白癜风外科治疗新进展

白癜风外科治疗对于稳定期白癜风及难治性白癜风疗效确切,可单独治疗也可与其他治疗方式联合治疗。手术方式分组织移植及细胞移植两种,前者常用的手术方式有组织负压吸疱表皮移植法、钻孔皮片移植法与单株毛囊移植法;后者常用的手术治疗方式包括非培养表皮细胞悬液移植法及培养表皮细胞移植法,组织移植及细胞移植各有优势与不足。近年来,一些新的手术方式的出现为外科治疗中复色率提高提供了较好的解决方式。本文将对新型手术方式等相关方面进行概述。     

自体细胞移植治疗稳定期白癜风疗效的Meta分析

目的 系统评价培养与非培养自体黑色素细胞移植及联合其他方法治疗稳定期白癜风的疗效。方法检索PubMed、Embase、Web of Science、The Cochrane Library、中国期刊全文数据库（CNKI）、维普中文科技期刊全文数据库（VIP）、万方数据库,纳入研究为自体细胞移植治疗稳定期白癜风的临床研究。计数资料以合并后相对危险度（RR）值为效应指标,用Revman5.4软件对符合分析的研究进行Meta分析。结果 最终纳入文献14篇,Meta分析显示：自体培养黑色素细胞移植（CMT）与黑色素细胞+角质细胞、CMT与自体非培养混悬液移植（NCES）治疗稳定期白癜风疗效差异无统计学意义（P>0.05）;CMT与CMT+光疗治疗稳定期白癜风疗效差异有统计学意义（P<0.01）;NCES与NCES+其他成分、NCES与NCES+其他疗法、NCES与NCES+光疗治疗稳定期白癜风疗效差异无统计学意义（P>0.05）;细胞移植与细胞移植+其他疗法、细胞移植与细胞移植+光疗、细胞移植与细胞移植+窄谱中波紫外线（NBUVB）治疗稳定期白癜风疗效差异有统计学意义（P&l...     

白癜风的外科治疗进展

【摘要】 白癜风是一种常见的色素脱失性皮肤疾病,目前尚无特效疗法,临床常见的治疗手段有药物疗法、光疗和外科手术处理。白癜风的外科处理手段主要包括组织移植和细胞移植,组织移植常见的方法包括微小/钻孔皮片移植、刃厚皮片移植、表皮负压吸疱移植;细胞移植包括自体黑素细胞直接及培养后移植。这些方法对处于稳定期、局限型或者其他手段治疗无效的患者治疗安全、有效。     

自体表皮细胞移植加神经生长因子治疗白癜风

为了探讨神经生长因了（NFG）治疗白癜风的疗效，在自体表皮细胞移植的同时加用NFC观察35例白癜风患者的疗效，并与单纯使用自体表皮细胞移植病例对照，结果添加NFG的皮片全部存活，且色素恢复较快，色斑扩大更为显著，未见明显副作用，为目前治疗白癜风的一种更安全有效的治疗方法。     

个体化培养自体黑素细胞移植治疗白癜风

目的 探讨使用个体化培养基进行自体黑素细胞培养移植治疗白癜风的疗效。方法 负压吸疱获取患者正常表皮片,制成细胞悬液,在Hu16黑素细胞选择性培养基中培养。检测黑素细胞分裂时间（DOT）和黑素含量,根据DOT的大小、黑素含量和细胞形态,调整血清、细胞因子浓度及补充内皮素-1,进行个体化黑素细胞培养。经2 ~ 5次传代后收集黑素细胞,白斑区用超脉冲CO2激光磨削后进行黑素细胞移植,随访观察复色效果。结果 共治疗155例稳定期白癜风患者的204处皮损,进行1次移植119例,进行2 ~ 4次移植36例。应用个体化黑素细胞培养后细胞扩增可达50 ~ 80倍。84.80%的皮损复色面积超过50%,其中52.94%的皮损复色面积超过90%,且复色均匀,未见瘢痕及其他不良反应。性别、年龄、病程长短和皮损面积大小对疗效没有影响。节段型白癜风移植疗效好于寻常型白癜风,两组有效率分别为93.62%和82.16%,痊愈率分别为65.96%和49.04%。手臂和腿部的皮损（不包括肘部和膝盖）移植后痊愈率达73.08%,疗效好于躯干、面颈;肢端皮损疗效最差,痊愈率仅为25.93%。结论 个体化培养技术能提高白癜风患者黑素细胞的培养成功率与细胞扩增倍数。体外培养的自体黑素细胞移植治疗稳定期白癜风疗效肯定,用少量供皮区即可治疗大面积皮损,值得临床应用。     

