title: Haemostatic agents of the gelatin matrix for a large liver wound by percutaneous injection without pressure under the guidance of contrast-enhanced ultrasound.
abstract: BACKGROUND
  The non-operation treatment of intra-abdominal trauma guided contrast enhanced ultrasound (CEUS) is one of the hottest research topic. Gelatin/thrombin/calcium (GTC) was developed as a novel haemostatic agent for non-operable intra-abdominal trauma. We hypothesized that GTC can achieve haemostasis (without the use of pressure) within a short time in a large wound model by percutaneous injection under CEUS guidance.
  
  
  METHODS
  Forty Wister rats received large liver injuries by haemostatic clamp and were randomly divided into four groups, according to the haemostatic agent used. These included normal saline (NS) group A, lyophilising thrombin powder (LTP) group B, GTC group C, and absorbable α-cyanoacrylate (ACNA) group D. Each injury site was treated with one of the above materials and total bleeding time was recorded. All liver wounds were evaluated using CEUS at three periods: pre-injury, injury and post-treatment. The liver wounds were also evaluated by histology 3, 6, and 9 days after injury and the extents of abdominal adhesions were recorded.
  
  
  RESULTS
  The sensitivity of CEUS (100%) in detecting blunt traumatic liver lesions was significantly higher than conventional ultrasound (42.5%). Bleeding times at the injury site in the GTC group C ((129.3 ± 14.0) seconds) and ACNA group D ((5.2 ± 1.0) seconds) were significantly shorter than those in the NS group A ((369.5 ± 48.8) seconds, P < 0.01) and LTP group B ((324.7 ± 52.22) seconds, P < 0.01). The LTP group B showed no significant difference compared with the NS group A. Gross examination of liver tissue revealed that there were fewer intra-abdominal adhesions in the GTC group C (10%) than in the ACNA group D (100%). Histopathologic examination showed that GTC was completely absorbed after nine days.
  
  
  CONCLUSIONS
  GTC, delivered by percutaneous injection under CEUS, may achieve haemostasis (without the use of pressure) within a short time in a large wound model. GTC is absorbable and may prevent intra-abdominal adhesions. Therefore, it may be the optimal choice for first aid treatment of large abdominal wounds in the setting of blunt trauma.
authors: Department of Ultrasound, Chinese People's Liberation Army General Hospital, Beijing 100853, China.
authors: Teng-fei
authors: TF
authors: Yu
authors: Fa-qin
authors: FQ
authors: Lü
authors: Zhi-yan
authors: ZY
authors: Li
authors: Ling
authors: L
authors: Liu
authors: Qiang
authors: Q
authors: Liu
authors: Ai-jun
authors: AJ
authors: Liu
authors: Ya-qin
authors: YQ
authors: Huang
authors: Jie
authors: J
authors: Tang
mesh_terms: D000818:Animals; D002118:Calcium / Q000008:administration & dosage / Q000627:therapeutic use*; D005780:Gelatin / Q000008:administration & dosage / Q000627:therapeutic use*; D006470:Hemorrhage / Q000000981:diagnostic imaging / Q000188:drug therapy; D006490:Hemostatics / Q000008:administration & dosage / Q000627:therapeutic use*; D007267:Injections; D008099:Liver / Q000000981:diagnostic imaging* / Q000293:injuries*; D008297:Male; D011897:Random Allocation; D051381:Rats; D017208:Rats, Wistar; D013917:Thrombin / Q000008:administration & dosage / Q000627:therapeutic use*; D014463:Ultrasonography
chemical_list: D006490:Hemostatics; D005780:Gelatin; D013917:Thrombin; D002118:Calcium