【摘要】：目的探討臨床應(yīng)用以人羊膜為基質(zhì)的活性皮膚替代物(amniotic membrane-living skin equivalent,AM-LSE)修復(fù)皮膚缺損的可行性。方法 2016年7月收治1例5歲頸肩背部先天性巨痣患兒。首先取其正常皮膚分離擴(kuò)增表皮角化細(xì)胞和真皮成纖維細(xì)胞,再以自愿捐贈的人去上皮AM為基質(zhì),經(jīng)氣液面培養(yǎng)10 d構(gòu)建含有真皮基質(zhì)和重層分化表皮的AM-LSE。對AM-LSE行大體及組織學(xué)觀察。手術(shù)切除巨痣至深筋膜層,遺留創(chuàng)面面積為20 cm×15 cm;覆蓋膠原蛋白海綿人工真皮,2周后改用AM-LSE貼敷于肉芽創(chuàng)面,之后常規(guī)換藥。術(shù)后觀察AM-LSE成活以及創(chuàng)面修復(fù)效果。結(jié)果氣液面培養(yǎng)10 d后,成功構(gòu)建具有真皮層以及重層分化良好的表皮層的AM-LSE。臨床修復(fù)術(shù)后見AM-LSE貼敷良好,逐漸擴(kuò)大融合,至術(shù)后6個月其色澤接近正常皮膚,質(zhì)地柔軟,皮片間隙為淡紅色瘢痕。組織學(xué)觀察,可見呈柱狀緊湊排列的基底層細(xì)胞,以及分化的棘細(xì)胞層、顆粒層以及角質(zhì)層。真皮層內(nèi)分布大量成纖維細(xì)胞以及血管,未見明顯炎性細(xì)胞浸潤。結(jié)論采用自體皮膚細(xì)胞構(gòu)建的AM-LSE移植修復(fù)創(chuàng)面可行,術(shù)后能長期存活,且無排斥反應(yīng)。
[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.
【作者單位】： 汕頭大學(xué)醫(yī)學(xué)院第二附屬醫(yī)院燒傷整形外科;汕頭大學(xué)醫(yī)學(xué)院轉(zhuǎn)化醫(yī)學(xué)研究中心;陜西省人民醫(yī)院燒傷整形外科;
【基金】：國家自然科學(xué)基金資助項目(81272116) 陜西省自然科學(xué)基礎(chǔ)研究計劃項目(2014JM4192) 教育部留學(xué)回國人員科研啟動基金(教外司[2013]693號)~~
【分類號】：R758.51

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