自体黑素细胞移植治疗白癜风细胞生物学活性与疗效关系

目的探讨黑素细胞移植治疗白癜风细胞活性与疗效的关系。方法应用黑素细胞的分裂时间(DOT)、黑素细胞培养总时间(T)以及黑素细胞传代次数(Tn)作为黑素细胞生长的指标,观察黑素细胞移植后白癜风患者的疗效。结果共治疗40例稳定期白癜风患者,24例DOT≤3.5d,16例DOT3.5d,DOT≤3.5d的患者痊愈率和有效率均高于DOT3.5d的患者;30T≤50d的患者23例,痊愈率和有效率显著高于T≤30d和T50d的白癜风患者;Tn≤4的患者移植痊愈率和有效率均显著高于Tn4的白癜风患者。结论自体纯培养黑素细胞移植是治疗白癜风的有效方法,其移植疗效与黑素细胞的分裂时间、黑素细胞培养总时间以及黑素细胞传代次数密切相关。     

口服中药联合自体表皮移植治疗白癜风疗效观察

目的：中药对自体表皮移植治疗白癜风的治疗作用。方法：以口服中药联合自体表皮移植与单纯自体表皮移植治疗白癜风的疗效进行比较。结果：中药联合自体表皮移植与单纯自体表皮移植组（对照组）治疗白癜风的疗效比较差异有显著性意义（P＜0．05）,结论：提示中药能迅速控制病情,使白癜风进展期转为稳定期,提高自体表皮移植治疗白癜风的成功率。     

白癜风外科治疗新进展——毛囊外根鞘细胞悬液移植

白癜风是一种皮肤色素异常性疾病,表现为慢性局限性的皮肤色素脱失斑,表皮黑素细胞功能进行性丢失,如果出现毛发变白则提示预后较差。白癜风的外科疗法即手术治疗,适用于对光疗或药物治疗无效的稳定期白癜风患者,对非手术疗法不敏感的皮损,如唇部、手足、手指及生殖器等部位也可采用外科疗法。除了常见的自体表皮移植和自体黑素细胞移植,近年来采用毛囊单位提取法获取毛囊外毛根鞘细胞悬液移植作为一种新的外科手段,逐渐显现出其在白癜风治疗中的优势。该文就该方法在白癜风中的应用作一综述。     

白癜风的移植治疗

白癜风移植治疗的目的是将正常皮肤内的黑素细胞移植到没有黑素细胞的白斑区。主要分为组织移植和细胞移植 ,及介于两者之间培养的表皮片移植。组织移植包括全厚层钻孔移植、刃厚皮片移植、负压吸疱移植和单株毛发移植 ,细胞移植包括表皮细胞悬液移植和培养的黑素细胞移植。现将各种移植方法作一综述     

自体表皮细胞悬液移植治疗白癜风影响因素

自体表皮细胞悬液移植是一种将自体表皮细胞不经培养直接移植至白斑区从而达到治疗白癜风的方法,具有简便、省时、易于操作等优点.为提高移植的疗效,近年来研究者在改良细胞悬液的制备方法、改进移植技术、寻找最佳的悬液移植浓度等方面进行不断的探索.未来研究的重点在于如何更加有效地提高细胞悬液中细胞数目及细胞活力、增大移植治疗的面积以提高治疗有效率.     

Successful Repigmentation of Vitiligo after Allogeneic Bone Marrow Transplantation for Hodgkin's Lymphoma by Autologous Noncultured Melanocyte-keratinocyte Transplantation

The treatment of vitiligo is derisory since the pathogenesis of vitiligo is not clear at present. Most conservative treatments are difficult to approach satisfactory therapy. So transplantation is the only way left when the disease becomes insensitive to those conservative treatments. Here we describe an 18-year-old patient who developed vitiligo, which was triggered by graft-versus-host disease after a allogeneic bone marrow transplantation for the treatment of Hodgkin''s lymphoma from his sister. In the following treatment to vitiligo, the patient successfully performed the transplantation of autologous uncultured melanocyte on the premise of poor reaction to other conservative methods. We infer that transplantation can be a treatment of the vitiligo after allogeneic bone marrow transplantation.     

