大面积烧伤微粒皮移植应用脱细胞猪皮与异体皮作为覆盖物的对比研究

Acellular porcine skin and allogeneic skin as wound-covering materials for extensive deep burns:a comparative study

目的通过与异体皮覆盖自体微粒皮移植术进行对比研究,评价异种脱细胞猪皮覆盖自体微粒皮移植术的临床优势。方法回顾性分析1999年1月至2011年1月间昆明医科大学第二附属医院烧伤科收治的70例大面积深度烧伤患者资料,根据手术方法的不同分为2组:脱细胞猪皮覆盖自体微粒皮移植术组(35例)和异体皮覆盖自体微粒皮移植术组(35例),观察患者术后第4周微粒皮成活率、术后2种覆盖物排斥情况、体温变化,血白细胞计数、中性粒细胞比例、淋巴细胞绝对值及血清蛋白水平变化。结果 (1)脱细胞猪皮组术后第4周微粒皮成活率与异体皮组比较差异无统计学意义[(71.5±6.6)%vs(70.6±7.5)%,P>0.05]。(2)脱细胞猪皮组术后3d脱细胞猪皮与创面附着良好,大部分猪皮不变色,部分呈褐色。3～4周脱细胞猪皮干燥与基底分离,受压部位有少量积液,但无猪皮溶解,揭去猪皮后见微粒皮成活、融合成片。异体皮组移植后3～14d异体表皮开始排斥剥脱,移植后10～30d异体真皮干枯,移植后25～60d异体真皮剥脱,覆盖的异体真皮完全脱落,微粒皮扩展成片,创面愈合。(3)两组患者术后体温均较术前下降(P<0.01),异体皮组在术后第14天体温较脱细胞猪皮组升高(P<0.01)。(4)两组患者外周血白细胞计数和中性粒细胞比例较术前降低(P<0.05),术后第7、14天时脱细胞猪皮组白细胞计数低于异体皮组(P<0.05,P<0.01);两组患者外周血淋巴细胞绝对值较术前升高(P<0.01),术后第14天时脱细胞猪皮组低于异体皮组(P<0.01);术后两组患者血清蛋白水平差异无统计学意义(P>0.05)。结论应用异种脱细胞猪皮代替异体皮行自体微粒皮复合移植治疗大面积深度烧伤创面可减轻患者全身炎性反应,改善患者的营养状况,减少对异体皮的依赖,说明脱细胞猪皮可作为同种异体皮的良好的替代材料。

Objective To evaluate the advantages of microskin graft using acellular porcine skin for treatment of extensive deep burns by comparing with that using allogeneic skin.Methods A retrospective analysis was conducted on 70 severe burn patients who were treated in the Second Affiliated Hospital of Kunming Medical University during Jan.1999 to Jan.2011.The patients were divided into the acellular porcine skin group and allogeneic skin group,each containing 35 patients.The survival rates of microskin grafts were determined at 4 weeks post-operation.Besides,the rejection of acellular porcine skin and allogeneic skin,changes of body temperature,white blood cell（WBC） count,lymphocyte and serum protein were observed at pre-and post-operation.Results（1） The survival rate was（71.5±6.6）% in acellular porcine skin group and（70.6±7.5）% in allogeneic skin group,with no significant difference found between the two groups（P〈0.05）.（2） Acellular porcine skin group.At 3 days post-operation the acellular porcine skin was still attached to the wound,most of the skin was not discolorated,and small part of the skin became cinnamomeous.The acellular porcine skin was gradually separated from the auto-microskin at 3-4 weeks post operation,and there was small amount of exudates under the acellular porcine skin,which could be drained through a small cut.In the pressed area,there was still a small amount of exudates,but the acellular porcine skin was not dissolved and the microskin grafts survived and became confluent.（3） Allogeneic skin group.The allogeneic epidermal was rejected and was off from the wound at 3-14 days post transplantation,and at 10-30 days after transplantation the allogenic dermis became dry.During 25-60 days after transplantation,the allogenic dermis was completely stripped off,the microskin grafts became confluent,and the wound was healed.（4） The body temperature of the two groups was significantly descended after operation（P〈0.01）.The temperature of acellular porcine skin group was significantly lower than that of allogeneic skin group at 14 day post-operation（P〈0.01）.（5） The WBC count and percentage of neutrophils were also significantly decreased in both two groups after operation（P〈0.05）,and WBC counts in the acellular porcine skin group was significantly lower than those in the allogeneic skin group at 7 and 14 days after operation（P〈0.05,P〈0.01）.The peripheral blood lymphocytes were also significantly increased after operation（P〈0.01） and the lymphocytes in the acellular porcine skin group were significantly less than those in the allogeneic skin group at 14 days after operation（P〈0.01）.Blood biochemistry results showed no significant differences in the protein levels between the two groups（P〉0.05）.Conclusion Microskin graft using acellular porcine skin,instead of allogeneic skin,for extensive burn patients can inhibit systematic inflammatory response,improve the nutrition condition,and reduce the using of allogeneic skin.Acellular porcine skin might be a suitable alternative for allogeneic skin.