整形外科的脱细胞基质材料:研究进展和临床应用的有机结合

Acellular tissue matrix in plastic surgery: research progress and clinical application

背景:脱细胞基质材料作为一种新型生物材料,在皮肤、颌面、乳房整形等整形美容外科领域的应用范围不断扩大,且有明显的治疗效果。目的:阐述脱细胞基质材料的特点及其在整形外科的临床应用研究和进展。方法:由第一作者用计算机检索中国期刊全文数据库和PubM ed数据库1990至2017年发表的相关文献,中文检索词为"脱细胞基质,整形,烧伤,瘢痕,乳房,软骨,唇腭裂,鼻,眼,唇",英文检索词为"acellular tissue matrix,plastic/cosmetic,burn,scar,breast,cartilage,cleft lip/palate,nose/nasal,eye/ophthalmic,lip"。筛选出应用于整形外科领域的脱细胞基质材料,对纳入的53篇文献进行分析探讨。结果与结论:(1)脱细胞基质材料具有耐受感染与实现组织再生的优势,植入后可主动诱导和促进周围细胞的迁入、黏附、增殖和分化,迁入的细胞进一步对材料进行改造、降解和塑形,实现组织的形成和结构重塑;(2)脱细胞基质材料在整形外科的临床应用日益广泛,目前主要应用于烧伤创面愈合修复、病理性瘢痕、乳房重建及唇腭裂、眼鼻部整形、隆唇等面部整形与美容方面,在软骨组织修复方面尚处于动物实验阶段;(3)在细胞外基质源脱细胞基质材料中,小肠黏膜下层材料免疫原性低,相容性好,活性高,能实现组织部分程度的特异性、功能性修复,是一种潜在的高活性整形外科填充材料。

BACKGROUND： Acellular tissue matrix as a new biological material has been extensively used in plastic surgerywith prominent therapeutic effects. OBJECTIVE： To review the characteristics of acellular tissue matrix and its clinical progress in plastic surgery. METHODS： A computer-based search of CNKI and PubMed was performed by the first author for relevant articlespublished from 1990 to 2017, using the key words of “acellular tissue matrix, plastic/cosmetic, burn, scar, breast, cartilage, cleft lip/palate, nose/nasal, eye/ophthalmic, lip” in Chinese and English, respectively. After screening,finally 53 articles were included in result analysis. RESULTS AND CONCLUSION： （1） Acellular tissue matrix has the following advantages： immune tolerance in bacterial infection and tissue regeneration. When implanted into humans, acellular tissue matrix can induce and promote migration, adhesion, proliferation and differentiation of surrounding cells to achieve tissue regeneration and structural remodeling. （2） Acellular tissue matrix has been widely used in plastic surgery, including burn repair, pathological scar, breast reconstruction, lip/palate cleft, ocular and nasal plastic surgery, and lip augmentation. Application of acellular tissue matrix in cartilage repair still remains in the stage of animal experiment. （3） Small intestinal submucosa is a potential filling material for plastic surgery in consideration of its low immunogenicity, good compatibility and high activity.