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烧伤创面愈合领域的基础与临床研究

[Basic and clinical research in the field of burn wound healing].

作者信息

Lu Shu-liang

机构信息

Department of Burns, Ruijin Hospital, Medical College of Shanghai Jiaotong University, Shanghai 200025, P.R. China.

出版信息

Zhonghua Shao Shang Za Zhi. 2008 Oct;24(5):359-61.

Abstract

The basic and clinical research in wound healing have made great progress in China in the past 50 years. The method of "intermingle skin transplantation" which was first advocated by surgeons of Ruijin Hospital in 1966 greatly reduced the amount of autologous donor skin, thus making the coverage of an extensive burn wound possible. This method is also known as "Chinese therapy". In 1986, doctors of Jishuitan Hospital reported successful coverage of an extensive burn wound with microautografts and allogeneic skin. The basic research of wound healing has been carried out since 1992, a series of studies showed the characteristics of biological behaviours of cells in concern, extracellular matrix and growth factor, the mechanism underlying progressive injury in deep second burn wound, the effect of "skin island" and the local immune tolerance induced by it (which are the key factors of intermingle transplantation). The induction of local immune tolerance has now become the research hot subject of skin transplantation immunology. Stem cell research in the field of wound healing has been extensively carried out. The theory of "dermal template defection" has been proposed as one of the mechanisms of scar formation. On the other hand, great progress has been achieved in the treatment of burns on the basis of clinical researches. Doctors of PLA 304 hospital found that excision of eschar on patients with extensive deep burn injury at early shock stage greatly decreased the occurrence of complications and mortality. Doctors of Ruijin Hospital reported that healing of deep second burn wound could be improved by tangential excision of burn eschar within 24 hours after burn injury. Doctors of Xiangya Hospital reported patients suffering from deep burns of the hands got satisfied functional restoration when treated with tangential excision of eschar while degraded dermal tissue could be retained with transplantation of autoskin grafts.

摘要

在过去的50年里,中国在伤口愈合的基础研究和临床研究方面取得了巨大进展。1966年,瑞金医院的外科医生首次倡导的“混合皮肤移植”方法大大减少了自体供皮量,从而使大面积烧伤创面的覆盖成为可能。这种方法也被称为“中国疗法”。1986年,积水潭医院的医生报告了用微小自体皮片和异体皮成功覆盖大面积烧伤创面。自1992年以来开展了伤口愈合的基础研究,一系列研究显示了相关细胞、细胞外基质和生长因子的生物学行为特征,深Ⅱ度烧伤创面进行性损伤的机制,“皮岛”的作用及其诱导的局部免疫耐受(这是混合移植的关键因素)。局部免疫耐受的诱导现已成为皮肤移植免疫学的研究热点。伤口愈合领域的干细胞研究也已广泛开展。“真皮模板缺损”理论已被提出作为瘢痕形成的机制之一。另一方面,在临床研究的基础上,烧伤治疗也取得了很大进展。解放军304医院的医生发现,对大面积深度烧伤患者在休克早期进行切痂,可大大降低并发症的发生率和死亡率。瑞金医院的医生报告说,烧伤后24小时内对深Ⅱ度烧伤创面进行削痂可促进创面愈合。湘雅医院的医生报告说,对手部深度烧伤患者进行削痂治疗,同时保留变性真皮组织并移植自体皮片,可获得满意的功能恢复。

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