交联型猪脱细胞真皮基质与自体微粒皮复合移植的临床应用  

Composite grafting of cross-linked heterogeneous swine acellular dermal matrix and auto-microskin in clinic

作　　者：张先安[1] 罗文福[1] 潘银根 关少强[1] 任大宏[1] 陈渝萍[1] 

机构地区：[1]珠海市人民医院暨南大学医学院第三附属医院整形烧伤科,广东省珠海市519000 [2]启东市医疗用品研究所,江苏省启东市226200

出　　处：《中国组织工程研究与临床康复》2007年第29期5680-5683,共4页Journal of Clinical Rehabilitative Tissue Engineering Research

基　　金：广东省科技计划资助项目(2004B36001088);珠海市科技计划资助项目(PC200310053)~~

摘　　要：目的:观察交联型异种(猪)脱细胞真皮基质与自体微粒皮复合移植修复大面积深度烧伤早期切痂创面的疗效。方法:选择2001-09/2006-10在珠海市人民医院暨南大学医学院第三附属医院整形烧伤科就诊的中面积和大面积深度烧伤患者16例共48个观测创面,患者均知情同意。患者于伤后3～5d休克期平稳渡过后行肢体创面切痂术,自体微粒皮移植组观测24个创面,均位于复合皮移植组创面的邻近或对侧肢体相同部位。①复合皮移植组:切痂创面用交联型异种(猪)脱细胞真皮基质(由江苏启东医疗用品研究所提供)+自体微粒皮复合移植+异体皮覆盖。②自体微粒皮移植组:切痂创面用自体微粒皮移植+异体皮覆盖。术后6周异体皮脱落,两组散在肉芽创面行小邮票状皮片补充移植修复创面。术后定期观察创面愈合情况,计算创面愈合率及收缩率,并行创面组织学检测。结果:两组48个创面均进入结果分析,无脱落。①两组异体皮成活情况相近。②术后6周,复合皮移植组患者的创面愈合率均显著低于自体微粒皮移植组(P<0.05);经补充植皮后即术后8周两组创面愈合率差异无显著性意义(P>0.05)。③移植术后6,8,12周,复合皮移植组患者的移植创面收缩率均显著低于自体微粒皮移植组[(10.28±2.36)%,(16.25±3.78)%;(15.68±1.79)%,(30.42±3.65)%;(22.07±1.39)%,(42.83±2.74)%(P<0.05)]。④术后8周组织学观察结果显示,复合皮移植组创面愈合处上皮化良好,胶原纤维排列有序,基底膜结构完整;自体微粒皮移植组上皮层仍较薄,细胞分化不良,真皮内胶原排列较紊乱。结论:交联型异种(猪)脱细胞真皮基质与自体微粒皮复合移植修复大面积深度烧伤早期切痂创面,能够抑制瘢痕增生,改善创面愈合质量,疗效满意。AIM： To observe the effect of composite grafting of the cross-linked heterogeneous （swine） acellular dermal matrix and auto-microskin to repair extensive deep bums following eschar excision, METHODS： Between September 2001 and October 2006, 48 wounds of full thickness bums were selected from 16 inpatients in the Department of Plastic Surgery and Bums, People＇s Hospital of Zhuhai, the Third Affiliated Hospital, Jinan University Medical College. All the patients undergoing eschar excision at 3-5 post-wound days were averagely divided into compound skin grafting group （test group） and auto-microskin grafting group （control group）, each contained 24 wounds.①The wounds in test group were grafted with the cross-linked heterogeneous （swine） acallular dermal matrix ＋ auto-microskin ＋ allogeneic skin. ②The wounds in control group were near to the wounds or same focus of contralateral limb in test group; and were grafted with auto-microskin and allogeneic skin. Six weeks postoperatively, a stamp skin graft was supplemented for granulation wound repairing, following allogeneic skin was separated. The area of wound healing and the rates of wound contraction were measured. Tissue specimens were harvested for histological examination. RESULTS： All the 48 wounds were included in the analysis. ①The two groups were similar in the survival of allogeneic skin. ②The wound healing rate in test group was significantly lower than that of control group at 6 post-operative weeks （P〈0.05）; but no difference was found between the two groups at 8 posy-operative weeks （P〉0.05）.③At 6, 8, 12 post-operative weeks, the wound contraction rate in test group was significantly lower compared with control group [（10.28±2.36）%, （16.25±3.78）%; （15.68±1.79）%, （30.42±3.65）%; （22.07±1.39）%, （42.83±2.74）%, P 〈 0.05].④Histological detection revealed that there were full differentiations of epithelium, ordedy collagen arrangement and intact basement membrane in the test group

关 键 词：皮肤移植 烧伤 细胞外基质 真皮 猪 移植 自体 组织移植 

分 类 号：R617[医药卫生—外科学]