定向皮肤软组织扩张器在腹部瘢痕整复中扩张规律的前瞻性研究  

A prospective study on the expansion rule of the directional skin and soft tissue expander in abdominal scar reconstruction

作　　者：薛继东[1] 梁琰 邢培朋 狄海萍[1] 张建[1] 杨高远 夏成德[1] Jidong Xue;Yan Liang;Peipeng Xing;Haiping Di;Jian Zhang;Gaoyuan Yang;Chengde Xia(Department of Burns,Zhengzhou First People's Hospital,Zhengzhou 450004,China)

机构地区：[1]郑州市第一人民医院烧伤科,郑州450004

出　　处：《中华烧伤与创面修复杂志》2023年第2期150-157,共8页Chinese Journal of Burns And Wounds

基　　金：河南省医学科技攻关计划(联合共建)项目(LHGJ20190999);河南省二〇一九年科技发展计划(192102310368)。

摘　　要：目的观察定向皮肤软组织扩张器(以下简称扩张器)在腹部瘢痕整复中的扩张规律。方法采用前瞻性自身对照研究方法。采用随机数字表法选择2018年1月—2020年12月郑州市第一人民医院收治的20例符合入选标准的腹部瘢痕患者,其中男5例、女15例,年龄12~51(31±12)岁,Ⅰ型瘢痕患者12例、Ⅱ型瘢痕患者8例。Ⅰ期在瘢痕两侧置入额定容量为300~600 mL的扩张器2或3枚,其中至少1枚额定容量为500 mL(作为后续观察对象)。拆线后开始注水治疗,扩张时间为4~6个月,注水量达扩张器额定容量2.0倍后,Ⅱ期行腹部瘢痕切除+扩张器取出+局部扩张皮瓣转移修复。分别测定注水量达扩张器额定容量1.0、1.2、1.5、1.8、2.0倍时扩张处的皮肤表面积,并计算扩张相应倍数(1.0、1.2、1.5、1.8、2.0倍)和相邻倍数区间(1.0~1.2、1.2~1.5、1.5~1.8、1.8~2.0倍)时扩张处的皮肤扩张率;测定术后0(即刻)、1、2、3、4、5、6个月时修复处的皮肤表面积,并计算术后不同时间点(术后1、2、3、4、5、6个月)和术后不同时间段(术后0~1、1~2、2~3、3~4、4~5、5~6个月)修复处的皮肤回缩率。对数据行重复测量方差分析、LSD-t检验。结果与扩张1.0倍[(287.6±2.2)cm^(2)、(47.0±0.7)%]比较,扩张1.2、1.5、1.8、2.0倍时患者扩张处的皮肤表面积和扩张率[(315.8±2.1)、(356.1±2.8)、(384.9±1.6)、(386.2±1.5)cm^(2),(51.7±0.6)%、(57.2±0.6)%、(60.4±0.6)%、(60.5±0.6)%]均明显增加(t值分别为46.04、90.38、150.14、159.55,45.11、87.83、135.82、118.48,P<0.05);与扩张1.2倍比较,扩张1.5、1.8、2.0倍时患者扩张处的皮肤表面积和扩张率均明显增加(t值分别为49.82、109.64、122.14,144.19、49.51、105.85,P<0.05);与扩张1.5倍比较,扩张1.8倍(t值分别为38.93、39.22,P<0.05)、2.0倍(t值分别为38.37、38.78,P<0.05)时患者扩张处的皮肤表面积和扩张率均明显增加;与扩张1.8倍比较,扩张2.0倍时患者扩张处的皮肤表Objective To observe the expansion rule of directional skin and soft tissue expander(hereinafter referred to as expander)in abdominal scar reconstruction.Methods A prospective self-controlled study was conducted.Twenty patients with abdominal scar who met the inclusion criteria and admitted to Zhengzhou First People's Hospital from January 2018 to December 2020 were selected by random number table method,including 5 males and 15 females,aged 12-51(31±12)years,with 12 patients of typeⅠscar and 8 patients of typeⅡscar.In the first stage,two or three expanders with rated capacity of 300-600 mL were placed on both sides of the scar,of which at least one expander had rated capacity of 500 mL(as the follow-up observation object).After the sutures were removed,water injection treatment was started,with the expansion time of 4 to 6 months.After the water injection volume reached 2.0 times of the rated capacity of expander,abdominal scar excision+expander removal+local expanded flap transfer repair was performed in the second stage.The skin surface area at the expansion site was measured respectively when the water injection volume reached 1.0,1.2,1.5,1.8,and 2.0 times of the rated capacity of expander,and the skin expansion rate of the expansion site at corresponding multiples of expansion(1.0,1.2,1.5,1.8,and 2.0 times)and adjacent multiple intervals(1.0-1.2,1.2-1.5,1.5-1.8,and 1.8-2.0 times)were calculated.The skin surface area of the repaired site at 0(immediately),1,2,3,4,5,and 6 months after operation,and the skin shrinkage rate of the repaired site at different time points(1,2,3,4,5,and 6 months after operation)and different time periods(0-1,1-2,2-3,3-4,4-5,and 5-6 months after operation)were calculated.Data were statistically analyzed with analysis of variance for repeated measurement and least significant difference-t test.Results Compared with the expansion of 1.0 time((287.6±2.2)cm^(2) and(47.0±0.7)%),the skin surface area and expansion rate of the expansion site of patients((315.8±2.1),(356.1±2.8),(384

关 键 词：瘢痕 扩张术 组织扩张装置 腹部 扩张率 

分 类 号：R619+.6[医药卫生—外科学] R622+.1[医药卫生—临床医学] R61