, and leave the serosal film after the fenestration. After the drainage, the glue is sprayed on the wall of the cyst wall. The large net anal is attached to the cyst cavity to thoroughly debride, scrape the abscess and necrotic tissue to the new Granulation smear clean blood spray The membrane of the cancer membrane is sprayed, the spray range is larger than that of the cancer 2-3cm. FAL is sprayed around the anastomosis to inject the FAL pancreaticoduodenectomy, and the FAL is injected into the main pancreatic duct for embolization. After, spray FAL adhesive skin adhesion beautiful hemostasis closed wound hemostasis spleen hemostasis anti-cholesteric closure prevention bile leakage closed wound protection cancer serosa surface anti-metastasis closed anastomosis to prevent stenosis blocked sputum intestines anastomosis anti-pancreatic leakage hemostasis Laparoscopic cholecystectomy, reflux, tubal ostomy, laparoscopic laparoscopic surgery, laparoscopic surgery, laparoscopic appendectomy, leak-proof standard, four-hole operation: cholecystectomy The treatment of the tube and gallbladder veins was performed by the classical method. After the right axillary anterior 5 mm cone sheath was placed into the FAL special endoscopic catheter, the tube tip was 2-3 cm from the gallbladder triangle and the gallbladder tube stump 2-3 cm. Liquid, evenly spray FAL1.5ml, 3-6S solidified into a film, immediately stop bleeding cover closed wound face with normal saline rinse and attract, through the FAL spray long nozzle from the wound 4 cm, began to press 6-7 At the 8th, the glue is sprayed, and the 3-6S can be cured to form a film to stop bleeding immediately. After the fenestration of the tube, the large osmotic surface of the oozing surface will affect the function of the fallopian tube. The function of the re-pregnancy of the fallopian tube can be used to stop the blood from the base of the clamp. The laparoscopic operation of the varicose force is the device-dependent operation. The operation time is easy to cause the secondary injury. The FAL long nozzle is sent from the puncture cannula into the abdominal cavity. The FAL3-6S is solidified in the 3-4 cm from the wound surface. A small amount of FAL that is left in the gel bottle beforehand is applied to the surface of the skin. Apply a glue stick to evenly remove the appendix. Insert the FAL long nozzle along the endoscope barrel into the stump. Debride FAL. Immediately close. Stump wound closed hemostasis closed hemostasis without abdominal cavity hemorrhage and fever complications closed wounds without sutures simplified perforation closure no leakage no bleeding without peritonitis and other complications neurosurgery 1 sinus wall hemostasis 2 sinus wall defect 3 drainage vein into the sinus wall The fracture of the 4 internal carotid artery anterior cerebral artery rupture 5 intracranial large vessel laceration hemorrhage 6 wound oozing 7 intervertebral artery / venous plexus hemorrhage 8 intraoperative hemostasis 9 assisted anastomotic vascular 10 filling intracranial venous sinus 11. Tumor wall reinforcement 12. Arteriovenous malformation 13. Dural adhesion 14. Cranioplasty 1 15 Repair of skull defect: 16 open brain injury 17 skull base fracture with dural damage 18 sinus sinus nasal cavity smash Fracture, with dural tears 19 intracranial and extracranial communication tumors in the application of 20 transsphenoidal sinus removal of the saddle tumor, the first stage reconstruction of the saddle 21 brain tumor resection, repair the dura mater to prevent epidural effusion or CSF leakage 22 treatment of craniocerebral surgical incision CSF leakage compression crack control at both ends to control bleeding, with glue gelatin sponge applied to fix 5-6S loose hand to force the sinus leak with cotton, take a little more than the leakage of the periosteum or sarcolemma paste on it Spraying glue, then applying gelatin sponge to drain the vein to coagulate and stop bleeding. At the same time, find the hole that introduces the sinus sinus. When controlling the bleeding, apply a gelatin sponge with a spray FAL slightly larger than the leak to the leak. Press the carotid artery and apply the glued muscle piece to the fracture port 5-6S. Temporarily clamp the two ends of the gap, absorb the blood, and spray the FAL sarcolemma to the rupture port 3-5S to loosen the brain tissue or large area of ​​the dura mater. Seepage blood: Immediately spray FAL thin on the wound surface <0.5mm, evenly spray the FAL, separate the skull and the dura mater Leaching blood FAL spray on the gelatin sponge to fill the wound with the periosteum wrapped around the anastomosis drop 1-2 drops of FAL, lightly moving one end of the blood clip, a little blood to promote solidification. 