本文選題：微等離子體 + 增生性瘢痕　； 參考：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:組織損傷后會(huì)進(jìn)行自我修復(fù),在修復(fù)過程中組織生長(zhǎng)過度和異常增生,形成瘢痕,是創(chuàng)傷后愈合最常見的并發(fā)癥,是外科修復(fù)的熱點(diǎn)、難點(diǎn)話題。分析影響臨床預(yù)后的原因,可能是由于Ⅰ型膠原、Ⅲ型膠原構(gòu)成比發(fā)生了變化。本實(shí)驗(yàn)采用Plasma對(duì)不同時(shí)期的兔耳增生性瘢痕進(jìn)行照射,經(jīng)過觀察各實(shí)驗(yàn)組與對(duì)照組中Ⅰ型膠原、Ⅲ型膠原構(gòu)成比的變化情況及瘢痕組織中膠原纖維的分布特征,探討Plasma治療增生性瘢痕不同時(shí)期的區(qū)別,為臨床確定Plasma治療增生性瘢痕的最佳時(shí)期提供理論依據(jù)。方法:選取體重在2.5±0.18kg的雄性新西蘭大白兔6只,用圓形環(huán)鉆沿兔耳耳腹長(zhǎng)軸各做6個(gè)直徑為8mm,深及軟骨表面的圓形全層皮膚創(chuàng)面缺損,各創(chuàng)面間隔1.0cm,6只兔子共形成72個(gè)圓形創(chuàng)面。隨機(jī)將72個(gè)瘢痕創(chuàng)面分成6組,分別行Plasma治療和對(duì)照(不做任何治療):1增生期治療組(n=12):造模后1個(gè)月(增生期)行Plasma照射治療。Plasma參數(shù):定點(diǎn)TIP,直徑12毫米,像束點(diǎn)間距1毫米,能量設(shè)定為80瓦,無(wú)套管治療頭(熱效應(yīng)弱,剝脫效應(yīng)強(qiáng))重復(fù)掃描4次。Plasma治療術(shù)后21天取材。2消退期治療組(n=12):造模后2個(gè)月(消退期)行Plasma照射治療。治療參數(shù)、取材時(shí)間同1組。3成熟期治療組(n=12):造模后3個(gè)月(成熟期)行Plasma照射治療。治療參數(shù)、取材時(shí)間同1組。4增生期對(duì)照組(n=12):作為增生期治療組的空白對(duì)照,不做治療,與1組同時(shí)取材。5消退期對(duì)照組(n=12):作為消退期治療組的空白對(duì)照,不做治療,與2組同時(shí)取材。6成熟期對(duì)照組(n=12):作為成熟期治療組的空白對(duì)照,不做治療,與3組同時(shí)取材。經(jīng)脫水、浸蠟、石蠟包埋等步驟后,將標(biāo)本做成厚度約為5.0μm組織切片。蘇木精-伊紅染色(hematoxylin-eosinstaining,he)、masson和天狼猩紅染色后分別觀察每個(gè)實(shí)驗(yàn)組與對(duì)照組中兔耳增生性瘢痕膠原纖維的分布特征;用苦味酸-天狼猩紅偏振光法以及圖像分析技術(shù)對(duì)各實(shí)驗(yàn)組及對(duì)照組兔耳增生性瘢痕組織中Ⅰ型膠原纖維、Ⅲ型膠原纖維的構(gòu)成比進(jìn)行測(cè)定,以反映plasma治療增生性瘢痕的成效。將各實(shí)驗(yàn)組及對(duì)照組兔耳增生性瘢痕組織中Ⅲ型膠原占的比例進(jìn)行統(tǒng)計(jì),數(shù)據(jù)用均數(shù)±標(biāo)準(zhǔn)差表示。選擇spss13.0軟件進(jìn)行數(shù)據(jù)分析,進(jìn)行完全隨機(jī)分組兩因素析因設(shè)計(jì)與方差分析,設(shè)定p0.01時(shí)差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:1組織形態(tài)學(xué)變化對(duì)照組增生期:局部腫脹充血,逐漸增厚,高出周圍正常皮膚,凸出表面,外形不規(guī)則,表面呈紅色,質(zhì)實(shí)韌,未超出原術(shù)野范圍;光鏡下見排布紊亂的膠原纖維大量增生,可見旋渦結(jié)構(gòu),微血管增生明顯。消退期:瘢痕組織厚度有所減低,硬度也開始向軟轉(zhuǎn)化,顏色由紅色向淺紅轉(zhuǎn)變、輕度萎縮;光鏡下可見到外形粗大、較增生期更密集、排列進(jìn)一步紊亂、膠原結(jié)節(jié)少見膠原纖維及減少的微血管。成熟期:瘢痕組織厚度明顯減低,但仍然高出于皮膚表面,質(zhì)地較正常皮膚硬,中央部位色白,明顯萎縮;光鏡下顯示膠原纖維外形變細(xì)、更加密集、排列明顯紊亂且無(wú)膠原結(jié)節(jié),同時(shí)微血管進(jìn)一步減少。治療組增生期:瘢痕組織質(zhì)地較軟、觸之有彈性,顏色變淺,光鏡下可見到膠原纖維變細(xì),顏色由深變淺,膠原排列有序。消退期:瘢痕組進(jìn)一步變軟、彈性增加,顏色變淡,光鏡下可見到纖維變細(xì),顏色明顯變淺,膠原排列疏散、規(guī)則的瘢痕組織膠原纖維。成熟期:瘢痕組織變得更加平軟,彈性和顏色更與周圍皮膚更加接近,光鏡下可見真皮層變薄,成纖維細(xì)胞減少;與消退期相比,膠原纖維變得細(xì)而長(zhǎng),排列更加有序。2偏光顯微鏡觀察與圖象分析對(duì)照組增生期:Ⅰ型膠原纖維約占57%,束狀分布、黃色、粗大且排列無(wú)序;Ⅲ型膠原纖維約占43%,網(wǎng)疏狀分布、綠色、細(xì)絲狀,分布于Ⅰ型膠原周圍。消退期:Ⅰ型膠原纖維增加,約占全視野的83%,外形粗大,排列明顯紊亂,相互聚集形成團(tuán)塊,相比之下Ⅲ型膠原纖維少,所占比約17%,分布于Ⅰ型膠原周圍。成熟期:Ⅰ型膠原纖維大量增加,約占整個(gè)視野的92%以上,排列更加紊亂,呈竹節(jié)狀,Ⅲ型膠原少見,所占比約為8%。治療組增生期:膠原纖維排列較增生期對(duì)照組有序,Ⅰ型膠原纖維為53%左右,低于對(duì)照組,而Ⅲ型膠原在47%左右,比例提高。消退期:可見排列較對(duì)照組規(guī)則、疏散的膠原纖維,Ⅰ型膠原纖維所占比例為69%,且型膠原纖維所占比明顯高于消退期對(duì)照組,約占31%。成熟期:可見排列疏散并趨于一致的膠原纖維,更接近于正常組織,Ⅰ型膠原纖維所占比例為75%,Ⅲ型膠原纖維所占比顯著增高,約占25%。3統(tǒng)計(jì)學(xué)分析分別統(tǒng)計(jì)各實(shí)驗(yàn)組及對(duì)照組兔耳增生性瘢痕組織中Ⅰ型膠原、Ⅲ型膠原所占的比例;應(yīng)用spss13.0對(duì)各組標(biāo)本Ⅲ型膠原所占的比例行兩因素多水平的析因分析,以p0.01作為判斷差異顯著性的標(biāo)準(zhǔn)。結(jié)果表明:在增生性瘢痕的三個(gè)不同階段,Ⅲ型膠原所占的比例不同且具有統(tǒng)計(jì)學(xué)差異(f=307.038,p=0.0000.01),plasma治療后,Ⅲ型膠原在瘢痕組織中所占的比例明顯增加(f=142.806,p=0.0000.01)。分析表明,plasma對(duì)增生性瘢痕中Ⅲ型膠原的增加程度在不同時(shí)期的亦有顯著差別(f=16.214,p=0.0000.01)。與對(duì)照組相比分別為:成熟期增加17%;消退期增加14%;增生期增加4%。因而,跟據(jù)統(tǒng)計(jì)學(xué)結(jié)果認(rèn)為:plasma治療兔耳增生性瘢痕在成熟期效果最好,其次為消退期,最后為增生期。結(jié)論:1plasma治療后,瘢痕組織質(zhì)地改善明顯,由質(zhì)地實(shí)韌變得柔軟而有彈性。將正常皮膚與瘢痕組織中的膠原纖維形態(tài)進(jìn)行比較后發(fā)現(xiàn),治療組瘢痕組織中Ⅰ、Ⅲ型膠原比值降低,更接近于正常皮膚中比例,膠原纖維形態(tài)也趨向于正常皮膚膠原纖維,這可能是微等離子體治療增生性瘢痕的機(jī)理之一。2 Plasma對(duì)不同時(shí)期增生性瘢痕的治療效果截然不同。在增生期微等離子體治療增生性瘢痕的效果不明顯;在消退期微等離子體治療增生性瘢痕的效果較增生期有所提高;在成熟期微等離子體治療增生性瘢痕的效果是最好、最明顯的。