Autologous melanocyte–keratinocyte suspension in the treatment of vitiligo

Background In stable vitiligo, several techniques of autologous transplantation of melanocytes are used. Autologous melanocyte transplantation of non‐cultured melanocytes is one of those techniques with variable reported outcomes. Objective The objective of this study was to evaluate the response to autologous melanocyte–keratinocytes suspension transplantation in cases of stable vitiligo. Methods A total of 25 cases of vitiligo were treated by autologous melanocyte–keratinocytes suspension transplantation. After 6–17 months, patients’ response was evaluated according to the extent of pigmentation (excellent 90–100%, good 50–89%, fair 20–49% and poor response <20%). Results Of the 25 patients treated, 22 continued the follow‐up period. Five (23%) patients showed excellent response, 7 (32%) good, 6 (27%) fair and 4(18%) showed poor response. Conclusion Unlike transplantation of cultured melanocytes, which requires experience in culture technique, autologous melanocyte–keratinocytes suspension transplantation is an easy economic technique, which may be used in resistant areas of stable vitiligo.     

Vitiligo surgery: A journey from tissues via cells to the stems!

Depigmented patches in vitiligo, a common dermatosis, cause a great psychological distress to the patients. Hence, apart from halting the disease process, the strategies to impart normal skin colour to these white patches carry an important role in the management of vitiligo. Surgical procedures are often required for stable vitiligo lesions not responding to medical therapies. It involves “shuffling” of melanocytes from the pigmented skin to the depigmented areas. During the last fifty years, the vitiligo surgery has evolved from tissue transplantation via cellular transplantation to reach a stage where the use of stem cells or immunomodulatory cells is contemplating. We would like to depict this wonderful journey of vitiligo surgery through this viewpoint.     

Long-term follow-up of leucoderma patients treated with transplants of autologous cultured melanocytes,ultrathin epidermal sheets and basal cell layer suspension

BACKGROUND: In vitiligo and piebaldism the lack of melanin in the epidermis is due to the fact that melanocytes are missing. The patients suffer psychologically and the white areas have lost the part of the skin barrier protection normally provided by the melanocytes. Medical treatments are ineffective in many of the patients, and surgical methods have therefore been developed. OBJECTIVES: It is important to investigate the long-term results and factors that might influence the outcome of melanocyte transplantations in order to form a basis for guidance in the selection of patients who will benefit most from the treatments. METHODS: A follow-up of 132 patients who had been treated by transplantation on 176 occasions in total, 1-7 years previously, was carried out by questionnaires and clinical examinations. We investigated the responses in five types of leucoderma to three different transplantation methods: autologous cultured melanocytes, ultrathin epidermal sheets and basal layer cell suspension. RESULTS: Stable types of leucoderma, i.e. segmental vitiligo and piebaldism, responded in most cases with 100% repigmentation, regardless of the surgical method used. For these types of leucoderma surgery seems to be the method of choice. The largest group, vitiligo vulgaris, was thoroughly scrutinized and three statistical models were used to analyse the data. The ultrathin epidermal sheet method gave somewhat better overall results, but was the method that gave the worst outcome in knee and elbow areas, emphasizing the importance of the right choice of method depending on the anatomical location to be treated. Irrespective of the method, fingers and elbows were the most difficult areas to repigment. The trunk and the arms and legs (not including elbows and knees) responded best. Patients with increasing and/or extensive vitiligo vulgaris more often showed incomplete repigmentation. They also had a lower chance of retaining their repigmentation compared with those with less extensive vitiligo. Patients in whom untreated white lesions had increased in recent years tended to respond less well to transplantation compared with patients with unchanged or decreased lesions. Within the vitiligo vulgaris group, patients with short disease duration or with small total vitiligo area responded best to transplantation. The subgroup of vitiligo vulgaris patients with hypothyroidism tend to respond less well to the transplantation and they were generally older at vitiligo onset. This information is of great importance for the selection of patients and when informing about the chances of improvement after transplantation. Slight hyperpigmentation was common, especially when ultrathin epidermal sheets had been used. No scars or indurations were seen in treated areas. CONCLUSIONS: Transplantations are the methods of choice in stable types of leucoderma. Progressive, widespread vitiligo vulgaris should never be selected for transplantation.     

