应用改良型异种脱细胞真皮基质修复重建小型舌鳞癌切除术后缺损

中国口腔颌面外科杂志 ›› 2014, Vol. 12 ›› Issue (1): 56-60.

应用改良型异种脱细胞真皮基质修复重建小型舌鳞癌切除术后缺损

周瑜, 叶茂昌, 李容新, 王来平

安徽医科大学附属省立医院口腔医学中心口腔颌面头颈外科,安徽合肥 230001

收稿日期:2013-01-25 修回日期:2013-07-25 出版日期:2014-02-10 发布日期:2014-02-10
通讯作者: 叶茂昌,Tel:0551-62283374, E-mail:ye_maochang@yahoo.com.cn
作者简介:周瑜(1979-),男,硕士,主治医师,E-mail:zyugj@sina.com

Reconstruction of minor defect after resection of tongue squamous cell carcinoma with improved C-type heterogenic acellular dermis matrix

ZHOU Yu, YE Mao-chang, LI Rong-xin, WANG Lai-ping.

Department of Oral and Maxillofacial Head and Neck Surgery, Stomatology Center in Provincial Hospital Affiliated to Anhui Medical University. Hefei 230001, Anhui Province, China

Received:2013-01-25 Revised:2013-07-25 Online:2014-02-10 Published:2014-02-10

摘要/Abstract

摘要： 目的: 研究应用改良C型异种脱细胞真皮基质(H-ADM)修复重建“<25 mm×25 mm仅侵及黏膜下或肌浅层”的小型舌鳞癌切除缺损的临床价值。方法：选择2008—2011年间按入选标准收治的应用C型H-ADM修复重建小型舌癌切除遗留的舌组织缺损64例,全部以C型H-ADM覆盖创面,以拉网打包严密固定,观察拆包当天,第1、2、7、14、28天的近期疗效和3、6、12个月中期缺损创面的上皮黏膜化情况。结果：本组病例均获得随访。拆包当天即出现缺损创面的愈合过程,作为愈合过程最重要的特征是H-ADM降解后遗留的类黏液状伪膜,在1周内达到高峰,以后随时间下降,在2个月时已完全消除,此时创面已为界限模糊、稍有萎缩、光滑平坦的组织覆盖。结论：H-ADM对小型舌癌切除后遗留的缺损创面有明显促进愈合作用,局部以凡士林外裹碘仿纱条加压包扎,具有一定益处。

关键词: 异种脱细胞真皮基质, 修复重建, 舌鳞癌

Abstract: PURPOSE: To study the clinical value of reconstruction of minor defect after resection of tongue squamous cell carcinoma which was smaller than 25 mm×25 mm and only involved submucosa or superficial muscle with improved C-type heterogenic acellular dermis matrix. METHODS: Sixty-four cases were selected which underwent improved C-type heterogenic acellular dermis matrix (H-ADM) to reconstruct minor defect after resection of tongue squamous cell carcinoma. All wound surfaces were packaged and fixed with H-ADM. Changes of epithelium converting into mucosa was observed when the package was removed and 1, 2, 7, 14, 28 days, 3, 6, 12 months after surgery. RESULTS: All patients were followed up. Wound surface recovered well, and the most important feature was the para-mucus pseudomembrane after H-ADM degraded. The para-mucus pseudomembrane reached peak at 1-week, then descended gradually and disappeared 2 months later. Wound surface was then covered with indefinite, slightly atrophied and smooth tissues. CONCLUSIONS: H-ADM can obviously promote wound healing after resection of tongue squamous cell cancer; pressure dressing with vaseline indoform gauze also play an important role in wound healing promotion; H-ADM has satisfactory biocompatibility.

Key words: Heterogenic acellular dermis matrix, Reconstruction, Tongue squamous cell carcinoma

周瑜, 叶茂昌, 李容新, 王来平. 应用改良型异种脱细胞真皮基质修复重建小型舌鳞癌切除术后缺损[J]. 中国口腔颌面外科杂志, 2014, 12(1): 56-60.

