自体表皮干细胞膜片修复巨痣切削术后创面缺损

发布时间：2018-06-12 07:52

本文选题：表皮干细胞 + 膜片　；参考：《河南科技大学》2012年硕士论文

【摘要】：目的巨痣是一种以黑色素细胞异常迁移聚集于体表，且分布面积巨大为特征的皮肤良性肿瘤，可累及整个肢体、全头皮、肩部、躯干部等。巨痣皮肤可粗糙，增厚，附有毛发，溃烂，甚至伴有神经纤维瘤，部分有恶变可能，如继发黑色素瘤等。从前瞻性随访结果来看，巨痣的恶变率在10%-20%不等，而巨痣切除术后标本阳性检出率低于上述数值，相关报道认为黑色素瘤患者继发于巨痣者占40%-60%。同时，巨痣常位置暴露，严重影响美观，给患者心理健康及社会带来较多的负面影响，其治疗势在必行。大多数学者认为，当巨痣病灶较明显地增大、颜色改变、破溃、脱毛、出现卫星灶、继发感染以及疼痛等表现时，应尽早手术，并进行病理检查。即使没有上述表现时，也应进行预防性的手术治疗。当前研究较多地集中于巨痣手术方式的改进，以期促进功能的稳定和形态的改观。国内外报道其治疗方式报道较多，如激光、化学药物、冷冻.电灼.中草药涂抹等，而手术则是治疗巨痣较为可靠的方法，手术方法有切削法、巨痣切除后皮片移植法、皮肤软组织扩张后扩张皮瓣转移法、局部皮瓣转移法、皮管转移法分次切除法等。术后创面的缺损修复、皮源困难和愈后瘢痕等并发症，往往给患者机体造成难以承受的痛苦. 创面的上皮化对创面愈合极为重要，创面上皮化的进程，反映了创面愈合程度，在创面愈合过程中，适当早的上皮化不仅可保护创面，减少感染等并发症的发生机率，而且对后期瘢痕挛缩或增生等方面并发症的防治具有积极的意义。相关研究表明表皮干细胞在创面上皮化过程中发挥着重要的作用，说明表皮干细胞在创面愈合中具有较为积极的意义。既往相关研究和临床治疗方式为巨痣治疗提供了较好的基础，然而其治疗效果常不能更充分地获得病人的满意，特别是对于面积较大、部位特殊的巨痣，因缺乏标准化的治疗指导模式，而使其功能形态改善效果欠理想。本文利用表皮干细胞膜片修复巨痣切削术后创面缺损，观察其临床疗效，探讨一种既能节约皮源，又能较好地改善巨痣功能形态的有效手术方式。方法本组男4例，女6例；年龄1岁～3.5岁，平均2.5岁，均为先天性，巨痣面积随年龄增长逐渐增大。巨痣范围为25cm×10cm～45cm×65cm。10例患者均未曾治疗。手术部位为躯干，双大腿。入院检查见巨痣表面皮肤破溃及渗出1例，毛发生长3例，其余6例皮肤质地与周围一致；皮肤感觉瘙痒明显2例。病理学检查确诊为交界痣4例，混合痣6例。根据患者巨痣分布部位设计手术分期方案，实验组经患者家长同意，签订伦理协议，在组织工程国家工程中心河南科技大学生物工程研究所抽取静脉血进行表皮干细胞的分离、培养。干细胞培养三周将表皮干细胞膜片，移植于巨痣切削术后创面，外用油性愈帮敷料，，无菌纱布包扎固定，4-5天拆除敷料。对照组入院行手术切削后自体刃厚皮片移植,外用油性愈帮敷料，无菌纱布包扎固定，4-5天拆除敷料。观察创面愈合时间，及愈后情况。采用SPSS16.0统计软件包进行分析。数据以均数±标准差表示，组间比较采用t检验；检验水准α=0.05。结果 1.两组巨痣患者切削术后均无感染等明显并发症。 2.实验组较对照组创面愈合时间明显缩短，（P0.05）。 3.患者术后均获随访，随访时间为7个月～2年，平均15个月。实验组较对照组在瘢痕增生或挛缩、皮肤色泽及弹性和局部器官牵拉皮肤的功能等方面表现良好。结论 1.以表皮干细胞膜片修复巨痣切削术后继发创面，术后并发症轻微； 2.以表皮干细胞膜片修复巨痣切削术后继发创面，可明显缩短愈合时间； 3.以表皮干细胞膜片修复巨痣切削术后继发创面，无需供皮区，扩大了巨痣切除面积。 4.以表皮干细胞膜片修复巨痣切削术继发创面该法仅适合交界痣，混合痣。不适合皮内痣。 5.以刃厚皮片修复巨痣切削术后继发创面，并发症较多。 6.以刃厚皮片修复巨痣切削术后继发创面该法仅适合皮内痣,混合痣，不适合交界痣.
[Abstract]:Purpose

