CAJ | 학술논문

目的观察几丁糖对皮肤软组织扩张的影响.方法选择具有面部扩张器埋置适应证的患者25例,同体对照法随机选择每例患者的一侧面部为实验组,另一侧为对照组.2组面部均置入1个容量为100 ml的扩张器,实验组在皮下软组织与扩张器之间预置一根细硅胶管.术后5～7 d,待引流管被拔除,实验组经预置硅胶管注入2 ml医用几丁糖,对照组不做处理.次日2组同时开始注水,于2次注水间歇每日指压2组扩张器中央表面皮肤比较皮肤弹性及松弛度,记录2组2次注水间隔时间、注水2周和3周后总注水量以及扩张至100 ml时所用时间.待2组扩张器均注水完毕并维持2周后,Ⅱ期术中,取出扩张器,切取扩张皮瓣中央1 cm×1 cm纤维包膜,制作病理切片,比较2组纤维包膜厚度、胶原纤维平均灰度及毛细血管数量.并对比观察400倍视野光镜下成纤维细胞(FB)、胶原纤维及毛细血管的形态,对数据进行配对t检验.结果相同时间内实验组扩张器注水量多于对照组,注水期缩短,组织扩张速度明显加快；几丁糖使纤维包膜中成纤维细胞减少,向成熟期转变受到抑制,胶原纤维减少,纤维包膜变薄,但不影响纤维包膜内的毛细血管.结论几丁糖能通过抑制FB增殖及胶原产生,加速组织扩张且效果显著,值得推广应用.
목적 관찰궤정당대피부연조직확장적영향.방법 선택구유면부확장기매치괄응증적환자25례,동체대조법수궤선택매례환자적일측면부위실험조,령일측위대조조.2조면부균치입1개용량위100 ml적확장기,실험조재피하연조직여확장기지간예치일근세규효관.술후5～7 d,대인류관피발제,실험조경예치규효관주입2 ml의용궤정당,대조조불주처리.차일2조동시개시주수,우2차주수간헐매일지압2조확장기중앙표면피부비교피부탄성급송이도,기록2조2차주수간격시간、주수2주화3주후총주수량이급확장지100 ml시소용시간.대2조확장기균주수완필병유지2주후,Ⅱ기술중,취출확장기,절취확장피판중앙1 cm×1 cm섬유포막,제작병리절편,비교2조섬유포막후도、효원섬유평균회도급모세혈관수량.병대비관찰400배시야광경하성섬유세포(FB)、효원섬유급모세혈관적형태,대수거진행배대t검험.결과 상동시간내실험조확장기주수량다우대조조,주수기축단,조직확장속도명현가쾌；궤정당사섬유포막중성섬유세포감소,향성숙기전변수도억제,효원섬유감소,섬유포막변박,단불영향섬유포막내적모세혈관.결론 궤정당능통과억제FB증식급효원산생,가속조직확장차효과현저,치득추엄응용.
Objective To observe the influence of chitosan on the skin and soft tissue expansion.Methods Twenty-five patients were selected,who were suitable to be embedded soft tissue expanders in the face,a 100-milliliter expander was implanted in one side of the face,and other side was used as control.A 100-milliliter expander was implanted in each group,and a slender silicon duct was embedded between the expander and subcutaneous tissue in the experimental group.About five to seven days after the operation,the negative drainage tube was removed,and then two-milliliter medical chitosan injected with the silicon duct in the experimental group,but not in the control group.Two groups were injected with normal saline in the second day.The center of expanded skin was pressed and skin elasticity and relaxation were compared between the two groups during the injection interval.The time of injection interval,the quantity of normal saline inside the expanders after two weeks and three weeks and the total time of expansion to 100 milliliters were recorded.After injection was completed in the two groups and maintained for two weeks.In the stage Ⅱ operation,the expanders were taken out,1 cm × 1 cm fibropeplos was removed from the center of the expanded skin flap from the two groups,and pathological section was prepared to measure the thickness of fibropeplos,average gray scale of collagen and the quantity of blood capillaries.The fibroblasts,collagen fiber and capillaries were observed and compared under light microscope.A matched-pairs t analysis was used to analyze the data.Results Compared with the control group,the quantity of normal saline inside the expanders in the experimental group was increased at the same time; the water injection period was shorten and tissue expansion was significantly accelerated.The number of fibroblasts in the fibropeplos decreased with the influence of chitosan.The fibroblasts were restrained to mature period and collegan decreased.The fibropeplos became thinner but the capillaries were not affected.Conclusions Chitoson can inhibit fibroblast proliferation and collagen production,and the effect of accelerating tissue expansion is significant and deserves to be recommended.