3-5S anastomosis where hemostasis such as sagittal sinus sinus The sinus cavity occluded by the tumor, the venous sinus bleeding after the tumor is removed, and the saline gauze is pressed and sprayed with FAL. The aneurysm body is thick and short, and it is difficult to distinguish the clip, and the FAL is sprayed around the aneurysm with a thin cotton fiber. Strengthen the tumor wall, prevent bleeding under direct vision with FAL on the arterial embolization around the aneurysm clip or aneurysm wall, dural repair gap and small defect, reset between the skull flap and the bone window edge, removed during surgery Skull base, first cover the aponeurotic aponeurosis, and then apply FAL traumatic comminuted skull fracture: After repairing the dura mater, remove the broken bone piece and disinfect it with 3% H202, and use FAL to make the broken bone piece into place. For the dura mater, such as the anterior cranial traumatic skull fracture, the skull defect of 1.5-2cm can be used to repair the skull muscle flap with FAL: craniotomy can free the bone flap, and the bone flap is coated with FAL after surgery. No loose displacement does not affect healing: due to partial aponeurosis of the aponeurosis, it is impossible to repair the material, and the sarcolemma is covered. Lose, apply FAL around. Apply FAL-coated muscle or gelatin sponge to the tear of the skull base to remove the invigorating bone fragments. Repair the dura mater with FAL-coated muscles and apply FAL gelatin sponge reconstructs the nasal wall of the tarsal plate and fills the frontal sinus to remove the tumor. The muscle and the gelatin sponge are used to fill the defect of the dura mater and the skull base. For example, the anterior skull base-etheth sinus-nasal communication tumor is removed. After the tumor in the anterior skull base and the sinus sinus, the gelatin sponge coated with FAL is used to fill the ethmoid sinus sieve plate. The second phase of the nasal cavity is removed by nasal cavity. The tumor in the saddle is removed and the blood is properly stopped. The gelatin sponge coated with FAL is used. With the saddle bottom window size) reconstruct the saddle bottom, and then fill the sphenoid sinus in the same way. After the brain tumor is removed, sometimes the dura mater is difficult to suture or suture, which can lead to dural effusion, even CSF, conventional FAL muscle film or Gelatin sponge is applied to seal the hair around the shaving incision, routinely disinfected, spread the wound with tweezers, eliminate unhealthy grade weaving, dry CSF with sterile cotton ball, drop 1-3 drops of FAL in the leak (dose leak) The mouth size is fixed) at the same time, using the tweezers to squeeze the scalp 3-5S from both sides of the incision to the leak Adhesion. If the tension of the leak is too large, a needle can be added, and the FAL gelatin sponge coated with an appropriate size can be applied to the surface. Hemostasis, hemostasis, repair, hemostasis, hemostasis, hemostasis, hemostasis, hemostasis, hemostasis, hemostasis, hemostasis, hemostasis, hemostatic, hemostatic Dural adhesive skull repair skull closure repair closure plugging plugging leakage leak prevention leaking orthopedics application in vertebral surgery 2 application in knee surgery 3 application of comminuted fracture 4 adhesion of tendon ligament 5 spine surgery During the application, the vertebral body of the resection site is exposed, and FAL is injected into the vertebral body to embolize the gap between the bones of the bone and the microcirculatory blood vessels. After the FAL is completely solidified, the trephine bites off the bone without obvious bleeding. Extensive soft tissue release in joint ankylosis, soft tissue wound and bone surface oozing. After the wound gauze compression and