自体脂肪颗粒及微粒皮混合移植修复烧伤患者深度创面  

Clinical study on the repair of extensive deep burn wounds with autogenous fat granules and autologous microskin grafts in mixed grafting

作　　者：刘顺利[1] 彭毅志[1] 李晓鲁[1] 袁志强[1] 罗高兴[1] 张家平[1] 唐进[1] 颜洪[1] 

机构地区：[1]第三军医大学西南医院全军烧伤研究所.创伤、烧伤与复合伤国家重点实验室,重庆400038

出　　处：《中华烧伤杂志》2008年第2期122-125,共4页Chinese Journal of Burns

基　　金：第三军医大学第一附属医院临床研究专项基金A类（WWH2005A002）

摘　　要：目的了解自体脂肪颗粒及微粒皮混合移植修复大面积烧伤深度创面的效果。方法选择20例重度烧伤患者，采用自身同体对照法，将患者双侧肢体或躯干对称部位创面分为脂肪颗粒＋微粒皮组和微粒皮组，分别行自体脂肪颗粒＋微粒皮（体积比1：1）混合移植和自体微粒皮移植。术后30、45、60d计算2组创面愈合率；术后7、14、21、28d取创面组织，行HE染色和增殖细胞核抗原（PCNA）免疫组织化学观察。结果移植术后30、45、60d，脂肪颗粒＋微粒皮组创面愈合率分别为（56．3±3．1）％、（76．4±6．1）％、（96．2±1．5）％，均明显高于微粒皮组的（28.3±2.0）％、（47．3±4．8）％、（85．4±2．2）％（P〈0．01）。HE染色显示脂肪颗粒＋微粒皮组创面上皮化早于微粒皮组，胶原纤维排列较整齐。脂肪颗粒＋微粒皮组PCNA阳性细胞较微粒皮组多，主要分布于表皮基底层。结论自体脂肪颗粒＋微粒皮混合移植可促进创面愈合。Objective To observe the effects of autologous fat granules in mixed grafting with autologous microskin grafts on repair of extensive deep burn wounds in patients. Methods Twenty severe burn patients hospitalized in our ward were enrolled for autogenous self-control test in wounds on both extremities or symmetrical parts of wounds of the trunk, and they were randomly divided into experimental（E） and control （C） groups, the wounds in E group were repaired with autologous fat granules together with autologous microskin in mixed grafting （ volume ratio 1：1 ） , and in C group only autologous microskin grafting was given. Wound healing rate was measured on 30th,45th, and 60th day after operation. Wound specimens were harvested for HE staining and PCNA immunohistochemistry examination on 7th, 14th, 21st, and 28th day after operation. Results （ 1 ） The mean wound healing rate on 30th ,45th, and 60th day after operation in E group was （ 56.3 ± 3.1 ） % , （ 76.4 ± 6. 1 ） % , （ 96.2 ± 1.5 ） % , which were respectively higher than that in C group [ （28.3 ± 2.0） % , （47.3 ± 4.8 ） % , （ 85.4 ± 2.2） % , P 〈 0.01 ]. HE staining showed epithelization in E group was earlier than that in C group , with regular arrangement of collagen fibers. The quantity of PC- NA positive cells in E group were larger than that in C group,and PCNA was mainly expressed in epithelial cells of basal layer . Conclusion Autologous fat granules in mixed grafting with autologous microskin can promote wound healing.

关 键 词：烧伤 脂肪组织 皮肤移植 创面愈合 

分 类 号：R644[医药卫生—外科学] R392-33[医药卫生—临床医学]