人羊膜活性皮肤替代物修复巨痣切除术后创面的可行性及疗效研究

发布时间：2018-10-19 09:11

【摘要】：目的探讨临床应用以人羊膜为基质的活性皮肤替代物(amniotic membrane-living skin equivalent,AM-LSE)修复皮肤缺损的可行性。方法 2016年7月收治1例5岁颈肩背部先天性巨痣患儿。首先取其正常皮肤分离扩增表皮角化细胞和真皮成纤维细胞,再以自愿捐赠的人去上皮AM为基质,经气液面培养10 d构建含有真皮基质和重层分化表皮的AM-LSE。对AM-LSE行大体及组织学观察。手术切除巨痣至深筋膜层,遗留创面面积为20 cm×15 cm;覆盖胶原蛋白海绵人工真皮,2周后改用AM-LSE贴敷于肉芽创面,之后常规换药。术后观察AM-LSE成活以及创面修复效果。结果气液面培养10 d后,成功构建具有真皮层以及重层分化良好的表皮层的AM-LSE。临床修复术后见AM-LSE贴敷良好,逐渐扩大融合,至术后6个月其色泽接近正常皮肤,质地柔软,皮片间隙为淡红色瘢痕。组织学观察,可见呈柱状紧凑排列的基底层细胞,以及分化的棘细胞层、颗粒层以及角质层。真皮层内分布大量成纤维细胞以及血管,未见明显炎性细胞浸润。结论采用自体皮肤细胞构建的AM-LSE移植修复创面可行,术后能长期存活,且无排斥反应。
[Abstract]:Objective to investigate the feasibility of the application of human amniotic membrane as an active skin substitute (amniotic membrane-living skin equivalent,AM-LSE) in repairing skin defect. Methods A 5-year-old child with congenital giant nevus of neck, shoulder and back was treated in July 2016. Firstly, keratinocytes and fibroblasts were isolated and amplified from normal skin, then AM-LSE. containing dermis matrix and epidermis differentiation was constructed by using human epithelial AM donated by voluntary donation as matrix and gas liquid level culture for 10 days. Gross and histological observations were made on AM-LSE. The area of residual wound was 20 cm 脳 15 cm; covered with collagen sponge artificial dermis. After 2 weeks AM-LSE was applied to granulation wound and then routine dressing was changed. The survival rate of AM-LSE and the effect of wound repair were observed. Results after 10 days of gas-liquid level culture, AM-LSE. with well differentiated epidermis and dermis were successfully constructed. After clinical repair, AM-LSE was applied well, gradually expanded and fused, until 6 months after the operation, the color was close to normal skin, the texture was soft, and the skin gap was reddish scar. Histologically, columnar, compact arrangement of basal layer cells, as well as differentiated spinous cell layer, granular layer and cuticular layer were observed. A large number of fibroblasts and blood vessels were distributed in the dermis without inflammatory cell infiltration. Conclusion AM-LSE graft constructed by autologous skin cells is feasible to repair wounds and can survive for a long time without rejection.
【作者单位】：汕头大学医学院第二附属医院烧伤整形外科;汕头大学医学院转化医学研究中心;陕西省人民医院烧伤整形外科;
【基金】：国家自然科学基金资助项目(81272116) 陕西省自然科学基础研究计划项目(2014JM4192) 教育部留学回国人员科研启动基金(教外司[2013]693号)~~
【分类号】：R758.51

【相似文献】