几丁糖对扩张后皮瓣纤维包膜影响的临床研究  

Clinical Application and Research of Chitosan's effect on the flap of fibrous capsule

作　　者：郭文哲[1] 仇树林[2] 闫焱[3] 褚国华 崔胜国 张志欣[1] 张淑香[1] 

机构地区：[1]河北大学附属医院整形外科,河北保定071000 [2]河北省人民医院整形外科,050051 [3]北京电力医院五官科 [4]河北沧州市二院整形外科

出　　处：《中国美容医学》2011年第7期1090-1093,共4页Chinese Journal of Aesthetic Medicine

摘　　要：目的:探讨几丁糖干预纤维包膜形成的作用机理。方法:共对24例患者行皮肤软组织扩张术,每个患者均在病变周围两侧各埋植100ml皮肤软组织扩张器一枚;将其中一侧设为治疗组,将2%医用几丁糖2ml注入腔隙内,然后植入100ml皮肤软组织扩张器;另一侧设为对照组腔隙剥离完毕后观察无活动性出血,直接植入100ml皮肤软组织扩张器。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,同时标本做电镜观察。结果:治疗组纤维包膜厚度532.500±112.033μm,对照组897.000±206.023μm两组比较有统计学差异(P<0.05)。治疗组平均灰度169.935±16.015,对照组平均灰度156.945±13.546,两组比较有统计学差异(P<0.05)。实验组毛细血管数量平均每视野8.300±2.002个,对照组平均每视野7.900±1.287个,两组比较实验组与对照组无统计学差异(P>0.05);透射电镜观察,治疗组: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,有效减轻了扩张后皮瓣的收缩率;同时不影响纤维包膜增加扩张后皮瓣血运的作用。Objective To probe into the mechanism that how chitosan can intervene the formation of fibrous capsule.Methods A total of 24 cases of patients have had skin and soft tissue expansion,the 100ml one skin and soft tissue expander were implanted around both sides of the lesions of each patient,set the treatment group on one side,inject 2ml 2% Chitosan into the inner compartment,and then implanted 100ml skin and soft tissue expander;the other side is seted as control group,after stripping the compartment no active bleeding observed,then implant 100ml skin and soft tissue expander directly.Produced a HE staining,Masson staining,CD34 immunohistochemical staining for the relevant observation;and selected 15 visions in each group randomly with the application of micro-scale to measure the thickness of the fibrous capsule,and use electron microscopy to observe the specimens.Results Thickness of the fibrous capsule of the treatment group was 532.500 ± 112.033μm,the control group was 897.000 ± 206.023μm,there were significant differences between the two groups（P0.05）.Average gray of the treatment group was 169.935±16.015,the control group was 156.945 ± 13.546,the two groups was statistically significant（P0.05）.Experimental group,the number of capillaries per field was 8.300 ± 2.002,the control group was 7.900 ± 1.287,the two groups（the experimental group and control group）had no significant difference（P0.05）.Use the TEM to observe,the treatment group： fibroblast cell rough endoplasmic reticulum into a pool-like,the quantity was significantly reduced,and degranulation phenomenon was obvious,some or most of the mitochondria crest fusioned or disappeared,Golgi＇s body was occasionally normal,and there was no or occasionally microfilament structures,the number of free ribosomes was reduced.Control group： the expansion rough endoplasmic reticulum could be seen in the fibroblasts,degranulation phenomenon was rarely seen,the mitochondria was basically complete,many obvious actin structure were showed,no

关 键 词：几丁糖 纤维包膜 皮肤软组织扩张术 组织学 

分 类 号：R622[医药卫生—整形外科]