ZHOU Yu, YE Mao-chang, LI Rong-xin, WANG Lai-ping.. Reconstruction of minor defect after resection of tongue squamous cell carcinoma with improved C-type heterogenic acellular dermis matrix[J]. China J Oral Maxillofac Surg, 2014, 12(1): 56-60.

参考文献

[1] Fuchs E. Skin stem cells: rising to the surface[J]. J Cell Biol, 2008, 180(2): 273-284.
[2] Mansbridge J. Skin tissue engineering[J]. J Biomater Sci Polym Ed, 2008, 19(8): 955-968.
[3] Clark RA, Ghosh K, Tonnesen MG, et al. Tissue engineering for cutaneous wounds[J]. J Invest Dermatol, 2007, 127(5): 1018-1029.
[4] Priya SG, Jungvid H, Kumar A. Skin tissue engineering for tissue repair and regeneration[J]. Tissue Eng Part B Rev, 2008, 14(1): 105-118.
[5] 黄婕, 叶茂昌, 周来生, 等. 应用无机活性元素敷料治疗老年人术后难愈性创面溃疡的初步报告[J]. 中华老年口腔医学杂志, 2008, 6(1): 21-24.
[6] 叶茂昌, Chou L, 王来平, 等. 无机活性元素骨组织工程支架材料修复山羊颌骨缺损[J]. 中国组织工程研究与临床康复, 2007, 11(48): 9627-9632.
[7] 周来生, 廖镇江, 张勤, 等. 无机活性元素对皮肤创面愈合的生物诱导作用[J]. 中华烧伤杂志, 2005, 21(5): 363-366.
[8] Obermayer A, Göstl K, Walli G, et al. Chronic venous leg ulcers benefit from surgery: long-term results from 173 legs[J]. J Vasc Surg, 2006, 44(3): 572-579.
[9] Phillips J, Rockwell WB. Surgical treatment of recessive dystrophic epidermolysis bullosa in the hand: use of tissue-engineered skin[J]. Ann Plast Surg, 2003, 50(4): 441-442.
[10] Ekiz F, Kircs V, Seker A, et al. The effect of epidermal growth factor on anastomosis, fascia, and skin wound healing[J]. Ulus Travma Acil Cerrahi Derg, 2005, 11(2): 96-101.
[11] Myers S, Leigh IM, Narsaria H. Epidermal repair results from activation of follicular and epidermal progenitor keratinocytes mediated by a growth factor cascade[J]. Wound Repair Regen, 2007, 15(5): 693-701.
[12] Wei PC, Laurell L, Linger MW, et al. Acellular dermal matrix allografts to achieve increased gingival.Part 2.A histological comparative study[J]. J Periodontol, 2002, 73(3): 257-265.
[13] Woodyard JG, Greenwell H, Hill M, et al. The clinical effects of acellular dermal matrix on gingival thickness and root coverage compared to coronally position flap alone[J]. J Periodontol, 2004, 75(1): 44-56.
[14] 蒋灿华, 李超, 石芳琼, 等. 异种脱细胞真皮基质修复膜在口腔黏膜下纤维性变手术治疗中的应用[J]. 上海口腔医学, 2011, 20(3): 273-277.
[15] Liu AS, Kao HK, Reish RG, et al. Postoperative complications in prosthesis based breast reconstruction using acellular dermal matrix[J]. Plast Reconstr Surg, 2011, 127(5): 1755-1762.
[16] 张庆泉, 孙岩, 宋西成, 等. 异种脱细胞真皮基质修复膜修复喉黏膜缺损的临床动态观察[J]. 中华耳鼻咽喉头颈外科杂志, 2009, 44(7): 561-564.
[17] Tang R, Gu Y, Gong DQ, et al. Immediate repair of major abdominal wall defect after extensive tumor excision in patients with abdominal wall neoplasm: a retrospective review of 27 cases[J]. Am Surg Oncol, 2009, 16(10): 2895-2907.
[18] Gapski R, Parks CA, Wang HL. Acellular dermal matrix for mucogingival surgery: a meta-analysis[J]. J Periodontol, 2005, 76(11): 1814-1822.
[19] Steele MH, Seagle MB. Palatal fistula repair using acellular dermal matrix: the university of Florida experience[J]. Ann Plast Surg, 2006, 56(1): 50-53.