Giant moles are a benign tumor of the skin characterized by abnormal migration of melanin cells into a body surface and characterized by a large distribution area . The giant moles of skin may be rough , thickened , with hair , ulceration , and even with neurofibroma , and the positive detection rate of the specimens is below 40 % -60 % .

Most scholars think that when the focus of giant moles is obviously enlarged , color change , ulceration , hair loss , satellite focus , secondary infection and pain , the operation should be carried out as early as possible and pathological examination should be carried out .

The epithelialization of the wound surface is very important to the wound healing , and the process of wound epithelialization reflects the degree of wound healing . In the course of wound healing , the proper early epithelialization can not only protect the wound surface , reduce the incidence of complications such as infection , but also have positive significance for the prevention and treatment of complications such as scar contracture or hyperplasia .

The present study provides a good basis for the treatment of giant moles with the previous relevant research and clinical treatment modality , however , the treatment effect is often unable to obtain the satisfaction of the patient more fully , especially for the giant moles with large area and special site , and the function form improvement effect is not ideal due to the lack of standardized treatment guidance mode .

method

There were 4 males and 6 females .
The average age ranged from 1 to 3.5 years , the mean age of 2.5 years was congenital , and the area of giant moles increased with age . The range of giant moles was 25 cm 脳 10 cm ~ 45 cm 脳 65 cm . 10 patients were not treated . The surgical site was trunk and bilateral thigh .
The skin stem cells were isolated and cultured for 3 weeks . The skin stem cells were removed from venous blood for 3 weeks . The wounds were treated with oily calluses and sterile gauze . The dressing was removed by external oily callus dressing and sterile gauze . The dressing was removed from 4 - 5 days .

The SPSS 16.0 statistical software was used to analyze the data . The data was expressed by mean 卤 standard deviation , and t test was used between the groups .
Inspection level 伪 = 0.05 .

Results

1 . There were no obvious complications such as no infection after cutting in both groups .

2 . The healing time of the experimental group was shorter than that of the control group ( P0.05 ) .

3 . All patients were followed up for a follow - up period of 7 months to 2 years with an average of 15 months .

Conclusion

1 . After repairing giant moles with epidermal stem cell membrane , the postoperative complications were mild .

2 . After repairing giant moles with epidermal stem cell membrane , the time of healing can be shortened obviously .

3 . The epidermal stem cell membrane is used to repair the secondary wound surface after the treatment of giant moles , and the area of the giant moles is enlarged without the need of the skin donor area .

4 . Using epidermal stem cell membrane to repair the secondary wound surface of giant moles , this method is suitable for the delivery of moles and mixed moles . It is not suitable for intradermal nevi .

5 . To repair the secondary wound and complications after the treatment of giant moles with the edge - thick skin graft .

6 . The method is suitable for skin moles and mixed moles , and is not suitable for the delivery of moles .
【学位授予单位】：河南科技大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R758.51

【参考文献】