中国组织工程研究与临床康复
中國組織工程研究與臨床康複
중국조직공정연구여림상강복
JOURNAL OF CLINICAL REHABILITATIVE TISSUE ENGINEERING RESEARCH
2009年
47期
9365-9368
,共4页
刘蓉蓉%陈继川%姬长友%张民%王宜南
劉蓉蓉%陳繼川%姬長友%張民%王宜南
류용용%진계천%희장우%장민%왕의남
脱细胞真皮基质黏膜组织补片%喉咽癌%组织修复
脫細胞真皮基質黏膜組織補片%喉嚥癌%組織脩複
탈세포진피기질점막조직보편%후인암%조직수복
背景:异体脱细胞真皮基质黏膜组织补片(acellular dermalmatrix,ADM)作为一种新型组织修复材料,目前已经广泛应用于头颈部肿瘤术后组织缺损修复.但下咽癌手术多涉及咽、喉部组织缺损的修复与功能重建,其在下咽癌术后下咽缺损修复中的应用效果有待更多的研究验证.目的:实验拟验证脱细胞真皮基质黏膜组织补片在喉咽癌切除术后喉咽修复中的作用效果.设计、时间及地点:回顾性病例分析,于2005-05/2006-06在解放军第三军医大学大坪医院野战外科研究所耳鼻咽喉-头颈外科完成.对象:男性喉咽癌确诊患者25例,年龄45-68岁,其中肿瘤原发于梨状窝侧壁22例,原发于喉咽后壁3例,病理诊断为均鳞状细胞癌.方法:根据临床分期不同采用部分或全喉咽切除术,术后均采用正海生物有限公司提供的海奥~(TM)脱细胞异体真皮基质组织补片进行咽腔黏膜修复.修复黏膜片状缺损时可单独使用ADM,其局限性在于单纯应用ADM不能完成空间结构重建,因此对于喉咽全切除患者,喉咽腔重建时结合肌皮瓣等其他材料.主要观察指标:咽腔术部黏膜修复情况及患者吞咽、呼吸、发音等功能重建情况.结果:25例患者均进入结果分析,无脱落.25例患者均无咽瘘发生,1例部分喉咽切除术后20 d出现颈部局灶性皮下感染,换药后创面愈合.喉咽部分切除的15例患者均发生不同程度呛咳.术后30～60 d吞咽功能基本恢复,3例患者进食流质时仍有轻微呛咳,可以忍受,不影响进食.喉呼吸功能均恢复,术后6～12个月拔除气管套管.喉咽全切除10例患者喉咽腔重建均获得成功,术后20 d左右即恢复正常饮食.术后随访12～30个月,ADM修复区外观与正常黏膜相似,无明显咽腔狭窄.随访24个月以上10例,其中1例肿瘤复发,再次手术后健在.结论:ADM具有良好的组织相容性、塑形性和易操作性,与受区组织可以完全无差别融合,可用于喉咽癌术后组织缺损修复,利于发音、呼吸、吞咽等功能恢复,与肌皮瓣及其他颈部修复材料联合应用亦能取得满意疗效.
揹景:異體脫細胞真皮基質黏膜組織補片(acellular dermalmatrix,ADM)作為一種新型組織脩複材料,目前已經廣汎應用于頭頸部腫瘤術後組織缺損脩複.但下嚥癌手術多涉及嚥、喉部組織缺損的脩複與功能重建,其在下嚥癌術後下嚥缺損脩複中的應用效果有待更多的研究驗證.目的:實驗擬驗證脫細胞真皮基質黏膜組織補片在喉嚥癌切除術後喉嚥脩複中的作用效果.設計、時間及地點:迴顧性病例分析,于2005-05/2006-06在解放軍第三軍醫大學大坪醫院野戰外科研究所耳鼻嚥喉-頭頸外科完成.對象:男性喉嚥癌確診患者25例,年齡45-68歲,其中腫瘤原髮于梨狀窩側壁22例,原髮于喉嚥後壁3例,病理診斷為均鱗狀細胞癌.方法:根據臨床分期不同採用部分或全喉嚥切除術,術後均採用正海生物有限公司提供的海奧~(TM)脫細胞異體真皮基質組織補片進行嚥腔黏膜脩複.脩複黏膜片狀缺損時可單獨使用ADM,其跼限性在于單純應用ADM不能完成空間結構重建,因此對于喉嚥全切除患者,喉嚥腔重建時結閤肌皮瓣等其他材料.主要觀察指標:嚥腔術部黏膜脩複情況及患者吞嚥、呼吸、髮音等功能重建情況.結果:25例患者均進入結果分析,無脫落.25例患者均無嚥瘺髮生,1例部分喉嚥切除術後20 d齣現頸部跼竈性皮下感染,換藥後創麵愈閤.喉嚥部分切除的15例患者均髮生不同程度嗆咳.術後30～60 d吞嚥功能基本恢複,3例患者進食流質時仍有輕微嗆咳,可以忍受,不影響進食.喉呼吸功能均恢複,術後6～12箇月拔除氣管套管.喉嚥全切除10例患者喉嚥腔重建均穫得成功,術後20 d左右即恢複正常飲食.術後隨訪12～30箇月,ADM脩複區外觀與正常黏膜相似,無明顯嚥腔狹窄.隨訪24箇月以上10例,其中1例腫瘤複髮,再次手術後健在.結論:ADM具有良好的組織相容性、塑形性和易操作性,與受區組織可以完全無差彆融閤,可用于喉嚥癌術後組織缺損脩複,利于髮音、呼吸、吞嚥等功能恢複,與肌皮瓣及其他頸部脩複材料聯閤應用亦能取得滿意療效.