Treatment of vitiligo with khellin liposomes,ultraviolet light and blister roof transplantation

Background Various surgical and non‐surgical methods are available to treat vitiligo. Surgical techniques such as epidermal blister graft transplantation may be effective for the re‐pigmentation of stable, but refractory vitiligo areas. Khellin has phototherapeutic properties that are similar to those of the psoralens, but with substantially lower phototoxic effects and DNA mutation effects. Its penetration into the hair follicles is enhanced by encapsulating it into liposomes. Subsequent activation of the khellin with UV light stimulates the melanocytes in the hair follicles. Objective The first objective was to evaluate the additional value of combining blister roof transplantation (BRT) with khellin in liposomes and ultraviolet light (KLUV) in the treatment of recalcitrant vitiligo patches. The second objective was to assess patients’ satisfaction. Materials and methods Nineteen patients with vitiligo lesions which did not respond to KLUV treatment for at least a year were treated with BRT followed by KLUV. The transplantation was performed by creating blisters with a suction device, preparing the target site with Erbium laser ablation and the actual transplantation. Locations where randomly assigned. A blinded observer established the results. Results Seventy‐five percent of the patients were satisfied with the cosmetic result. All of the patients would recommend the treatment to other vitiligo patients. More than 75% re‐pigmentation of the vitiligo areas was noted in 47% of the patients according to the blinded evaluation of photographs taken before and after the treatment.     

自体培养黑素细胞移植联合窄谱中波紫外线治疗白癜风疗效观察

目的评估自体纯培养黑素细胞移植联合窄谱中波紫外线(NB-UVB)治疗白癜风的临床疗效。方法应用自体纯培养黑素细胞移植治疗44例非节段型白癜风患者,其中23例患者在移植后2周进行NB-UVB治疗。结果共移植治疗了44例患者,其中联合NB-UVB组23例,两组中(联合NB-UVB组和单纯移植治疗组)获得较好复色效果(复色面积>50%)的患者分别为86.9%、76.2%,有统计学差异(P<0.05);两组的平均复色率分别为78.9%、70.0%。面颈部获得较好复色效果的患者分别为92.3%、90.9%,两组间对比无统计学差异;躯干部获得较好复色效果的患者分别为80.0%、60.0%,两组间对比有统计学差异(P<0.05)。结论自体纯培养黑素细胞联合NB-UVB是治疗白癜风的有效方法之一,且NB-UVB能够提高移植的疗效,尤其是对于局限于躯干的皮损。     

白癜风同种异体黑细胞移植初步研究

目的 探索同种异体黑素细胞移植治疗稳定期白癜风的可行性。方法 用负压吸疱法在白癜风患者白斑区吸疱，注入纯培养的同种异体黑素细胞悬液，连续观察外观效果，并做组织病理学和免疫学检查，通过PCR扩增Y染色体特异性片段方法确定异体黑细胞的转归。结果 1月后移植区出现部分色素，两个半月时色素恢复明显，至半年时恢复的色素稳定存在，且颜色与邻近正常皮肤接近。组织病理显示移植区基底层有黑素细胞存活，黑素细胞周围的角质形成细胞内有黑素颗粒。疱皮组织DNA检查有Y染色体特异性片段。结论 同种异体黑素细胞移植治疗白癜风具有可行性，值得进一步探讨。     

自体单株毛囊移植术治疗眉部白癜风疗效观察

目的探讨自体单株毛囊移植术治疗眉部白癜风的治疗效果。方法回顾性分析我科2012年7月—2013年8月,采用自体单株毛囊移植术治疗21例眉部白癜风患者的临床资料。结果术后随访6个月~1年,18例患者(85.7%)在白斑区出现毛囊周围复色,发生在移植后的4~8周,6个月后复色的直径为3~12 mm。6例患者(21%)眉毛复色。结论自体单株毛囊移植术不仅能使眉毛周围皮肤复色,还能使眉毛复色,是一种有效的治疗眉部白癜风的方法。     

单株毛囊移植联合光疗治疗白癜风白发疗效评价

目的：评价单株毛囊移植（FUE）联合光疗治疗顽固性白癜风伴毛发变白的治疗效果。方法：选取2019年6月至2020年12月稳定期伴毛发变白的白癜风患者,将单株毛囊移植于白癜风皮损区域内, 血痂脱落后,皮损区给予308准分子激光照射,初始剂量50 mJ,1周照射2~3次,3个月一个疗程。结果：入选患者20例, 共25处白斑,治疗3个月后,19处出现移植毛囊周围的色素恢复,其中痊愈2处,显效17处;24处皮损出现黑色毛发生长。结论：单株毛囊移植（FUE）联合光疗治疗顽固性白癜风可有效改善顽固性白癜风伴毛发变白。