hemostasis, immediately spray FAL (thickness <0.5mm). Suitable for comminuted fractures of the extremities: femoral shaft comminuted, humeral shaft fracture, Tibial fracture, internal and external tibial fracture, ulnar fracture, clavicular fracture, etc. Method: routinely open the exposed fracture end, clear the broken bone block, soak the salt water, first fix the internal fixation (steel plate or intramedullary nail) Good, will The bones of the defect are cleaned, the blood of the defect is cleaned, and the fracture surface of the bone is sprayed with FAL. The assistant quickly binds the broken bone to the defect in situ. After 2-3 minutes, the hand is released and the partial adhesion is checked. Good, close the wound layer by layer; if it is open comminuted fracture, the broken bone block should be immersed in gentamicin brine, washed and dried quickly and adhered to the defect. 1 single cerclage + FAL bonding, suitable for 2 tendon combination tension is less; 2 double cerclage + FAL adhesion, suitable for tendon fusion tension; 3 four fixed point + FAL adhesion, muscle ligament four fixed point fixation, then FAL adhesive tendon ligament gap And stump; 4 old tendon ligament or tendon ligament defect used: A autologous tendon displacement replacement, displacement instead of docking single ring or double loop + FAL adhesion; B artificial tendon replacement, the application of domestic carbon fiber braid (hand The tendon is generally used in three bundles, and the tendon ligament is applied in 12 bundles. When the anastomosis is replaced, the tendon is cut into a fish-like shape, the artificial tendon is inserted, the double loop is wrapped, and the FAL bonded stump is removed. After the wound hemorrhage, the effect of hemostasis directly with FAL is satisfactory; 2 it is difficult to control the above method, and it is difficult to control the above method, using FAL+ Gelatin sponge or free partial muscle flap or tendon + FAL adhesion; 3 hard muscle rupture or cerebrospinal fluid leakage, the injury is directly blocked with FAL, or with gelatin sponge + FAL covering and muscle flap or fascial flap + FAL bonding Hemostatic anti-adhesion bonding forming adhesive sealing closed cardiothoracic surgery 1 arterial anastomosis bleeding 2 venous anastomosis pulmonary artery incision suture bleeding 3 cardiac surface hemostasis 4 deeper leakage blood sternal concealed bleeding 5 thoracic surgery chest wall residual bleeding bleeding 6 trachea Bronchial morphometry 7 Esophageal and cardiac cancer surgery with 8 incomplete leaf remnant or wound closure 9 bronchial resection 9 mediastinal resection and intrathoracic mediastinal lymphadenectomy 10 rib fracture 11 empyema pleural exfoliation and Heller's surgery Application of 12 bronchial stump 瘘 esophageal tracheal fistula 13 endoscopic refractory pneumothorax occlusion aorta anastomosis - artificial vascular anastomosis: preventive spraying before releasing blood flow. Dry local residual blood, spray FAL; If there is still a bleeding point after releasing the blood flow, then the FAL is sprayed again and the FAL is sprayed again. When the artificial blood vessel transplantation is completed or the right atrial surface is hemorrhage, the needle vent hole is jetted, and the side wall forceps are used. Clamp the sides of the bleeding and dry After that, only a small amount of glue is applied, and the clamp is released after about 10 seconds. The ejection bleeding is invalid. The vein or pulmonary anastomosis is placed in the natural state (circular shape), the local residual blood is wiped off, and the FAL heart surgery incision is mostly in the spray. In front of the heart, there is often a bleeding in the incision margin and the needle hole after suturing. For example, the quadruple syndrome outflow tract widening repair is performed on the separation surface of the pericardial adhesion of the heart. Some patients have long-term anticoagulant drugs, and heparin is used during surgery. , causing multiple bleeding in the heart wound, it is not easy to sew, and it is not suitable for electrocautery to stop bleeding. Method: dry the wound with dry gauze, spray FAL immediately after light pressing (spray thickness <0.5mm), hand-colored film on the surface of the heart