烧伤后24h内削痂防治深Ⅱ度创面进行性加深的组织学观察  

Histological observation of the effects of tangential excision within twenty-four postburn hours on the progressive injury of the progression of deep partial thickness burn wound

作　　者：陆树良[1] 向军[1] 金曙雯[1] 杨丽英[1] 王志勇[1] 乔亮[1] 廖镇江[1] 史济湘[1] 

机构地区：[1]上海第二医科大学瑞金医院上海市烧伤研究所,200025

出　　处：《中华烧伤杂志》2002年第4期235-237,共3页Chinese Journal of Burns

基　　金：国家重点基础研究发展规划资助项目 (19990 5 42 0 5 ) ;上海市"百人计划"资助项目 (97BR0 0 2 ) ;上海市教委"曙光计划"资助项目 (98SG41) ;教育部骨干教师资助计划 (GGJS2 0 0 0 10 )

摘　　要：目的　探讨烧伤后 2 4h内行削痂手术 ,对深Ⅱ度烧伤创面进行性加深的防治作用。方法　选择 12例深Ⅱ度烧伤患者 ,在伤后 2 4h内进行创面削痂手术。分别从手术前、手术后 (伤后 5～7d)和未手术创面 (伤后 5～ 7d)获取标本。采用HE染色、Masson′s染色和免疫组化技术标记Vi mentin抗原阳性细胞的方法 ,对创面组织标本进行组织学观察。　结果　随病程演进 ,未手术创面炎性反应程度明显加重 ,组织坏死范围扩大 ,原来残存的皮肤附件因炎症加重而消失 ;Masson′s染色棕红色范围扩大 ,亮绿色范围缩小 ;Vimentin抗原阳性细胞数量明显减少。伤后 2 4h内削痂创面局部炎症反应较未削痂创面明显减轻 ,可见新鲜肉芽形成和部分上皮修复 ,组织坏死范围未见进一步扩大 ,与未手术区比较差异有显著性意义 (P <0 .0 5 ) ;Masson′s染色亮绿色范围无明显缩小 ;Vimentin抗原阳性细胞数量明显多于未手术区 (P <0 .0 5 )。　结论　烧伤后 2 4h内削痂 ,能适时去除创面坏死组织、阻断组织变质性损害的加剧 ,从而有效改善深Ⅱ度创面的进行性加深现象 ,对创面愈合具有促进作用。Objective To evaluate the effects of early tangential excision on the prevention of the progression of deep partial thickness burn wound. Methods Twelve burn patients with deep partial thickness burn wound were enrolled and received tangential excision of the burn wound within 24 postburn hours (PBHs). The histological samples were harvested from the wound before and 5 7 postoperative days (PODs) after the operation and the wound without operation 5 7 postburn days (PBDs). The samples were observed by means of HE staining, Masson′s staining and the labelling of Vimentin antigen positive cells by immunohistological skill. Results The inflammatory reaction of the burn wound without operation aggravated progressively along with that of disease and the tissue necrosis area enlarged. And the residual skin appendages disappeared due to the enhanced inflammatory reaction. The brown area expanded and light green area shrinked by Masson's staining. The Vimentin antigen positive cell count decreased significantly. But in the burn wound being performed tangential excision within 24 PBHs, focal inflammatory reaction exhibited evident ligher than that in burn wound without operation. Moreover, there appeared fresh granulation formation and partial epithelial coverage with no enlarged necrotic tissue area in the operated wound when compared with that in non operated wound (P<0.05). Furthermore, the light green area exhibited no obvious shrinking by Masson's staining and the Vimentin antigen positive cell count was much more in the operation area than that in non operative area (P<0.05). Conclusion It might be beneficial to the host to perform tangential excision within 24 PBHs, which could remove burn wound necrotic tissue in time and hamper the progression of tissue degenerative injury. The healing process of deep partial thickness burn wound was therefore accelerated. [

关 键 词：削痂 烧伤 组织细胞 创面愈合 病理过程 

分 类 号：R644[医药卫生—外科学]