[Abstract]:Objective: after tissue injury, self repair will be carried out. Hypergrowth and abnormal hyperplasia and scar formation during the repair process are the most common complications of post-traumatic healing. It is a hot and difficult topic for surgical repair. The analysis of the causes of clinical prognosis may be due to the change in the ratio of type I collagen and type III collagen. Plasma was used to irradiate the hypertrophic scars of rabbit ears at different times. After observing the change of collagen type I, the ratio of collagen type III and the distribution characteristics of collagen fibers in the scar tissue, the difference of Plasma in the treatment of hypertrophic scars in different periods was observed, and the best treatment for the treatment of hypertrophic scar in the clinic was to determine the most clinical value of Plasma in the treatment of hypertrophic scar. The theoretical basis was provided at the good time. Methods: 6 male New Zealand white rabbits with a weight of 2.5 + 0.18kg were selected, with round ring drilling along the long axis of the ears of the rabbit ear, 6 diameters of 8mm, deep and cartilaginous surface of the full layer skin wound defect, each wound interval 1.0cm, 6 rabbits were formed 72 circular wounds, and 72 scar wounds were randomly divided into 6 groups. Plasma treatment and control (no treatment): 1 hyperplastic period treatment group (n=12):.Plasma parameters were treated by Plasma irradiation after 1 months of modeling: designated TIP, 12 mm in diameter, 1 mm like beam point spacing, 80 watts of energy, and 21 days after 4.Plasma treatments without cannula therapy head (heat effect weak, exfoliation effect) .2 treatment group (n=12): 2 months after the model (regression period) treated with Plasma irradiation. Treatment parameters, time and 1 groups of.3 mature period treatment group (n=12): 3 months after the model (mature stage) Plasma irradiation treatment. Treatment parameters, time and 1 groups of.4 proliferation period control group (n=12): as a blank control group of hyperplastic treatment group, no treatment, no treatment, The control group (n=12) was taken from the 1 group at the same time as the control group (.5). As a blank control group in the treatment group, the control group was not treated with the 2 group, and the.6 mature control group (n=12) was obtained simultaneously. As a blank control group of the mature period treatment group, no treatment was done, and the 3 groups were taken simultaneously. After dehydration, wax impregnation and paraffin embedding, the specimens were made into a thickness of about 5 mu m tissue. The distribution characteristics of collagen fibers in rabbit ear hypertrophic scar were observed by hematoxylin-eosinstaining (he), Masson and Sirius red staining in each experimental group and the control group, respectively. In the experimental group and the control group, the experimental group and the control group were treated with the image analysis