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

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

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。

[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-mueus 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.