异种脱细胞真皮基质的制作和临床应用观察  

The manufacturing and clinical application of heterogenous acellular dermal matrix

作　　者：姜笃银[1] 陈璧[1] 徐明达[1] 胡大海[1] 汤朝武[1] 朱雄翔[1] 

机构地区：[1]第四军医大学西京医院烧伤科

出　　处：《中华烧伤杂志》2002年第1期15-18,共4页Chinese Journal of Burns

基　　金：国家自然科学基金资助项目 (3 90 70 82 2 )

摘　　要：目的　降低异种 (猪 )真皮组织的抗原性 ,探讨在临床复合移植的可行性。　方法　健康小猪中厚皮 ,半数经戊二醛交联后采用胰蛋白酶和TritonX 10 0等脱细胞处理 ,制成未交联(sADM0 )和交联型 (sADM1)网状脱细胞真皮基质 ,通过动物实验和临床应用 ,观察 2种sADM组织学变化和移植效果。　结果　 (1)兔皮下埋植sADM0 宿主细胞侵入迅速 ,炎症反应和组织降解明显 ,而sADM1炎症反应轻 ,皮片降解和收缩不明显 ;(2 ) 10例烧伤患者Ⅲ度创面和 1例胸部瘢痕切除后 ,以自体薄中厚皮 (ATS)和自体刃厚皮或超薄皮 (UTS)为对照 ,进行sADM +UTS复合移植 ,19块复合皮平均成活率为 78.9% ,与ATS组无显著差异。其中sADM0 +UTS组早期炎症反应和创面收缩明显 ,外观效果与UTS组相当 ;在sADM1+UTS组 ,早期炎症反应和创面收缩较轻 ,外观平整 ,触软 ,与ATS组移植效果相当 ,但有 3例患者的 6块创面在术后平均 (12 .8± 6 .9)周时 ,出现表皮破溃、sADM1外露和组织学严重的异物巨噬细胞反应。　结论　临床用交联型sADM作复合皮的真皮替代物 ,能减缓早期免疫反应 ,提高UTS移植效果 ,但仍不可避免迟发性异种排异反应。Objective To lower down the antigenicity of heterogenous swine acellular dermal tissue, and to explore the feasibility of clinical using it as a composite graft for human patients. Methods Split thickness skin was harvested from healthy swines and then processed by two methods. The swine acellular dermal matrix (sADM) was prepared by removing cells from the skin with trypsin and Triton X 100. Then the cross linked sADM(sADM 1) and non cross linked sADM(sADM 0) were embedded subcutaneously in rabbits and also transplanted onto the burn wounds of patients. The histological changes and also transplantation results were observed. Results (1) In animals with sADM 0 embedded subcutaneously, the grafted tissue was invaded immediately by host cells with obvious inflammatory reaction and tissue degradation. But there was less inflammatory reaction, and with no obvious skin degradation and contraction with sADM 1. (2) In ten burn patients with Ⅲ degree burn wounds and one patient with wound in chest after scar removal, sADM and ultra thin skin (UTS) composite graft were grafted on the wounds with autologous thin skin (ATS) and autologous razor thin or UTS as the control. Nineteen pieces of composite skin of sADM with UTS were grafted on the wounds with survival rate of 78.9%,exhibiting no evident difference with that of ATS.When sADM 0 and UTS were grafed, there exhibited remarkable early inflammatory reaction and wound contraction with similar external appearance with that of UTS.Whereas when sADM 1 and UTS were grafted,there appeared less early inflammatory reaction and wound contraction,resulting in an even appearance and soft to touch similar to that with ATS.But ulceration occurred,with exposure of sADM 1,exposure and severe macrophage reaction to foreign body in 6 wounds of 3 cases 12.8 ±6.9 weeks after sADM 1 and UTS grafting. Conclusion Grafting of sADM as a dermal substitute of composite skin could alleviate early post grafting immune reaction and improve UTS grafting results.But the de

关 键 词：脱细胞真皮基质 异种基因 皮肤移植 烧伤 临床观察 

分 类 号：R644[医药卫生—外科学]