胎儿皮肤创伤无瘢痕愈合机制的研究进展

妊娠早期胎儿皮肤创伤后愈合迅速且无瘢痕形成,揭示胎儿无瘢痕愈合机制以提高创面修复愈合质量,对临床上瘢痕的防治具有极其重要的意义。近年来虽已做了大量研究,但对妊娠早期胎儿无瘢痕愈合的产生机制还不完全清楚,本文主要从胎儿相关环境、成纤维细胞、细胞外基质、细胞因子、基因表达等方面阐明其可能的形成机制。     

多种带蒂皮瓣治疗颈部中重度瘢痕挛缩畸形的比较研究

目的：比较颈胸前薄皮瓣、颔肩胛皮瓣、背阔肌肌皮瓣及颈部扩张皮瓣整复颈部挛缩瘢痕畸形的效果。方法：共治疗颈部挛缩瘢痕畸形104例，其中应用颈胸前薄皮瓣26例，颈肩胛皮瓣11例，背阔肌肌皮瓣8例，颈部扩张皮瓣59例。结果：所有手术均得到良好的远期效果。5例颈部扩张皮瓣术后出现血肿，3例出现皮瓣远端坏死；颈胸前皮瓣未出现血供障碍；早期有3例颈肩胛皮瓣术后出现远端部分坏死，在对皮瓣长宽比〉3．5：1者实施延迟手术后未再出现远端坏死；1例背阔肌肌皮瓣术后出现肌肉部分坏死。结论：颈部扩张皮瓣质地及色泽与受瓣区皮肤匹配，为修复颈部瘢痕挛缩畸形的首选；颈胸前皮瓣和颈肩胛皮瓣血供可靠，肤色与颈部相近，供瓣区面积大，能直接拉拢缝合，修复效果也比较满意；背阔肌肌皮瓣术后外形明显臃肿，应避免选用。     

多配体蛋白聚糖在创伤性愈合和病理性瘢痕中的作用

多配体蛋白聚糖家族(syndecan)是最近发现跨膜硫酸肝素蛋白聚糖,在伤口修复过程中,介导成纤维细胞增殖、迁移、调控细胞与细胞外基质之间信号交流。本文讨论多配体蛋白聚糖家族结构及其功能、分布,与其他细胞外基质(ECM)成分如纤连蛋白(FN),黏蛋白-C,整合素之间关系。     

剖宫产术后腹壁瘢痕子宫内膜异位症的彩超诊断

目的：探讨高频超声与彩色多普勒血流显像（CDFI）对腹壁切口瘢痕处，子宫内膜异位症的超声表现。方法：对26例经手术病理证实的腹壁瘢痕子宫内膜异位症的声像图特征进行分析。结果：腹壁瘢痕处探及边界不清，形态不规则，无包膜，内部回声不均质的中低回声团块。团块内呈斑片状液性暗区间杂弱回声光点及条带状低回声；CDFI：显示肿块周边及内部有点状、短棒状和条状血流信号。脉冲多普勒（PW）表现为低速高阻的特点，Vs5．0-20cm/s、RI0．65-0．82。结论：高频超声结合CDFI和PW能对剖宫产术后腹壁瘢痕子宫内膜异位症进行明确诊断，为临床提供可靠的诊断应用价值。     

脱细胞真皮与自体刃厚皮移植治疗瘢痕畸形

目的探讨用脱细胞真皮移植后代替自体真皮的效果。方法瘢痕切除时保留深筋膜上2~3mm脂肪组织,植入脱细胞真皮和自体刃厚皮,手术一次成功。结果本组35例,术后皮片全部成活,6例患者随访1年,皮肤弹性良好,触柔软,功能良好,供皮区可以多次供皮无瘢痕,节省自体皮源。结论形成的复合体达到厚皮片的效果,起到自体全厚皮的作用。     

Scar pregnancy: a rare complication of caesarean section

In this paper, we report a rare type of ectopic pregnancy implanted in a previous caesarean scar. Scar pregnancy was diagnosed at six weeks gestation in a woman with three prior caesarean deliveries. Management with the usual dose of Methotrexate was unsuccessful. The patient continued to have pelvic pain, the beta human chorionic gonadotropin (ßhCG) increased and there was persistent foetal cardiac activity. Subsequently, dilatation and curettage was performed under ultrasound guidance without complications. We conclude that scar pregnancy presents a diagnostic and therapeutic challenge to the clinician and the optimal management strategy needs to be explored.     

