负压封闭引流技术联合植皮治疗下肢静脉瘀积性溃疡的相关作用机制研究

On Effect Mechanism of Vacuum Sealing Drainage Technique Combined with Skin Grafting on Lower Extremity Venous Stasis Ulcer

目的探讨负压封闭引流技术联合植皮对下肢静脉瘀积性溃疡的疗效和相关作用机制.方法选取42例下肢静脉瘀积性溃疡患者,随机分为研究组(负压封闭引流技术联合植皮治疗)28例,对照组(传统纱布常规换药治疗)14例,比较两组的治愈率.分别于治疗前、治疗7 d后取创面组织,用4%多聚甲醛溶液固定,进行HE染色、Masson染色,观察创面组织病理学改变和胶原沉积情况;免疫组化染色观察b FGF表达情况.结果研究组患者溃疡创面愈合率明显高于对照组,差异具有统计学意义(P<0.05).研究组患者治疗后创面组织HE染色可见新生毛细血管形成,且成纤维细胞浸润、中性粒细胞明显多于对照组.研究组治疗后胶原纤维沉积明显高于对照组,差异具有统计学意义(P<0.05);对照组治疗前后胶原纤维沉积差异无统计学意义(P>0.05).研究组治疗前后胶原面密度差值明显高于对照组,差异具有统计学意义(P<0.05).研究组治疗后溃疡组织的b FGF表达水平明显高于治疗前,差异具有显著统计学意义(P<0.01);对照组治疗前后b FGF光表达水平差异无统计学意义(P>0.05).研究组治疗前后b FGF光密度差值明显高于对照组,差异具有显著统计学意义(P<0.01).结论负压封闭引流技术联合植皮治疗下肢静脉瘀积性溃疡疗效明确,可能是通过促进溃疡组织b FGF表达上调来达到创面愈合的.

Objective To investigate the curative effect of vacuum sealing drainage technique combined with skin grafting on lower extremity venous stasis ulcer and its mechanism. Method 42 cases of lower extremity venous stasis ulcer patients were randomly divided into study group （28 cases treated with vacuum sealing drainage technique combined with skin grafting） and control group （14 patients treated with the conventional gauze dressing therapy）, and the cure rates between the two groups were compared. The wound tissue was taken before treatment and after treatment for 7 days, respectively. The samples were divided into 2 parts, one part fixed with 4% poly formaldehyde solution, and dyed with HE staining and Masson staining,for the observation of the pathological changes and the deposition of collagen in wound tissue ; immunohistochemical staining was applied to observe the expression of bFGF. Results The rate of ulcer wound healing in the study group was significantly higher than that in the control group （P〈0.05）. In the study group, the wound tissue HE staining after treatment showed that the blood vessel formation and infiltration of fibroblasts and neutrophils were significantly more than those of the control group. After treatment, the collagen fiber deposition in the study group was significantly higher than that in the control group （ P〈0.05 ）. There was no significant difference in the collagen fiber deposition before and after treatment in the control group （P〉0.05）. Before and after treatment, the difference of collagen surface density in the study group was significantly higher than that in the control group （P 〈 0.05 ）. The expression level of bFGF in the study group after treatment was significantly higher than that before treatment （ P〈0.01 ）. There was no significant difference in the level of bFGF （ P〉0.05 ） before and after treatment in the control group. Before and after treatment, the difference of bFGF light density in the study group was significantly higher than that in the control group （P〈0. 01 ）. Conclusion The effect of vacuum sealing drainage technique combined with skin grafting in the treatment of lower limb venous stasis ulcer should be reliable, which may facilitate the wound healing by up-regulating the bFGF expression in the ulcer tissue.