technique. The composition ratio of type I collagen fiber and type III collagen fiber was measured to reflect the effect of plasma in the treatment of hypertrophic scar. The proportion of type III collagen in the hypertrophic scar tissue of the experimental group and the control group was counted and the data were expressed with the mean standard deviation of mean number. The SPSS13.0 software was selected to carry out the data analysis and carry out the complete random grouping. Two factor analysis of factorial design and variance analysis, the difference was statistically significant when setting P0.01. Results: 1 the hyperplastic period in the control group of the control group: local swelling and hyperemia, gradually thickening, high out of the normal skin, convex surface, irregular shape, red surface, solid and tough, not beyond the scope of the original field; under the light microscope, the collagen fibrous fiber arranging disorder was seen in the light microscope. A large number of hyperplasia, visible vortex structure, microvascular hyperplasia obvious. Decline period: the thickness of scar tissue decreased, the hardness began to change to soft, color from red to light red, light atrophy, light microscope can be seen thicker, more dense than the proliferation stage, a step disorder, collagenoid nodules rare collagen fibers and reduced microvessels. Mature period: the thickness of scar tissue decreased obviously, but still high out of the skin surface, the texture of the skin was more hard, the central part was white and atrophy, and the collagen fibers were thinner and denser in the light microscope, the arrangement of the collagen fibers was obviously disorderly and no collagen nodules, and the microvessels were reduced in one step. The hyperplastic period of the treatment group was softer and touch. It is elastic, light color, light microscope can see collagen fiber thinner, color from deep to shallow, collagen arrangement orderly. Decline period: scar group further soften, increase elasticity, color fade, light microscope can see fiber thinner, the collagen arrangement is evacuate, regular scar tissue collagen fiber. Mature period: scar tissue becomes even more Soft, elastic and color more close to the surrounding skin, the light microscope showed that the dermis thinned and fibroblasts decreased. Compared with the fading period, the collagen fibers became thinner and longer, arranged more orderly.2 polarizing microscope observation and image analysis control group proliferation period: type I collagen fibers accounted for about 57%, fascicular distribution, yellow, coarse and disordered. Type III collagen fibers accounted for about 43%, mesh sparse distribution, green, filamentous, distributed around type I collagen. Phase I collagen fibers increased, accounting for about 83% of the whole field of vision, the shape was large, the arrangement was obviously disorderly and formed a group, compared with type III collagen fibers, about 17%, distributed around type I collagen. Collagen fibers increased in a large amount, accounting for more than 92% of the whole field of vision, and the arrangement was more disorder. The collagen fibers were more disorder. The type III collagen was rare. The