异种脱细胞真皮基质修复膜在口腔黏膜下纤维性变手术治疗中的应用  

Clinical application of heterogeneous acellular dermal matrix in the surgical treatment of oral submucous fibrosis

作　　者：蒋灿华[1] 李超[1] 石芳琼[1] 陈新群[1] 唐瞻贵[1] 翦新春[1] 

机构地区：[1]中南大学湘雅医院口腔颌面外科,湖南长沙410008

出　　处：《上海口腔医学》2011年第3期273-277,共5页Shanghai Journal of Stomatology

基　　金：湘雅-正海联合科研基金(2010-001)~~

摘　　要：目的:评价异种脱细胞真皮基质修复膜在口腔黏膜下纤维性变手术治疗中的应用效果。方法:8例重度口腔黏膜下纤维性变患者,经鼻腔气管插管全麻下切除双侧颊部翼下颌韧带前方区域纵行的纤维条索,术中被动开口度达正常范围后,剪取相应大小的异种脱细胞真皮基质修复膜覆盖黏膜缺损创面,间断缝合后,碘纺纱包加压固定。术后10～14d拆除纱包与缝线后开始开口训练,定期随访并进行类固醇皮质激素黏膜下局部注射等辅助治疗,通过伤口愈合、瘢痕软化及开口度改善等指标评价手术效果。采用SPSS16.0软件包对数据进行单因素方差分析。结果:8例患者双侧颊部纤维条索切除后形成的手术创面,采用异种脱细胞真皮基质修复膜进行修复均获得成功,无感染或排异等并发症发生。术后随访6～18个月,患者颊部原手术区黏膜红润,质地柔软,开口困难明显改善。术前开口度为(12.04±2.93)mm,术中开口度为(35.46±3.17)mm,术后6个月时的开口度为(29.33±4.28)mm,经统计学分析,差异具有显著性(P<0.05)。结论:应用异种脱细胞真皮基质修复膜修复重度口腔黏膜下纤维性变手术治疗中的黏膜缺损创面,能够起到促进创面早期愈合、减轻瘢痕形成与改善开口困难的作用,其操作简单易行,值得临床推广应用。PURPOSE：The aim of this study was to evaluate the clinical effect of heterogeneous acellular dermal matrix in the surgical treatment of advanced oral submucous fibrosis（OSF）.METHODS：There were eight patients who had undergone surgical treatment of trismus caused by OSF.Surgery was performed under general anaesthesia given through a nasoendotracheal tube using a fibreoptic bronchoscope.All the fibrous bands on the buccal mucosa were incised and bluntly dissected to stretch the mouth opening.Based on the defect,heterogeneous acellular dermal matrix graft was applied directly on the bilateral wounds.A tie-over dressing technique was used to hold the graft firmly to its bed.The sutures and dressing material were removed on the tenth to fourteenth day after the operation.All the patients were asked to stretch the mouth opening 3 times daily and were followed up for at least 6 months.A modality of medical treatment including multiple micronutrient supplements and steroid injection therapy were carried out if necessary.The changes in the interincisal distances（IDs） were analyzed in the preoperative,intraoperative,and postoperative stages.The data was analyzed with SPSS16.0 software package for one-way ANOVA.RESULTS：The overall success rate was 100% without any or only partial graft loss.There were no immunologic reactions or significant complications.The mean preoperative,intraoperative,and final follow-up interincisal distances were 12.04,35.46,and 29.33 mm,respectively.Evaluation of the changes in the IDs revealed statistically significant differences between the values recorded at the different stages.（P0.05）.CONCLUSIONS：Heterogeneous acellular dermal matrix may be a valuable biomaterial for repairing oral mucosal defects after surgery on the fibrous bands in patients with advanced OSF through covering and protecting wound surface early,which shortens the healing time of wound,decreases relapse of fibrosis and improve the restricted mouth opening.

关 键 词：口腔黏膜下纤维性变 异种脱细胞真皮基质修复膜 口腔黏膜缺损 修复重建 

分 类 号：R781.5[医药卫生—口腔医学]