无细胞异种真皮基质动物移植实验和临床应用观察  

Fabrication and Observation of Clinical Application of Xenogeneic Acellular Dermal Matrix

作　　者：钱春华[1] 杜国强[2] 姜笃银[1] 张玮[1] 

机构地区：[1]泰州市第四人民医院整形烧伤外科,江苏省泰州市225300 [2]郑州铁路职业技术学院护理系,河南省郑州市450052

出　　处：《组织工程与重建外科杂志》2007年第3期129-133,共5页Journal of Tissue Engineering and Reconstructive Surgery

摘　　要：目的为降低异种(猪)真皮组织的抗原性,探讨其临床复合移植的可行性。方法健康小猪中厚皮,半数经戊二醛交联,采用胰蛋白酶和TritonX-100等处理,分别制成未交联(sADM0)和交联型(sADM1)网状脱细胞真皮基质,通过动物实验和临床应用,观察二种sADM移植效果和组织学变化情况。结果(1)兔皮下埋植sADM0早期自体组织细胞侵入迅速,炎症反应重,皮片降解和收缩明显,8周后外观和组织学均难辨别,而sADM1早期组织相容性较差,炎性反应轻,皮片降解和收缩均不明显,至30周时,其外观和组织学结构仍较完整。(2)10例烧伤患者Ⅲ度创面和1例胸部瘢痕切除后,以自体薄中厚皮(TTS)和自体刃厚皮或超薄皮(OTS)为对照,进行sADM+OTS复合移植,19块复合皮平均成活率为78.9%,与TTS组无显著差异。其中sADM0+OTS组早期炎症反应和创面收缩明显,外观效果与OTS组相当;在sADM1+OTS组,早期炎症反应和创面收缩较轻,外观平整,触软,与TTS组相当,但其中有3例患者的6块创面在术后13～20周时,复合皮出现破溃、sADM1外露及组织学异物巨噬细胞等排异反应。结论临床用交联型sADM作复合皮的真皮替代物,能减缓早期免疫反应,提高OTS移植效果,但仍不能完全防止迟发性异种排异反应,提示sADM的制备工艺有待改进。Objective To reduce the antigen of allogeneic dermis and investigate its availability for comoposite transplantation. Methods Split-thickness skin grafts from common swine were divided into two groups with or without glutaraldehyde cross-linking treatment. Then the cross-linked sADM （sADM1） and non cross-linked sADM （sADM0） were embedded subcutaneously in rabbits and transplanted after scar was excised off. The histological observation was performed to determine the results of sADM1 and sADM0 after transplantation. Results The sADM0 with severe immune response were infiltrated by autologenous tissue cells in the early phase after embeded in rabbits. Furthermore, the degeneration and contraction of sADM0 were observable. By comparison, the sADM1 with less histocompatibility, slight immune response, and unobservable degeneration and contraction, showed comparatively complete appearance and histological structure till 30 weeks after embedment, sADM overlaid with auto-over thin split-thickness skin （OTS） were compositely transplanted onto the wounds. The survival rate was about 78.9% similar to that of auto-thin split-thickness skin （TTS）. In the group of sADM0 overlaid with OTS, the survived grafts showed an early immune response and observable contraction, and appeared like OTS after transplantation. In the group of sADM1- overlaid with OTS, the survived grafts with slight early immune response and contraction locked flat and touched soft as TTS. Conclusion The sADM1 used as dermal substitute of composite skin could retard the early immune response and improve the result of OTS transplantation, but couldn＇t completely prevent delayed heterogeneous rejection, indicating the sADM need to be improved.

关 键 词：脱细胞真皮基质 异种基因 皮肤移植 烧伤 戊二醛 

分 类 号：R617[医药卫生—外科学]