Spray FAL on gelatin sponge, immediately compress the part and immediately stop bleeding. FAL can stop bleeding immediately (spray thickness <0.5mm). Spray the anastomosis with FAL to make it tightly closed without affecting blood supply (spray thickness <0.5mm) After the esophagogastric monolayer anastomosis, a layer of FAL (spray thickness <0.5mm) is sprayed around the anastomosis. It can prevent the anastomotic leakage and esophageal stenosis. It can suture the hemorrhage and air leakage of the lung wound. Or electrocoagulation to stop bleeding. It can retain more lung capacity than suture alone. Can. In the lung expansion state spray FAL (spray thickness <0.5mm) stump suture 8-10 needles intermittently, spray a layer of FAL on the anastomosis, immediately covered with a free pleura (Note that gauze covers the parts that do not need to be sprayed) (spray thickness <0.5mm) firstly stop the blood first, quickly spray FAL to cover the retained mediastinal pleura, press for a few seconds, so that it firmly adheres to the wound surface, can be reduced Mediastinal wound 1 1 patient lying side up, find the fracture part of the partner; 2 skin disinfection after local anesthesia, with a 16-gauge needle into the fracture, often have to slide along the periosteum into the fold tip; 3 connected with FAL0.2-0.5ml needle is injected quickly; 4 finger is pressed 30-60S after needle extraction, such as local pain, then injection of anesthetic closure, gauze dressing; 5 pairs of ribs double fold chest 襞 package, with cloth towel clamp After the reduction, the FAL bonding is performed at the end of the fold; 6 pairs of breast cancer enlargement radical surgery, cut the rib segment, clamp with the forceps, re-enter the original position, drop two drops of FAL to the broken end face, keep 30S, you can firmly stick In the process of pleural exfoliation, the pleura is often torn to cause air leakage, and there are often multiple small bronchioles on the surface of the lungs. After cleaning the abscess, dry the local scraping and stale the stale Tissue, spray FAL closed cleft on the fresh wound surface and clean the fistula by fiberoptic bronchoscope or bronchoscope, place it into the fissure, and inject FAL/1ml. Note: 1 Select patient's mouth should not be too large <0.5cm, there is Endobronchial tuberculosis patients should not use glue because of stump inflammation; 2 when the FAL is injected, the person should be affected by the lateral position to prevent inflow of the contralateral side (fibrous bronchoscopy); 3 postoperative antitussive treatment, surely the adhesion is successful After that, choose appropriate antibiotics or anti-spasmodic to flush the abscess to promote the healing of the fistula; 4 The treatment of the fistula should be smooth and clean, so that the FAL can be easily covered, and the secretion can be absorbed by the suction device; 5FAL is longer than the mirror by the special catheter 2 -3cm injection, stop the negative pressure when filling the glue; 6 take out the mirror immediately after the injection, take out the glue tube from the mirror end to prevent the stain on the mirror head 1 the affected side up 2 the fifth or sixth intercostal space is also the mirror point Line chest or lens compression form selection incision, should avoid the pleural adhesion; 3 local anesthesia cut the skin 0.5-1cm along the upper edge of the rib, pull the needle into the ferrule, insert the bronchoscope along the trocar, If there is effusion, it should be sucked out; 4 Look for leaking holes: Generally look for the gap in the spleen if there is a pulmonary pleural adhesion to fibrosis or calcium. Attention, there will be a break to see if there is a bubble name, and the normal saline is injected into the saline solution. 