脱细胞羊膜与脱细胞小肠黏膜下层修复猪创伤性皮肤缺损的比较研究  

A COMPARATIVE STUDY ON ACELLULAR SMALL INTESTINAL SUBMUCOSA AND ACELLULAR AMNION AS DRESSINGS FOR TRAUMATIC SKIN DEFECTS

作　　者：范伟杰[1] 杨志明[1] 罗静聪[1] 黄云[1] 李秀群[1] 王珍[1] 

机构地区：[1]四川大学华西医院生物治疗国家重点实验室

出　　处：《中国修复重建外科杂志》2006年第2期155-160,共6页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：国家高技术研究发展计划(863)资助项目(2001AA216011)

摘　　要：目的 比较脱细胞羊膜与脱细胞小肠黏膜下层作为创伤性皮肤缺损覆盖物,对创面修复的效果。方法 7只四川长白小猪,每只猪背部两侧各做3个4 cm×4 cm大小的皮肤缺损,深达深筋膜。每侧缺损随机分为3组,用不同敷料覆盖。A组：双层脱细胞羊膜；B组：双层脱细胞小肠黏膜下层；C组：空白,生理盐水纱布覆盖。术后观察创面局部情况、创面愈合率,10 d(2只,各组4个皮肤缺损)、20 d(2只,各组4个皮肤缺损)、30 d(3只,各组6个皮肤缺损)处死动物取材。行组织学观查,炎性细胞、血管内皮细胞及增殖细胞计数,羟脯氨酸含量测定。 结果A、B组覆盖的敷料与创面黏附紧密,与纱布无粘连,更换敷料时创面无渗血。C组纱布与创面黏附紧密,术后22 d前更换纱布时创面出血。组织学观察：术后各时间点A、B组皮下组织内炎性细胞数较C组少；C组皮下组织内胶原分布较A、B组紊乱。术后各时间点A、B组创面愈合较C组高,差异有统计学意义(P<0．05)；C组术后各时间点炎性细胞计数、皮下组织及肉芽组织内增殖细胞数明显高于A、B组,术后20、30 d,羟脯氨酸含量高于A、B组,差异有统计学意义(P<0．05)；3组内皮细胞计数,差异无统计学意义(P>0．05)。A、B组创面局部情况、创面愈合率、病理组织学检查、炎性细胞数计数、血管内皮细胞计数、增殖细胞计数和羟脯氨酸含量,差异均无统计学意义(P>0．05)。 结论 采用脱细胞羊膜、脱细胞小肠黏膜覆盖创伤性皮肤缺损,有提高创面愈合率、减少炎性反应,控制皮下组织及肉芽组织中细胞增殖,使胶原纤维有序排列的作用,能减少创面组织的出血和渗出。脱细胞小肠黏膜覆盖创面具有与脱细胞羊膜覆盖创面相近的修复效果。Objective To compare the reparative effects between the acellular small intestinal submucosa and the aeellular amnion as dressings for traumatic skin defects. Methods Three full-thickness skin defects, which were close to the vertebral column of the pig, were created on both sides of the dorsum. The skin defects were randomly divided into three groups. In each group, the following different materials were used to cover the skin defects. the acellular amnion in Group A, the acellular small intestinal submucosa （SIS） in Group B, and the physiological saline gauze in Group C （the control group）. The specimens from the skin defects were harvested for a histological evaluation and for determination of the hydroxyproline content at 10 （2 pigs）, 20 （2 pigs）, and 30 days （3 pigs）. We observed the healing process of the wound and its healing rate, counted the inflammatory cells, vascular endothelial cells, and proliferating cells, and determined the hydroxyproline content. Results The acellular amnion in Group A and the acellular SIS in Group B adhered to the wound tightly, but they did not adhere to the dressing; when the dressing was changed ,the wound did not bleed. The saline gauze in Group C adhered to the wound tightly, but when the dressing was changed, the wound bled until 22 days after operation. Under the microscope, the collagen in the tissue below the epithelium was arranged more regularly and there were fewer cells concerned with inflammation in Groups A and B than in Group C at 10, 20, and 30 days after operation. At 10, 20, and 30 days after operation, the wound healing rate was greater in Groups A and B than in Group C. The number of the inflammatory cells and the proliferating cells were greater in Group C than in Groups A and B. There was a statistically significant difference （P〈0.05）,At 20 and 30 days after operation, the content of hydroxyproline was greater in Group C than in Group A and B. There was a statistically significant difference （P〈0.05）. However,there was no

关 键 词：脱细胞小肠黏膜下层 脱细胞羊膜 创面愈合 猪 

分 类 号：R641[医药卫生—外科学]