负压封闭引流技术治疗损伤创面愈合的机制研究

Healing mechanism of vacuum sealing drainage in the treatment of injury wound

目的探讨负压封闭引流技术(vacuum sealing drainage,VSD)治疗损伤创面的愈合机制。方法选取连云港市第二人民医院急诊外科2018年2月至2019年2月收治的因外伤导致的严重软组织损伤伴软组织缺损患者60例,伤后均于8 h内进行急诊清创手术,清创后按奇偶数法随机分为VSD组和传统组,每组30例。分别于第1周和第2周取2组患者创面肉芽组织进行免疫组织化学染色,观察患者创面血管内皮生长因子(vascular endothelial growth factor,VEGF)和M2巨噬细胞表达量的差异。结果VSD组第1周和第2周伤口创面肉芽组织VEGF的表达量明显高于传统组,差异均有统计学意义(P<0.05)。VSD组第1周肉芽组织内M2巨噬细胞含量明显高于传统组,差异有统计学意义(P<0.05);第2周肉芽组织内M2巨噬细胞的含量与传统组相当,差异无统计学意义(P>0.05)。结论VSD是治疗大面积损伤的有效方法,可提高创面VEGF的表达量,加速M2巨噬细胞向创面的迁移,从而使伤口加速愈合。

Objective To investigate the healing mechanism of vacuum sealing drainage(VSD)in the treatment of injury wound.Methods A total of 60 patients with severe soft tissue injury and soft tissue defect caused by trauma admitted to the Department of Emergency Surgery of the Second People’s Hospital of Lianyungang between February 2018 and February 2019 were selected.All patients underwent emergency debridement within 8 hours after injury.Then they were randomly assigned to VSD group(n=30)or control group(n=30)by the odd and even number method.Granulation tissues were taken from the wound in the first and second weeks respectively to perform the immunohistochemical staining.The expression levels of vascular endothelial growth factor(VEGF)and M2 macrophages marker CD206 were analyzed.Results In terms of the VEGF,the expression level of CD206 was significantly higher in the VSD group than that in the control group both in the first and second weeks(P<0.05).In terms of the M2 macrophages,the level of CD206 was significantly higher in the VSD group than that in the control group in the first week(P<0.05).While in the second week,the levels of M2 macrophages in both groups were similar,with no significant difference observed(P>0.05).Conclusion VSD is an effective method to treat large area injury wound.It can speed up the healing by increasing the expression of the VEGF and accelerating the migration of M2 macrophages to the wound.