组织工程软骨在鼻再造术中的临床应用  

In vitro regeneration of tissue engineered cartilage and its clinical application for nasal reconstruction

作　　者：任朋洁 徐奕昊 范飞 田乐 陆晓娜 尤建军 王欢 郑若冰 REN Pengjie;XU Yihao;FAN Fei;TIAN Le;LU Xiaona;YOU Jianjun;WANG Huan;ZHENG Ruobing(Center of Rhinoplasty and Nasal Reconstruction,Plastic Surgery Hospital,Chinese Academy of Medical Sciences,Peking Union Medical College,Beijing,100043,P.R.China)

机构地区：[1]中国医学科学院北京协和医学院整形外科医院鼻整形与再造中心,北京100043

出　　处：《中国修复重建外科杂志》2021年第2期221-226,共6页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨临床应用组织工程软骨行鼻再造术的安全性及效果。方法2014年3月—2015年10月,收治5例拟行鼻再造术患者。其中,1例4岁患儿为先天性鼻畸形;其余4例成年患者为外伤所致鼻部亚单位缺损,男3例,女1例;年龄24~33岁,平均28.5岁。以鼻中隔软骨(儿童)或耳甲腔软骨(成人)来源的种子细胞与聚羟基乙酸-聚乳酸支架复合培养,在体外构建组织工程软骨。1例患儿一期行鼻部畸形矫正术、硅胶假体植入术,二期取出假体同时植入组织工程软骨;其余4例成年患者均采用额部皮瓣扩张法行鼻再造。鼻再造术后患者行1~4次鼻修整术;术中对植入的组织工程软骨进行观察,其中2例取材行组织学观察。结果术后3例患者出现低热;额部扩张皮瓣均成活,切口均Ⅰ期愈合,无感染、明显排斥反应、组织工程软骨外露等并发症发生。额部供区切口均Ⅰ期愈合。患者均获随访,随访时间9~74个月,平均54.8个月。随访期间患者鼻部无明显不适,通气功能良好,对鼻部外形基本满意。组织工程软骨组织学观察示术后早期1例有软骨存在;术后远期1例呈纤维结缔组织表现,另1例仍有软骨存留。结论临床应用初步表明使用组织工程软骨行鼻再造安全,但其有效性仍需进一步验证。Objective To explore the clinical application and effectiveness of a personalized tissue engineered cartilage with seed cells derived from ear or nasal septal cartilage and poly-glycolic acid(PGA)/poly-lactic acid(PLA) as scaffold in patients with nasal reconstruction. Methods Between March 2014 and October 2015, 4 cases of acquired nasal defects and 1 case of congenital nasal deformity were admitted. The patient with congenital nasal deformity was a 4-yearold boy, and the source of seed cells was nasal septal cartilage. The other 4 patients were 3 males and 1 female, aged 24-33 years, with an average of 28.5 years. They all had multiple nasal subunit defects caused by trauma and the source of seed cells was auricular cartilage. The tissue engineered cartilage framework was constructed in the shape of normal human nasal alar cartilage and L-shaped silicone prosthesis with seed cells from cartilage and PGA-PLA compound biodegradable scaffold. The boy underwent nasal deformity correction and silicone prosthesis implantation in the first stage, and the prosthesis was removed and implanted with tissue engineered cartilage in the second stage;the remaining4 adult patients all used expanded forehead flaps for nasal reconstruction. All 5 patients underwent 1-4 nasal revisions.The implanted tissue engineered cartilage was observed during the operation and taken from 2 patients for histological examination. Results All the incisions healed by first intention after the tissue engineered cartilage implantation, and the expanded forehead flaps survived. Postoperative low fever occurred in 3 patients. No complications such as infection,obvious immune rejection response, and tissue engineered cartilage protrusion were found in all patients. All patients were followed up 9-74 months(mean,54.8 months). During follow-up, the patients had no obvious discomfort in the nose and the ventilation function were good. All patients were satisfied with the nasal contour. Early-stage histological examination showed the typical cartilage cha

关 键 词：组织工程软骨 鼻再造 鼻缺损 鼻畸形 

分 类 号：R765.9[医药卫生—耳鼻咽喉科]