本文選題：表皮干細(xì)胞 + 膜片��； 參考：《河南科技大學(xué)》2012年碩士論文

【摘要】：目的 巨痣是一種以黑色素細(xì)胞異常遷移聚集于體表，且分布面積巨大為特征的皮膚良性腫瘤，可累及整個(gè)肢體、全頭皮、肩部、軀干部等。巨痣皮膚可粗糙，增厚，附有毛發(fā)，潰爛，甚至伴有神經(jīng)纖維瘤，部分有惡變可能，如繼發(fā)黑色素瘤等。從前瞻性隨訪結(jié)果來(lái)看，巨痣的惡變率在10%-20%不等，而巨痣切除術(shù)后標(biāo)本陽(yáng)性檢出率低于上述數(shù)值，相關(guān)報(bào)道認(rèn)為黑色素瘤患者繼發(fā)于巨痣者占40%-60%。同時(shí)，巨痣常位置暴露，嚴(yán)重影響美觀，給患者心理健康及社會(huì)帶來(lái)較多的負(fù)面影響，其治療勢(shì)在必行。 大多數(shù)學(xué)者認(rèn)為，當(dāng)巨痣病灶較明顯地增大、顏色改變、破潰、脫毛、出現(xiàn)衛(wèi)星灶、繼發(fā)感染以及疼痛等表現(xiàn)時(shí)，應(yīng)盡早手術(shù)，并進(jìn)行病理檢查。即使沒有上述表現(xiàn)時(shí)，也應(yīng)進(jìn)行預(yù)防性的手術(shù)治療。當(dāng)前研究較多地集中于巨痣手術(shù)方式的改進(jìn)，以期促進(jìn)功能的穩(wěn)定和形態(tài)的改觀。國(guó)內(nèi)外報(bào)道其治療方式報(bào)道較多，如激光、化學(xué)藥物、冷凍.電灼.中草藥涂抹等，而手術(shù)則是治療巨痣較為可靠的方法，手術(shù)方法有切削法、巨痣切除后皮片移植法、皮膚軟組織擴(kuò)張后擴(kuò)張皮瓣轉(zhuǎn)移法、局部皮瓣轉(zhuǎn)移法、皮管轉(zhuǎn)移法分次切除法等。術(shù)后創(chuàng)面的缺損修復(fù)、皮源困難和愈后瘢痕等并發(fā)癥，往往給患者機(jī)體造成難以承受的痛苦. 創(chuàng)面的上皮化對(duì)創(chuàng)面愈合極為重要，創(chuàng)面上皮化的進(jìn)程，反映了創(chuàng)面愈合程度，在創(chuàng)面愈合過(guò)程中，適當(dāng)早的上皮化不僅可保護(hù)創(chuàng)面，減少感染等并發(fā)癥的發(fā)生機(jī)率，而且對(duì)后期瘢痕攣縮或增生等方面并發(fā)癥的防治具有積極的意義。相關(guān)研究表明表皮干細(xì)胞在創(chuàng)面上皮化過(guò)程中發(fā)揮著重要的作用，說(shuō)明表皮干細(xì)胞在創(chuàng)面愈合中具有較為積極的意義。 既往相關(guān)研究和臨床治療方式為巨痣治療提供了較好的基礎(chǔ)，然而其治療效果常不能更充分地獲得病人的滿意，特別是對(duì)于面積較大、部位特殊的巨痣，因缺乏標(biāo)準(zhǔn)化的治療指導(dǎo)模式，而使其功能形態(tài)改善效果欠理想。本文利用表皮干細(xì)胞膜片修復(fù)巨痣切削術(shù)后創(chuàng)面缺損，觀察其臨床療效，探討一種既能節(jié)約皮源，又能較好地改善巨痣功能形態(tài)的有效手術(shù)方式。 方法 本組男4例，女6例；年齡1歲～3.5歲，平均2.5歲，均為先天性，巨痣面積隨年齡增長(zhǎng)逐漸增大。巨痣范圍為25cm×10cm～45cm×65cm。10例患者均未曾治療。手術(shù)部位為軀干，雙大腿。入院檢查見巨痣表面皮膚破潰及滲出1例，毛發(fā)生長(zhǎng)3例，其余6例皮膚質(zhì)地與周圍一致；皮膚感覺瘙癢明顯2例。病理學(xué)檢查確診為交界痣4例，混合痣6例。根據(jù)患者巨痣分布部位設(shè)計(jì)手術(shù)分期方案，實(shí)驗(yàn)組經(jīng)患者家長(zhǎng)同意，簽訂倫理協(xié)議，在組織工程國(guó)家工程中心河南科技大學(xué)生物工程研究所抽取靜脈血進(jìn)行表皮干細(xì)胞的分離、培養(yǎng)。干細(xì)胞培養(yǎng)三周將表皮干細(xì)胞膜片，移植于巨痣切削術(shù)后創(chuàng)面，外用油性愈幫敷料，，無(wú)菌紗布包扎固定，4-5天拆除敷料。對(duì)照組入院行手術(shù)切削后自體刃厚皮片移植,外用油性愈幫敷料，無(wú)菌紗布包扎固定，4-5天拆除敷料。觀察創(chuàng)面愈合時(shí)間，及愈后情況。 采用SPSS16.0統(tǒng)計(jì)軟件包進(jìn)行分析。數(shù)據(jù)以均數(shù)±標(biāo)準(zhǔn)差表示，組間比較采用t檢驗(yàn)；檢驗(yàn)水準(zhǔn)α=0.05。 結(jié)果 1.兩組巨痣患者切削術(shù)后均無(wú)感染等明顯并發(fā)癥。 2.實(shí)驗(yàn)組較對(duì)照組創(chuàng)面愈合時(shí)間明顯縮短，（P0.05）。 3.患者術(shù)后均獲隨訪，隨訪時(shí)間為7個(gè)月～2年，平均15個(gè)月。實(shí)驗(yàn)組較對(duì)照組在瘢痕增生或攣縮、皮膚色澤及彈性和局部器官牽拉皮膚的功能等方面表現(xiàn)良好。 結(jié)論 1.以表皮干細(xì)胞膜片修復(fù)巨痣切削術(shù)后繼發(fā)創(chuàng)面，術(shù)后并發(fā)癥輕微； 2.以表皮干細(xì)胞膜片修復(fù)巨痣切削術(shù)后繼發(fā)創(chuàng)面，可明顯縮短愈合時(shí)間； 3.以表皮干細(xì)胞膜片修復(fù)巨痣切削術(shù)后繼發(fā)創(chuàng)面，無(wú)需供皮區(qū)，擴(kuò)大了巨痣切除面積。 4.以表皮干細(xì)胞膜片修復(fù)巨痣切削術(shù)繼發(fā)創(chuàng)面該法僅適合交界痣，混合痣。不適合皮內(nèi)痣。 5.以刃厚皮片修復(fù)巨痣切削術(shù)后繼發(fā)創(chuàng)面，并發(fā)癥較多。 6.以刃厚皮片修復(fù)巨痣切削術(shù)后繼發(fā)創(chuàng)面該法僅適合皮內(nèi)痣,混合痣，不適合交界痣.
[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 鹵 standard deviation , and t test was used between the groups .
Inspection level 偽 = 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 .
【學(xué)位授予單位】：河南科技大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R758.51

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