高濃度のフィブリンを含有するフィブリンパッチの作成と臨床応用

Production and Clinical Application of Fibrin Sealant with High Concentrated Fibrin (Fibrin Patch)

I．はじめに

　フィブリン糊（fibrin glue）は，接着，止血創傷治癒を促進するためや膜として用いられる．特に，接着作用と膜としての特性を併せて応用し，漏孔閉鎖することをシーリング作用と呼んでいる^{2,3,4,6,9,11-13）}．脳神経外科領域でのフィブリン糊は主として，このシーリング作用を応用した髄液漏の防止に用いられる^{4,10,12,14）}．

　われわれは，このシーリング効果を高めるためにフイブリン糊の作用機序を検討し，様々な塗付方法や器具の開発，改良を行ってきた^{2,6-9,11,13）}．また，ヒト硬膜上のフィブリンクロットは，2-3週間では吸収されずに長期に残存し，数カ月の期間を経てコラーゲンを主体とした硬膜類似の結合組織膜に置換されることを病理組織にて確認した^7）．この所見は，フィブリン糊の改良により生体由来の理想的な代用硬膜を作り得る可能性を示唆していた．

[Object] The sealing properties of fibrin sealant with high concentrated fibrin (fibrin patch) were ex-amined.

[Material and methods] A commercial fibrin sealant (Bolheal^®) produced from pooled human plasma was utilized for this study. The fibrin sealant made of fibrinogen and thrombin solutions mixed in a volume ratio 5:1 was applied as the fibrin sealant with high concentrated fibrin (fibrin patch). The burst pressure of the fibrin clots of either 1:1 or 5:1 mixing ratio, which sealed the small holes, was measured by a water-leak preventing model. The tensile strength of the fibrin patch was measured by the breaking pressure of the fibrin clot. The burst pressure of the fibrin patch, which sealed the dural defect with a dia-meter of 15mm, was compared with that of expanded polytetrafluoroethylene (ePTFE).

[Results] The burst pressure was elevated from 287±23.1 to 445±30.5mmHg by changing the mixing ratio from 1:1 to 5:1. The breaking pressure of the fibrin patch showed 131±25.4mmHg and that of the patch mixed at the ratio of 1:1 showed 46.6±9.9mmHg. The result of dural repair with the fibrin patch re-vealed higher sealing effectiveness than that of ePTFE. The burst pressure averaged 70.5±21.4mmHg in the fibrin patch samples and 51.4±13mmHg in the ePTFE samples.

[Conclusion] The fibrin patch revealed higher performance as a sealant and has the potential to be a candidate for acceptance as the new dural repair material.