几丁糖对扩张后皮瓣纤维包膜影响临床探究.doc

几丁糖对扩张后皮瓣纤维包膜影响临床探究[摘要]目的：探讨几丁糖干预纤维包膜形成的作用机理。方法：共对24例患者行皮肤软组织扩张术，每个患者均在病变周围两侧各埋植100ml皮肤软组织扩张器一枚；将其中一侧设为治疗组，将2%医用几丁糖2ml注入腔隙内，然后植入100ml皮肤软组织扩张器；另一侧设为对照组腔隙剥离完毕后观察无活动性出血，直接植入100ml皮肤软组织扩张器。分别制作HE染色、Masson 染色、CD34免疫组化染色切片进行相关观察；并随机选取每组各15个视野应用显微标尺测量纤维包膜厚度，同时标本做电镜观察。结果：治疗组纤维包膜厚度532.500±112.033μm，对照组897.000±206.023μm两组比较有统计学差异（P0.05). Use the TEM to observe, the treatment group: fibroblast cell rough endoplasmic reticulum into a pool-like,the quantity was significantly reduced,and degranulation phenomenon was obvious, some or most of the mitochondria crest fusioned or disappeared,Golgi’s body was occasionally normal,and there was no or occasionally microfilament structures,the number of free ribosomes was reduced.Control group: the expansion rough endoplasmic reticulum could be seen in the fibroblasts,degranulation phenomenon was rarely seen,the mitochondria was basically complete, many obvious actin structure were showed, no obvious decrease of the number of ribosomes.ConclusionBy inhibiting fibroblast secretion of collagen, delaying the process of fibroblast differentiate to fiber cells, inhibiting the transfromationof fibroblast to myofibroblast and so on, Chitosan can effectively reduce the shrinkage of expanded flaps,without affecting fiber envelope to increase the role of blood supply of expanded flaps. Kay words: Chitosan；Ibra-peplos；elasticity recovery 本研究将通过应用几丁糖作为干预药物，预防软组织扩张器注入后包膜挛缩，并取得了成功的动物实验的基础上[1]，对临床24例患者应用几丁糖作为干预药物，对埋植的皮肤软组织扩张器纤维包膜形成过程实施干预，将实施干预的纤维包膜与未实施干预的纤维包膜进行组织学、免疫组织化学及微观、亚微观结构的比较，同时对比观察实施干预侧扩张后皮瓣与未实施干预侧扩张后皮瓣的回缩率变化，以进一步求证几丁糖能否作为一种安全有效的药物减轻扩张后皮瓣因纤维包膜而产生的弹性回缩作用，同时不降低纤维包膜对扩张后皮瓣的营养作用。为临床解决因纤维包膜挛缩而导致扩张后皮瓣利用率降低的问题提供依据。 1对象和方法 1.1 研究对象及分组：选取24例行扩张器植入治疗患者（均取得患者的知情同意），男女各12例，平均年龄27岁。入选标准：病损面积约为：5.0cm×10.0cm,且病损周围可同时放置2个100ml的扩张器行皮肤软组织扩张。 1.2 药品与扩张器：2%医用几丁糖（上海其胜生物制剂）；多聚甲醛（北京密利化学试剂厂）；4%中性戊二醛（河北医科大学电镜教研室提供）。 1.3 扩张器植入方法：手术前常规各项检查排除手术禁忌证,手术多采用局麻（具体操作见参考文献[2]。腔隙剥离完毕后，检查腔隙内无活动性出血，即将2%医用几丁糖2ml注入腔隙内[3]，四指并拢垫无菌纱布自剥离区皮肤面轻揉片刻以使几丁糖能均匀涂布于腔隙内表面，