3-5ml negative pressure attracts the patient. The patient has a light cough and a deep breath. The bubble is broken. The front end of the fiberoptic bronchoscope is placed at the air leakage port. At 2-3cm, use a sterile 20ml syringe to filter the air 5mlFAL/1-2ml through the catheter for rapid injection, see the pleural rupture closed by the white film to observe 5-10min without leaking and withdrawing the fiberoptic bronchoscope 6 to continue the indwelling chest closed Drainage tube, negative pressure suction 12-48h, X-ray confirmed lung re-expansion after extubation. Hemostasis, hemostasis, hemostasis, hemostasis, hemostatic, hemostatic, closed, adhesive, adhesive, adhesive, blockage, blockage, obstruction, obstetrics and gynecology, 1 gynecological surgery, application 2 Surgical incision adhesion 3 caesarean section uterine fibroids ovarian cysts and other abdominal incision 4 perineal incision adhesion 5 neonatal umbilical cord spray FAL treatment 6 covered cancer serosa surface uterus attachment resection after stump oozing uterine fibroids sputum postoperative residual cavity infiltration Blood is sprayed to stop bleeding. If there is active bleeding, the warp gauze is pressed to temporarily stop bleeding, and the FAL is sprayed on the wound surface quickly or with a gelatin sponge sprayed with FAL. The pressure is observed for 5 minutes. Obstetrics and gynecology abdominal surgery: conventional incision can be debrided The subcutaneous tissues of each layer of the abdominal wall were sutured to make the dermis a line, which was covered with a long gauze 3 cm from both sides of the incision edge. The surgeon used two hands to push the gauze and the lower abdomen to cover the two sides of the incision and wipe the residual blood. FAL spray evenly about 15cm, loose hands after 15S. Because the tension of the transverse transverse incision is small, the skin edge does not need to be sutured, and the FAL2cm/1 drop is applied to the dermis. The uniform fetal placenta is applied and the saline is routinely washed to incision and the deep vaginal mucosa is sutured. Muscle and subcutaneous tissue, 0.3-0.5cm from the margin of the skin, with two non-toothed forceps to pull the skin of the negative incision neatly, wipe the blood, drop a drop of FAL in FAL2cm, (apply evenly with a glue stick) to form a film Complete bonding Note: the incision should be clean, the skin edge should be tightly combined, and the amount of glue should be less. Otherwise, a hard block is formed in the wound, which affects the conventional disinfection around the root of the umbilical cord. The hemostatic forceps ligation and ligation from the 1-1.5 cm of the navel wheel ( Valve core ligation) cut the umbilical at 0.3cm Belt, routine disinfection of umbilical cord stump cross section, spray FAL evenly on observation 30SFAL solidified film formation without dressing local exposure dry water can be bathed in gynecological surgery on the resected cancer membrane surface can be sprayed with FAL before cutting blood adhesion bonding Adhesive closed urology 1 retropubic prostatectomy radical nephrectomy total cystectomy puberulous venous plexus hemorrhage 2 circumcision 3 kidney fragmentation 4 urethral fistula treatment 1 1 full exposure oozing wounds Cover with gauze does not need glue parts; 2 2 2 ligation of obvious bleeding points, try to absorb blood and water, and press with saline gauze for several seconds; 3 3 3 remove the gauze to spray FAL evenly on the wound; 4 4 43- 5 seconds to cure into a film, if still oozing blood can absorb the blood repeatedly spray FAL, if necessary, then cover a layer of gelatin sponge sprayed with FAL. 1 1 routine disinfection is blocked by penile root block; 2 2 2 according to the conventional range of circumcision for ligation and hemostasis (with laser ablation without ligation and hemostasis); 3 3 3 with cloth towel pliers or mosquito vascular clamp 4, the inner and outer plates Lift up the edge, press 1 drop of FAL in 2cm and quickly spread it evenly with glue stick. After 15S, loosen the pliers and make a sterile dressing. Routine exposure of the kidney and thorough cleansing of the wound, severely block the renal pedicle, detect the injury site, and ligature the obvious bleeding point; those with renal pelvis and renal pelvic laceration should suture the urinary tract first, and spray FAL at the renal parenchyma. After hemostasis and adhesion, then gently suture 1 1 first angiography to understand the renal ureter bladder and urethra, and then for the sacral angiography to clear the length of the sacral position and shape; 2 preoperative saline with normal saline 100ml + gentamicin 80,000 U The sacral road is 3-5 days twice a day. Then the sacral wall is scraped to form a new wound. Then