腹直肌-腹膜瓣转移修复舌缺损后的组织学变化研究  

Histological Changes after the Recontruction of Tongue Defect with Rectus Abdominis Musculoperitoneal Flap

作　　者：李军[1] 钟良军[1] 木合塔尔·霍加[2] 多力坤[2] 闫广鹏[2] 

机构地区：[1]新疆医科大学第一附属医院颌面外科,乌鲁木齐830054 [2]新疆维吾尔自治区人民医院颌面外科,乌鲁木齐830001

出　　处：《四川大学学报（医学版）》2013年第6期935-939,共5页Journal of Sichuan University(Medical Sciences)

基　　金：新疆自然基金课题(No.2010211A54)资助

摘　　要：目的观察携带与不携带神经的腹直肌-腹膜瓣转移修复舌缺损后,腹直肌-腹膜瓣的细胞形态及组织学改变。方法选用12只Beagle犬,随机分为2组,分别制备带肋间神经的腹直肌-腹膜瓣(A组)和不带肋间神经的腹直肌-腹膜瓣(B组)修复舌缺损。A组修复时行神经吻合,B组仅缝合修复舌缺损区,不行神经吻合。术后12周进行修复舌大体观察(腹直肌腹膜瓣长度、宽度、表面积),A、B两组腹直肌-腹膜瓣的细胞形态及肌细胞酶组织学染色,观察肌纤维类型。结果术后12周A组腹直肌腹膜瓣长度、宽度、表面积均大于B组,差异有统计学意义(P均<0.01);显微镜下A组腹直肌腹膜瓣有部分肌纤维萎缩,肌束出现部分结缔组织、脂肪组织,肌纤维排列不紧密,肌细胞结构基本正常。B组腹直肌-腹膜瓣肌纤维萎缩,可见脂肪组织,肌细胞结构紊乱,几乎无正常结构的肌细胞。A组Ⅱ型酵解型肌纤维向Ⅰ型肌纤维转化,Ⅰ型纤维比例增加。B组肌纤维萎缩,被大量脂肪组织替代,肌细胞结构紊乱,染色趋于一致,分型变模糊。结论带神经的腹直肌-腹膜瓣移植修复舌体缺损后,重获舌下神经支配的肌纤维类型发生转变,与舌肌接近,为舌体动力性恢复提供了基础。Objective To observe the cellular morphological and histological changes of the reconstructed tongue defect by rectus abdominis musculoperitoneal flap of dogs with or without nerve. Methods 12 Beagle dogs were randomly divided into two groups. Group A made rectus abdominis musculoperitoneal flap with the intercostal nerve while group 13 without the intercostal nerve. Nerve anastomosis was performed in Group A while not in Group B in the repairment. 12 weeks later, the length, width, surface area and cellular morphology and histological changes of the two transfer flaps were observed. Results The length, width, surface area of transplanted rectus abdominis musculoperitoneal flaps in group A were greater than those in Group B, and the differences were statistically significant at 12th week （P〈0.01）. The microscope study found that the transplanted rectus abdominis musculoperitoneal flaps of group A had part of muscle fiber atrophy with some connective and adipose tissue, loose muscle fiber arrangement, while the transplanted rectus abdominis musculoperitoneal flaps of Group B had muscle cells atrophy with some adipocyte. The structure of muscle cells in Group A was basically normal, but it was disorder in Group ]3. The type Ⅱ muscle fibers of Group B was atrophy and substituted by a lot of connective tissue. Conclusion After tongue defect reconstructed by rectus abdominis musculoperitoneal flap with nerve, the changes of muscle fibers could be similar to tongue muscles, providing a basis for the dynamic recovery of the tongue.

关 键 词：腹直肌-腹膜瓣 失神经支配 舌下神经 组织化学 

分 类 号：R782.2[医药卫生—口腔医学]