MEBT/MEBO治疗慢性难愈性创面的临床疗效分析

Analysis of Clinical Efficacy of Treating Chronic Refractory Wounds with MEBT/MEBO

目的探索原位再生医疗技术(MEBT/MEBO)治疗慢性难愈性创面的治疗特点及临床疗效。方法52例慢性难愈性创面患者在治疗基础疾病的同时局部采用MEBT/MEBO治疗;无法自愈的创面,查找病因,彻底清除病灶,待肉芽组织培养成熟后行植皮等手术治疗;动态监测创面分泌物的培养及药敏试验结果,并根据培养及药敏试验结果针对性用药;观察、分析治疗效果。结果52例患者经MEBT/MEBO治疗后感染得到有效控制,创面完全愈合时间为99.83 d±35.44 d(30 d^180 d),其中31例患者通过湿润烧伤膏(MEBO)换药治疗后创面自行愈合;2例患者在MEBO换药治疗后,行Ⅱ期手术缝合处理,创面愈合;2例患者创面通过邻近皮瓣推进手术修复;2例糖尿病足并发足趾坏疽患者接受截趾手术,术后创面愈合良好;其余15例患者共行20次植皮手术后创面愈合。随访1年发现,所有植皮创面的皮下组织饱满均匀,部分愈后皮肤散在色素沉着,皮肤质地柔软,延展性好,无明显增生性瘢痕,无溃疡复发;2例皮肤溃疡恶变患者,愈合后分别随访1年和4年,均未见肿瘤复发。结论MEBT/MEBO可抑制定植致病菌、耐药菌生长,控制创面感染,促进创面愈合,使愈后创面更自然、美观,为慢性难愈性创面的治疗提供了可靠的治疗方法。

Objective To explore the characteristics and clinical efficacy of treating chronic refractory woundswith MEBT/MEBO. Methods While receiving the treatment of underlying diseases, 52 cases of patients with chronic refraetory wounds were treated with MEBT/MEBO. For the woundsnot capable of self-healing, it was requiredto identify lhe cause, throughlyremove the focus, and performoperationincluding skin-grafting whengranulation tissues were mature after culture. The eultivation of wounds secretion and results of drug sensitive testsweredynamieally monitored, and targeting drug administrationwas conducted according to the results of cultivation and drug sensitive test. Therapeutic effectswere observed and analyzed. Results Infections of the 52 patients were effectively controlled after the treatment with MEBT/MEBO, and the healing time of wounds was 99.83 d ±35.44 d （30 d ±180 d）. Among the 52 patients, 31 healed after the treatment with MEBO; 2 patients were given Phase II surgical suture, and the wounds were healed; the wounds of 2 patients were repaired by flap advancement; 2 patients with diabetic foot andfoot gangrene reeeived toe amputation, anti wounds healed well; wounds healed aftellotally 20 timesof skin-graftingoperationsinl5 patients. In one-year follow-up visit, it was found that subcutaneous tissues of all wounds receiving skin-graftingwere plump and even; some skin was left pigmented; skin was soft,flexible and malleable without visible hypertrophic scars Or ulcer recurrence; 2 patients with malignant ulcer experienced no tumor recurrence in one year and four years follow-up visit respectively. Conclusion MEBT/MEBO can inhibit the growthof planting bacteria and drug-resistance bacteria, control wounds infection, stimulate recovery and make the surfaces of wounds more natural and pleasant to eyes, which serves as reliable treatments for chronic refractory wounds.