the above antibiotic solution is used to flush the sacral tract and 5 ml of sputum saline + 1 g of cefotaxime sodium is injected as a fistula; 3 urinary tract is inserted into the 18F balloon guide The urethral tube is slightly pulled; 4, insert the special catheter into the FAL through the fistula and then retract it until the glue overflows from the fistula. Lightly press the sides of the mouth for a few minutes, wipe off the excess glue, apply sterile gauze, pull out Go to the balloon catheter urinary hemostatic bonding closed plugging hemostasis stomatology 1 single tooth extraction 2 pull out multiple adjacent teeth 3 under the wisdom teeth removal after deciduous tooth extraction 4 tonsil removal surgery 5 mouth ulcers do not bite cotton to stop bleeding, can be in the teeth Inside the trough, the beginning of the blood clot After solidification, the FAL is directly applied to the surface of the blood clot and the surrounding rim. The nipples are torn or detached, and the nipples are directly glued. The iodine gauze can be placed on the gums and then sprayed on the FAL. Iodine gauze and then glue. After the tooth extraction, hemorrhagic tooth nodule and sacral bag resection, etc. Spray FAL tonsillectomy. Method: Spray FAL, dry wound, spray FAL, stop bleeding, stop bleeding, stop bleeding, stop pain, prevent infection, promote healing, middle ear transmission structure Reconstruction of the ossicle with the FAL fixed ossicular chain
1 rapid hemostasis of nosebleed 2 nasal septum correction for spontaneous nosebleed nasal sinus root surgery sinus surgery nasal inferior turbinate resection nasal polypectomy upper frontal sinus surgery spray FAL before the nasal cavity and wounds with cain cotton After pressing for 5 minutes, take out the cotton sheet and apply FAL to the small wound surface which has been temporarily cleaned. The large wound surface is FAL. In severe cases, the gelatin sponge sheet coated with FAL is applied to the surface of the wound under the local anesthesia. The alar-wing incision is cut along one side of the nasal sulcus, and is fixed by pulling. If necessary, the bone of the edge of the pear-shaped hole is removed; the butterfly-shaped incisor is cut along the edge of the nose and the small column of the nose; Separated to the junction of the nasal cartilage, and then separated to the perforation along the median side for repair; nasal endoscopic repair was also placed into the anterior nares to open the endoscopic operation; repair perforation with a diameter of 0.5cm using a single layer of free The tissue flap is sandwiched between two layers of mucosal perichondrug or repaired with a rotating vitreous cartilage. The perforation is repaired with a composite flap above 1 cm; the flap should be larger than the perforation 2-3 cm, and the free tissue flap taken over the inverted mucosa The wound is formed on the wound surface or sandwiched in the rotating mucosal perichonium flap Fix with FAL; after surgery, apply FAL gelatin sponge to cover hemostasis, seal burn, cut sputum, donor site, wound, wound, wound, wound, wound, wound, wound, wound, spray, spray, dry, spray, dry, spray Debridement, cut blisters, remove free cortex, 0.1% Xinjieer disinfection wound, saline rinse, sterile gauze swab dry face evenly spray FAL, spray glue should be thin (≤0.5mm) hemostasis sealing plastic incision method Eye bags repair surgery rhinoplasty ear deformity correction surgery cheek small scar resection surgery breast augmentation with FAL special suction bottle and glue stick: the incision is completely stopped serum, sutured with a silk thread layer by layer, Make the skin edge neatly aligned; if it is a heavy incision, the subcutaneous must be sutured with the anterior membrane of the tarsal plate, the surface is dipped with dry gauze, and then coated with a small amount of FAL on the neatly aligned skin or mucous membrane. About 3 -5S curing, the amount of FAL should be as thin as about 2 cm with 1 drop, and the glue layer should be ≤0.5mm. The tip of the triangular flap should be glued with the glue in the Z-shape. This can avoid the fierce narrow triangle flap caused by suturing. Far-end blood transport is poor. Incision adhesion due to limited space, the clinical application of FAL can not be