CAJ | 학술논문

目的应用脱细胞异体真皮基质(ADM)治疗动物模型肛瘘,探讨ADM治疗肛瘘的愈合机制.方法建立长白猪肛瘘动物模型(14头),应用ADM填塞治疗.ADM治疗后12h、24h、72 h、7d、14d、28 d和60d分别取肛瘘治疗标本(每组2头)行苏木精-伊红染色及免疫组织化学染色检查肛瘘组织恢复情况.结果术后12 h ADM边缘可见炎性细胞浸润,并可见成纤维细胞长入.术后7d浸润细胞密度较术后12 h显著升高(998.7±128.0比218.2±58.2,P＜0.01)；术后7～28 d,密度逐渐下降.术后7d,在ADM边缘可见成熟新生血管和肌成纤维细胞；术后14 d血管密度(30.5±5.2)较术后7d(11.2±-3.3)增加(P＜0.01),肌成纤维细胞的密度也较术后7d增加(6.8±0.4比3.8±0.8,P＜0.01).术后60 d可见规则排列的肌肉组织长入.结论脱细胞异体真皮基质植入体内后的血管化和被宿主细胞的再塑形可能在肛瘘愈合中起重要作用.ADM可成功用于治疗动物模型肛瘘,并可能进一步用于其他慢性感染创面的治疗.
목적 응용탈세포이체진피기질(ADM)치료동물모형항루,탐토ADM치료항루적유합궤제.방법 건립장백저항루동물모형(14두),응용ADM전새치료.ADM치료후12h、24h、72 h、7d、14d、28 d화60d분별취항루치료표본(매조2두)행소목정-이홍염색급면역조직화학염색검사항루조직회복정황.결과 술후12 h ADM변연가견염성세포침윤,병가견성섬유세포장입.술후7d침윤세포밀도교술후12 h현저승고(998.7±128.0비218.2±58.2,P＜0.01)；술후7～28 d,밀도축점하강.술후7d,재ADM변연가견성숙신생혈관화기성섬유세포；술후14 d혈관밀도(30.5±5.2)교술후7d(11.2±-3.3)증가(P＜0.01),기성섬유세포적밀도야교술후7d증가(6.8±0.4비3.8±0.8,P＜0.01).술후60 d가견규칙배렬적기육조직장입.결론 탈세포이체진피기질식입체내후적혈관화화피숙주세포적재소형가능재항루유합중기중요작용.ADM가성공용우치료동물모형항루,병가능진일보용우기타만성감염창면적치료.
Objective To evaluate the efficacy of acellular dermal matrix(ADM) in the closure of anal fistula in an experimental porcine model,and to explore its healing mechanism.Methods The fistula-in-ano model was created and treated with ADM in the porcine model (n=14).Fistula specimens were obtained at hour 12,24 and day 3,7,14,28,60 respectively with 2 pigs in each time point.Hematoxylin and eosin staining and immunohistochemical staining for the alpha smooth muscle actin(α-SMA) were performed.Results At 12 hours after implantation,neutrophils and scattered cells with a fibroblastic appearance were present at the interface and began to infiltrate into the ADM.The cell density increased from hour 12 (218.2±58.2)to day 7 (998.7±128.0) (P＜0.01),and decreased from day 7 to day 28.Mature vessels and myofibroblasts stained with α-SMA were identified at the edge of ADM at day 7.The density of vessels (11.2±3.3 vs.30.5±5.2,P＜0.01) and myofibroblasts (3.8±0.8 vs.6.8±0.4,P＜0.01) increased from day 7 to day 14.Partially organized bundles of muscle were found at day 60.Conclusions ADM is a reasonable new option for the closure of anal fistula.The ability of ADM to become vascularized and remodeled by autologous cells may be advantageous for anal fistula healing and other chronic septic wound.