Ⅲ度烧伤创面修复的病理组织学特点及其临床意义  

Pathohistology characteristics on wound healing of Ⅲ degree burn and its clinical significance

作　　者：常朋飞[1] 马印东[1] 贾军[1] 石文[1] 邵阳[1] 王芳[1] 宋国栋[1] 

机构地区：[1]山东大学附属济南市中心医院烧伤科,济南250013

出　　处：《山东大学学报（医学版）》2013年第7期36-41,共6页Journal of Shandong University:Health Sciences

基　　金：山东省医药卫生科技发展计划项目(2011HZ008);济南市留学人员创业计划资助项目(20080405)

摘　　要：目的研究Ⅲ度烧伤创面修复的基本规律及特点,探讨其与手术植皮时机、移植床处理方式的关系。方法选用成年Ⅲ系小型猪模拟临床制作Ⅲ度烧伤模型,利用HE染色、免疫组织化学染色、VG染色和透射电镜等方法,动态观察Ⅲ度烧伤创面及"交界处"病理组织学、血管内皮细胞、碱性成纤维细胞生长因子(bFGF)、胶原纤维和成纤维细胞超微结构等变化情况。结果烧伤后24～48 h,"交界处"血管内皮细胞、成纤维细胞开始增生。7 d时,肉芽组织初步形成,成纤维细胞功能活跃。伤后10～14 d,"交界处"组织发生广泛血管化,呈现肉芽组织纤维化与增生扩展相间的表现。21 d以后,肉芽外露并逐渐演变为结缔组织,肌成纤维细胞可见;30 d时创面收缩约14%,肉芽浅层明显水肿。血管内皮细胞增生和bFGF表达贯穿于肉芽组织化的全过程,高峰期分别为伤后72 h～7 d和5～7 d。结论Ⅲ度烧伤7～10 d以后,"交界处"组织已发生血管化、肉芽组织化并按自身规律发展,提示临床植皮修复创面时应根据全身及局部情况,使移植床位于已获血运改善的皮下组织浅层平面上,具有植皮成活率高、愈合质量好的确切效果。Objective To investigate the basic regularity and characteristic in the process of wound healing after Ⅲ de- gree burn, and the relationship with skin grafting and the treatment of transplant bed. Methods Ⅲ degree burn model was made on the selected adult minipigs and the changes of pathohistology, vascular endothelial cells, basic fibroblast growth factor（ bFGF）, collagen fibers, and fibroblastic ultrastructure in full-thickness skin burn wound and the junction area were observed dynamically by the techniques of HE staining, immunohistochemical staining, VG staining and transmission electron microscope examination. Results Vascular endothelial cells and fibroblasts started to proliferate in the junction area in 24-48 h postburn. At the 7th day, granulation tissue formed preliminarily and fibroblasts were in a state of active function. In 10-14 d postburn, widespread vascularization happened in the junction area and granulation tissue present fibrosis and expansion. After 21 days, granulation tissue revealed and developed into connective tissue with myofibroblast （MFB） visible. The wound shrunk approximately by 14% and evident edema happened in superfi- cial granulation tissue on 30th day. Proliferation of vascular endothelial cells and expression of bFGF occurred through the whole process of granulation tissue formation. And their crest-times arrived in 72 h-7 d and 5-7 d. Condusion Vascularization happened in the junction after 7-10 d postburn and granulation tissue expanded following its regularity. According to situations of the body and the local, autoskin grafting on the superficial hypodermis with improved bloodsupply should be implemented as soon as possible, which brought exact outcome of high survival rate of grafting and good quality of healing.

关 键 词：烧伤 肉芽组织 创面修复 皮下组织 皮肤移植 

分 类 号：R644[医药卫生—外科学] R361.2[医药卫生—临床医学]