戊二醛交联的异种/异体脱细胞真皮基质的制作及临床应用观察(英文)  

Manufacture and clinical application of heterogeneous/allogeneic acellular dermal matrix cross linked by glutaraldehyde

作　　者：姜笃银[1] 陈璧[1] 贾赤宇[1] 徐明达[1] 朱雄翔[1] 汤朝武[1] 王波涛[1] 

机构地区：[1]第四军医大学西京医院烧伤科

出　　处：《第四军医大学学报》1999年第5期371-374,共4页Journal of the Fourth Military Medical University

摘　　要：目的：为降低异种／异体真皮组织的抗原性，便于临床大面积烧伤患者复合皮（ＣＳ）移植的推广．方法：将胰蛋白酶和戊二醛等处理的、含基底膜成分的１８例人（ｈ－ＣＳ）和８例猪（ｓ－ＣＳ）无细胞真皮基质（ＡＤＭ）与自体刃厚表皮一起重叠移植于１３例烧伤患者Ⅲ度切痂创面上，同时以邻近移植的自体刃厚皮（ＯＴＳ）和自体薄中厚皮（ＴＴＳ）为对照，观察无细胞真皮制作前后的组织结构变化和各组皮片移植的成活率及外观效果．结果：ＡＤＭ表面含薄层基底膜成分，组织内附件上皮细胞、成纤维细胞、血管内皮细胞等细胞消失．临床应用观察，ｈ－ＣＳ和ｓ－ＣＳ组移植的成活率与ＴＴＳ组和ＯＴＳ组比较无显著性差异，未见排异反应，外观平滑、近期无瘢痕增生；ＣＳ组未成活５例，可能与ＡＤＭ制作过厚（＞０．３ｍｍ）、组织内残留戊二醛等因素有关．结论：ＡＤＭ，尤其是ｓ－ＡＤＭ作为自体刃厚皮移植的载体，可能方便于大面积烧伤患者的ＣＳ移植，但其有一定的占位性，制作仍有待改进．AIM: To reduce the antigen of heterogeneous/allogeneic dermis and to promote the application of composite skin(CS) graft on extensive burn. METHODS: 18 acellular dermal matrixes(ADM) cross linked by glutaraldehyde taken from human(h CS) and 8 acellular dermal sheets taken from swine(s CS) combined with thin split thickness autograft were grafted on 13 wounds of escharectomy, while autograft of epidermis was used as control. The change of tissue structure, survival rate of skin graft and its appearance were observed. RESULTS: There were thin sheets of basal membrane on the surface of ADM, and fibroblasts as well as endothelial cells disappeared. No significant difference of survival rate was found among different groups. The CS appeared smooth without observable immunologic rejection and hypertrophic scarring. Only 5 grafts failed to survive in CS group and the reason for the failure might be the overthickness of ADM (>0.3 mm) and glutaraldehyde remaining in the tissue. CONCLUSION: ADM, particularly the P ADM allograft, is convenient and effective for the management of extensive burn by CS grafting. In view of some of the disadvantages such as the occupancy on the wound, the manufacture method should be further improved.

关 键 词：脱细胞真皮基质 异种 异体 皮肤移植 烧伤 创面 

分 类 号：R622.1[医药卫生—整形外科] R644.05[医药卫生—外科学]