几丁糖对扩张后皮瓣纤维包膜影响的实验研究  

Experimental study of the effect of chitosan on the capsule inside the expanded flap

作　　者：闫焱[1] 仇树林[2] 褚国华 郭文哲[2] 李兵[2] 韩胜[2] 

机构地区：[1]首都医科大学教学医院北京电力医院健康管理中心,北京100073 [2]河北省人民医院整形外科 [3]沧州市中西结合医院

出　　处：《中华整形外科杂志》2009年第5期381-384,共4页Chinese Journal of Plastic Surgery

基　　金：河北省科学研究与发展计划基金（06276102D.77）.

摘　　要：目的旨在阐明几丁糖干预纤维包膜形成的作用机制，为应用几丁糖解决临床上因纤维包膜挛缩，而导致组织扩张术后皮瓣利用率降低这一难题提供理论依据。方法制作应用几丁糖干预的埋植扩张器动物模型及其常规对照模型各15个，取材计算带纤维包膜皮瓣回缩率后，分别制作HE染色、Masson染色、CD34免疫组化染色切片进行相关观察；并随机选取每组各15个视野应用显微标尺测量纤维包膜厚度，了解两组之间的差异性；同时将标本固定后送电镜观察。结果几丁糖干预组纤维包膜厚度516．000±128．49μm，对照组83μm，两组比较差异有统计学意义（P〈0．05）；实验组毛细血管数量平均每视野8．200±2．150个，对照组平均每视野7．900±1．729个，两组比较差异无统计学意义（P〉0．05）；透射电镜观察，实验组：成纤维细胞内粗面内质网扩张成池状，数量明显减少，脱颗粒现象明显，线粒体部分或大部分嵴融合或消失，偶见正常高尔基氏体，未见或偶见微丝结构，游离核糖体数量减少；对照组：成纤维细胞内可见扩张的粗面内质网，少见脱颗粒现象，线粒体嵴基本完整，可见许多明显的微丝结构，核糖体数量未见明显减少。结论几丁糖通过抑制成纤维细胞分泌胶原、延迟成纤维细胞分化为纤维细胞过程、抑制成纤维细胞向成肌纤维细胞转化等作用，有效地减轻了扩张后皮瓣的收缩率；同时由于其不影响随扩张皮瓣面积增大而出现的毛细血管增生和扩张，所以不影响纤维包膜增加扩张后皮瓣血运的作用。Objective To investigate the effect of chitosan on the capstde inside the expanded flap. Methods The expanders were implanted in animals with the treatment of chitosan（experimental group, n = 15） or without（control group, n = 15）. After taking out the expanders, the flap contraction rate was calculated. The samples were observed through HE, Masson dyeing and CD34 immunohistochemical study. The thickness of capsule inside the expanded flap was measured under microscope. The samples were also studied under electron microscope. Results The thickness of capsule was 516.000 ± 128.491μm in the experimental group, and 833.000± 227.379μm in the control group（ P 〈 0.05）. The number of microvessels was 8.200 ±2.150 per visual in experimental group, and 7.900 ± 1. 729 per visual in control group （ P 〉 0.05）. Under the electron microscope, the rough endoplasmic reticulum（RER） in the capsule in experimental group decreased and enlarged with degranulation. The mitochondria emerged or disappeared. The number of ribosome was reduced. In the control group, the RER enlarged without degranulation, the mitoehondria was intact. The number Of ribosome was not reduced. Conclusions The chitosan can effectively reduce the contraction of expanded flap through collagen secretion of fibroblast, delaying the differentiation from fibroblast to fiber cell, inhibiting thansform from fibroblast to myofibroblast. It has no effect on the microvascular generation and expansion, so the flap blood supply will not be affected with thicker capsule.

关 键 词：几丁糖 软组织扩张术 外科皮瓣 

分 类 号：R622[医药卫生—整形外科]