proportion of collagen fiber was about 8%. treatment group. The collagen fiber arrangement was more orderly than the control group, and the type I collagen fiber was about 53%, lower than the control group, and the proportion of type III collagen was about 47%. The proportion of collagen fiber in evacuation was 69%, and the proportion of type I collagen fiber was 69%, and the proportion of type collagen fibers was significantly higher than that in the control group, which accounted for the mature period of the collagen fibers, which were arranged to be identical to the normal tissue, and the proportion of type I collagen fibers was 75%, and the ratio of type III collagen fibers was the ratio of collagen fiber. The proportion of type I collagen and type III collagen in the rabbit ear hypertrophic scar tissue was statistically analyzed by 25%.3 statistical analysis, and the proportion of type III collagen in the rabbit ear hypertrophic scar tissue was measured by SPSS13.0, and two factors were used to analyze the proportion of type III collagen in each group, and P0.01 was used as the criterion to judge the difference significance. The results showed that: In the three different stages of hypertrophic scar, the proportion of type III collagen is different and has statistical difference (f=307.038, p=0.0000.01). After plasma treatment, the proportion of type III collagen in scar tissue is significantly increased (f=142.806, p=0.0000.01). The analysis shows that the increase of type III collagen in hypertrophic scar is different at the same time. There were also significant differences in the period (f=16.214, p=0.0000.01). Compared with the control group, the maturation period increased by 17%, the stage of extinction increased by 14%, and the proliferation period increased by 4%., and according to the statistical results, the effect of plasma in the treatment of hypertrophic scar in the rabbit ears was the best in the mature stage, followed by the elimination period, and the final hyperplastic period. Conclusion: after 1plasma treatment, scar tissue was treated. The texture improvement is obvious, and the texture is soft and flexible. After comparing the collagen fibers in the normal skin and the scar tissue, it is found that the ratio of type I and type III collagen in the scar tissue of the treatment group is lower, which is closer to the normal skin ratio, and the collagen fiber form tends to the normal skin collagen fiber, which may be the micro separation. The therapeutic effect of.2 Plasma on hypertrophic scar in different periods is very different. The effect of microplasma treatment on hypertrophic scar is not obvious in the stage of proliferation. The effect of microplasma treatment on hyperplastic scar in the stage of regression is higher than that in the proliferative stage. The effect of sexual scarring is the best and most obvious.

【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R622

【參考文獻(xiàn)】

相關(guān)期刊論文 前9條

1 張藝齡;張振;陳向東;;微等離子體射頻技術(shù)對(duì)人體皮膚組織及相關(guān)因子的影響[J];同濟(jì)大學(xué)學(xué)報(bào)(醫(yī)學(xué)版);2016年05期

2 王靚謙;賴琳英;耿yN楠;顏彤彤;馬奎;白馨月;梁黎明;陳敏亮;;不同功率微等離子射頻治療增生性瘢痕的效果評(píng)價(jià)[J];中國(guó)醫(yī)藥導(dǎo)報(bào);2016年07期

3 李穎平;謝紅付;簡(jiǎn)丹;丁榮;劉芳芬;汪r，

本文編號(hào)：1827374