移植物局部引流淋巴结对异体复合组织皮瓣移植后存活时间的影响  

Effect of graft local draining lymph nodes on survival time of allogeneic composite tissue flap transplantation

作　　者：马戈甲 裴蛟淼 李杨 韩岩[3] MA Gejia;PEI Jiaomiao;LI Yang;HAN Yan(Department of Burn and Plastic Surgery,Xi’an Central Hospital,Xi’an 710004,China)

机构地区：[1]西安市中心医院烧伤整形美容外科,陕西西安710004 [2]空军军医大学西京医院西京整形医院,陕西西安710032 [3]解放军总医院整复外科,北京100853

出　　处：《陕西医学杂志》2023年第5期499-502,512,共5页Shaanxi Medical Journal

基　　金：国家自然科学基金资助项目(81071582)。

摘　　要：目的:探讨移植物局部引流淋巴结在异体复合组织移植中是否参与了早期的排斥反应,干预淋巴结后能否延长皮瓣存活时间。方法:BN大鼠作为供体、Lewis大鼠作为受体,进行腹部游离皮瓣异体移植。将大鼠随机分为三组,A组:正常移植;B组:术中去除受体移植区域引流淋巴结;C组:将皮瓣卷成皮管,利用硅胶管隔离移植物和受体之间的皮肤接触,仅保留血管相通。观察三组皮瓣存活状态,术后不同时间点对各组皮瓣HE染色和血清白细胞介素-2(IL-2)水平检测。结果:B、C组皮瓣存活时间相对于A组均延长(均P<0.05)。A组3 d皮瓣出现水肿和出血点,B、C组在7 d以后才出现不同程度的水肿和出血点。A组相较于其他各组,IL-2表达水平明显升高,在排斥终点(术后第7天)达到最大;B、C组在术后第7天IL-2表达水平分别为(145.15±4.2)ng/L和(96.28±4.62)ng/L,A组与B、C组比较有统计学差异(均P<0.05)。结论:移植物局部引流淋巴结在免疫排斥早期起着关键的作用,移除移植物局部引流淋巴结可以延长皮瓣存活时间。如果早期能够干预引流淋巴结,就有可能减少效应T细胞的产生,从而减轻移植物的排斥反应。Objective:To investigate whether graft local draining lymph nodes participate in the early rejection of composite tissue allotransplantation immune,and whether the intervention of lymph nodes can prolong the survival time of flap.Methods:The Brown Norway rats were taken as donors and the Lewis rats were taken as receptor for abdominal free skin flap allotransplantation.The rats were divided into three groups.Group A were received normal transplantation.Group B were removed the recipients regional draining lymph nodes intraoperatively.In Group C,the skin flap was rolled as a skin tube and using the silicone hose to isolate the graft and the recipient skin,while retaining the blood vascular interlinked.The survival status of the flaps in the three groups was observed.HE staining was performed and serum IL-2 level was detected at different time points after operation.Results:The survival time of flaps in groups B and C was longer than that in group A(all P<0.05).Edema and bleeding occurred in 3 days in group A,and 7 days later in groups B and C.The level of IL-2 in group A was significantly higher than that in other groups,and reached the maximum at the end point of rejection(day 7).The levels of IL-2 in group B and C on the 7th day after operation were significant different from group A(all P<0.05).Conclusion:Local draining lymph nodes of the graft play a key role in early phase of the immunological rejection.The removal of the graft local draining lymph nodes can prolong the survival time of the skin flap.If the early intervention of the draining lymph nodes are taken,it can reduce the effector cytotoxic T cells significantly,and alleviate the immune rejection of the graft.

关 键 词：同种异体复合组织移植 引流淋巴结 次级淋巴组织 淋巴系统 皮瓣排斥反应 抗原提呈细胞 

分 类 号：R392.4[医药卫生—免疫学]