배경:이체탈세포진피기질점막조직보편(acellular dermalmatrix,ADM)작위일충신형조직수복재료,목전이경엄범응용우두경부종류술후조직결손수복.단하인암수술다섭급인、후부조직결손적수복여공능중건,기재하인암술후하인결손수복중적응용효과유대경다적연구험증.목적:실험의험증탈세포진피기질점막조직보편재후인암절제술후후인수복중적작용효과.설계、시간급지점:회고성병례분석,우2005-05/2006-06재해방군제삼군의대학대평의원야전외과연구소이비인후-두경외과완성.대상:남성후인암학진환자25례,년령45-68세,기중종류원발우리상와측벽22례,원발우후인후벽3례,병리진단위균린상세포암.방법:근거림상분기불동채용부분혹전후인절제술,술후균채용정해생물유한공사제공적해오~(TM)탈세포이체진피기질조직보편진행인강점막수복.수복점막편상결손시가단독사용ADM,기국한성재우단순응용ADM불능완성공간결구중건,인차대우후인전절제환자,후인강중건시결합기피판등기타재료.주요관찰지표:인강술부점막수복정황급환자탄인、호흡、발음등공능중건정황.결과:25례환자균진입결과분석,무탈락.25례환자균무인루발생,1례부분후인절제술후20 d출현경부국조성피하감염,환약후창면유합.후인부분절제적15례환자균발생불동정도창해.술후30～60 d탄인공능기본회복,3례환자진식류질시잉유경미창해,가이인수,불영향진식.후호흡공능균회복,술후6～12개월발제기관투관.후인전절제10례환자후인강중건균획득성공,술후20 d좌우즉회복정상음식.술후수방12～30개월,ADM수복구외관여정상점막상사,무명현인강협착.수방24개월이상10례,기중1례종류복발,재차수술후건재.결론:ADM구유량호적조직상용성、소형성화역조작성,여수구조직가이완전무차별융합,가용우후인암술후조직결손수복,리우발음、호흡、탄인등공능회복,여기피판급기타경부수복재료연합응용역능취득만의료효.
BACKGROUND: Acellular dermalmatrix (ADM), as a new material, is generally applied to tissue repair after head and neck tumorectomy. However, hypopharyngeal carcinoma surgery always involves in repair and functional reconstruction of defected tissue; therefore, the application effect of ADM needs to be further studied for repairing laryngopharynx defect. OBJECTIVE: To evaluate the clinical effect of ADM in repairing laryngopharynx defect following tumorectomy. DESIGN, TIME AND SETTING: A retrospective case analysis was performed at the Department of Otolaryngology-Head and Neck Surgery, Institute of Battle Surgery, Daping Hospital, the Third Military Medical University of Chinese PLA from May 2005 to June 2006.PATICIPANTS: A total of 25 male cases aged 45-68 years including 22 patients with tumor in the lateral wall of the unilateral piriform fossa and 3 patients with in the posterior wall of laryngopharynxat were finally diagnosed as squamous cell carcinoma. METHODS: According to clinical stages, patients underwent partial or complete laryngopharyngectomy. ADM was used to repair oropharynx mucosa following the laryngopharyngectomy. However, ADM alone was used to repair piece-shaped oropharynx mucosa, limiting by being unable to complete reconstruction of spatial structure. Therefore, myocutaneous flap or other materials combined with ADM was beneficial for reconstruction of laryngopharyngeal cavity following complete laryngopharyngectomy. MAIN OUTCOME MEASURES: The effect of ADM on functional reconstruction of swallowing, breathing, and pronouncing. RESULTS: A total of 25 patients were included in the final analysis. No patients suffered with the pharyngeal fistula. Only one case encountered the subcutaneous infection at day 20 after surgery, but recovering after regular change of dressing and treatment of antibiotics. About 15 patients who accepted the surgery of partial laryngopharyngectomy suffered with bucking, but after 30-60 days, the symptom relieved, even disappeared, in spite of 3 cases still bucking when they swallowed liquid diet. Breathing function was recovered, and tracheal cannula was removed 6-12 months after surgery. Ten of them who accepted total laryngopharyngectomy had resumption of normal oral diet after 20 days. The follow-up periods after the surgery lasted 12-30 months. The allograft became normal mucosa finally, without rejection or scar formation. The follow-up of 10 patients lasted more than 24 months, one case had relapse of tumor, still alive after the second surgery. CONCLUSION: ADM with perfect histocompatibility and easy operability, can be applied to repair deletion of laryngeal or pharyngeal tissue and recover functions of pronouncing, breathing, and swallowing after tumorectomy. The combined use of ADM and musculo-cutaneous flap was effective and satisfactory.