detailed Shao. With the passage of time, the clinical application of FAL will develop into a deeper and broader field. The application of doctors has made medical gel therapy. Here, I would like to contribute to the development of medical adhesives. The hundreds of doctors led by Prof. Xia Suisheng, the father of organ transplantation, expressed heartfelt gratitude and high respect. References 1. Experiences With Pdhesive in the Nonsuture Repair of Body Tissues JOHN E.HEALEY American Journal of Surgery Vol 109 April 19652. Transcatheter Occlusive Therapy of Genitourinary Abnormalities Using Isobutyl 2-Cyanoacrylate (Bucryate) FREENY ET AL AJR: 133; October 19793. CLOSURE Medical Corporation November 21 19974. Tianxia J-2 Gel Sterilization Adhesive Agent Successfully Developed Xi'an Chemical 1979 (1) 5 . Synthesis Chemistry and Bonding of Tianxia α-Cyanoacrylate Medical Adhesive 1983. (1) 6. Tian Xia Lu Yongshun Sterilization Adhesive Agent J-3 Adhesive Bonding 1986.7. (6) 7. Song Qixia The new sterilization plugging agent passed the appraisal of People's Daily 1983.8.238. Tianxia Xiasheng Lu Yongshun fast medical adhesive 508 series application manual China Science and Technology Literature Publishing Beijing 1995.49. Zhou Huan comprehensively infiltrated the health report in various fields of clinical therapy 1990.1.1110. Xia Suisheng Zhang Wei Wang Li The 4th National Medical Adhesive Clinical Application Seminar Meeting Minutes Chinese Journal of Surgery 1997.35.(8)11. Approved Medical Devices Checklist China Medical Device Regulations Compilation of State Food and Drug Administration P246 2005.612. Xia Suisheng talks about medical adhesive treatment health report 2002.10.2413. Song Huimin, Song Guangmin, Li Yuehua, Fu Ailee Medical Glue Clinical Application Journal of Clinical Surgery 2003.11.(1) 14. Xia Suisheng Tian Xia Lu Yongshun New Generation Spraying Fuerle Medical Glue (Basic Research) Journal of Clinical Surgery 2003.11.(2)15. Xia Suisheng Tian Xia Lu Yongshun New Generation Spraying Fuerle Medical Glue (Clinical Application) Clinical Surgery Journal 2003.11.(3)16. Wang Shubao, Xu Huimian, Wu Yunfei, Fu Ailee, Medical Adhesive Coverage, Clinical Report of Clinical Surgical Journal, 2003.11(4)17. Xi Yanyan Leihujiang Lianglu Medical Glue in the Treatment of Spleen Trauma: Review of Clinical Surgery 2003 .11.518. Ma Haitao Qin Yong He Jing Kang Fu Aile Medical Glue Application in General Thoracic Surgery 2003.11.(6 19. Li Ming Liu Wei Liu Yingsong Spraying Fu Aile Medical Glue in the Clinical Application of General Surgery Journal of General Surgery 2004.12. (2)20. Yang Jun Yang Senfu Ailee Medical Glue Blocking Treatment of Anal fistula 10 Cases of Clinical Surgery 2004.12 (3) 21. Su Ying Ma Lan Yang Lihua modified fascia intra-submandibular resection in 100 cases of clinical surgery magazine 2004.12. (5) 22. Wang Shubao, Xiaodong Yao Fanfu, Ailee medical glue for the treatment of massive hemorrhage after pancreaticoduodenectomy Journal 2004.12.(7)23. Tian Xia Lu Yongshun Spraying Fu Aile Medical Glue Performance and Clinical Application and Endoscopic Hemostasis 2004 CHINA MATERIALS BIOMATERIALS P66-69 BEIJNG CHINA 24. Wang Shubao Jin Feng Yao Fanfu Philharmonic Medical Glue in Pancreatectomy Journal of Applied Clinical Surgery 2004.12.(9)25. Li Shanquan Wan Jieqing Li Xiaoxiong Fu Ailee Medical Glue Clinical Application in Dural Sealing of Posterior Cranial Surgery Clinical Surgery Journal 2004.12.926. Song Jiming Xu Hongchun Fu Aile Medical Glue Clinical Journal of Clinical Surgery in Bronchial Pleural Essence 2004.12.(11)27. Zhang Tao Wang Jianhua Wang Xiaoqiang Fu Aile Medical Glue in the Treatment of Colon Cancer Journal of Clinical Surgery 2004.12.(11)28. Li Mingzhang, Qi Haifeng, Yao Bihui, Fu Aile Medical Glue for hemostasis in hepatic resection. Journal of Clinical Surgery 2005.13.(2)29. Xie Fangping, Zhang Zonglin, Chen Jinchuan, Fu Aile Medical Adhesive 120例应用体会临床外科杂志2005.13.（4）30. 张世明周岱福爱乐医用胶在神经外科手术中的应用临床外科杂志2005.13.（6）31. 王黎娜赵春艳邢玲玲福爱乐医用胶在腹腔镜手术中的应用临床外科杂志2005.13.（9）32. 邹一平李为民郑方腹腔镜胆囊切除术中福爱乐医用胶的应用研究临床外科杂志2005.13.（9）33. 专利01 233681534. 专利2004 20077876835.专利87 1 03468936. 专利86 1 07191337. 专利02 1 579822 此文转载自：中华医学会《国际外科学杂志》 2006年1月第33卷第1期

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