几丁糖对不同来源成纤维细胞生物学特性的影响

目的　探讨医用几丁糖 (以下简称几丁糖 )对病理性瘢痕成纤维细胞生物学活性的作用。方法　以瘢痕疙瘩及增生性瘢痕成纤维细胞为研究对象 ,正常皮肤成纤维细胞为对照 ,用组织块法进行不同标本成纤维细胞体外培养。分别观测不同浓度的几丁糖作用后 ,不同来源成纤维细胞吸光度A、形态结构、合成及分泌胶原的量以及细胞因子TGF β1 、b FGF、IL 8等的变化。结果　几丁糖对不同来源成纤维细胞增殖及胶原、TGF β1 、b FGF、等的分泌均呈剂量依赖性抑制 ,对IL 8则促进 ;且对各组的影响差异无显著性意义。结论　几丁糖可以抑制瘢痕疙瘩和增生性瘢痕成纤维细胞的生长、增殖、合成及分泌胶原功能 ,有望在病理性瘢痕的防治中发挥重要作用。     

Revascularization of myocardial scar tissue following prostaglandin E1-therapy in patients with ischemic heart disease

Prostaglandin E1 (PGE-1) treatment has proved to stimulate angiogenesis in vital non-infarcted myocardium of patients with ischemic cardiomyopathy (ICMP). We investigated infarcted myocardial tissue for a possible angiogenic response to PGE-1. Neovascularization was investigated in infarcted areas of 12 hearts explanted from patients with ICMP who had been treated with PGE-1 before heart transplantation (HTX). In transmural sections containing myocardial scar tissue, CD34 and VEGF were immunohistochemically quantified to estimate capillary density and the extent of angiogenesis. To investigate a possible effect of PGE-1 on collagen turnover, the collagen content was determined in myocardial scar tissue by assessing the intensity of the area positively stained with sirius red. PGE-1-treated patients had significantly more CD34- and VEGF-positive cells in infarcted areas, and showed a significant reduction in collagen content as compared with the non-PGE-1 group (CD34: 120.3 +/- 6.1 vs. 47.7 +/- 6.1 capillary profiles/mm2; VEGF: 52.8 +/- 5.6 vs. 24.0 +/- 4.8 capillary profiles/mm2, and collagen content: 2.18 +/- 0.4 eU vs. 3.59 +/- 0.38 eU). Our data demonstrate that PGE-1 stimulates angiogenesis by upregulating VEGF expression, and reduces fibrosis in cardiac scar tissue of ischemic origin. The induction of therapeutic angiogenesis in vital and at sites of putative dead myocardial scar tissue, along with the hemodynamic improvement in patients with severe ICMP, might explain the favorable clinical outcome in PGE-1-treated patients before HTX.     

Endometriosis on laparotomy scar. A three-case report

Endometriosis of surgical scar is a rare late complication of cesarean section. 3 cases of endometriosis after Pfannenstiel-type laparotomy are reported. The typical surgical presentation, present in all 3 cases, is a nodule on laparotomy scar after cesaren section, spontanously painful during the menstrual period. Ultrasound, performed in two cases, and cytological examination, performed in one, proved to be ineffective in establishing the diagnosis. The histopathological analysis of surgical specimens revealed in all cases multiple foci of well developed endometrial tissue scattered in a sclerotic stroma. Both stromal and glandular components of the endometrial mucosa were present showing the typical changes of the various phases of the menstrual cycle. In our opinion, an accurate clinical history should directly lead the surgeon to the excision with inclusion of the needle tract, whenever biopsy is performed. Surgical excision is at present the most appropriate diagnostic and therapeutic procedure. Received: 3 November 2000 / Accepted: 30 November 2000     

烧伤后瘢痕局部应用辣椒素治疗的初步临床观察

目的　观察局部外用辣椒素对增生性瘢痕的治疗效果。　方法　采用随机、双盲、自身对照法。治疗组瘢痕表面涂抹 0 .0 5 %的辣椒素霜 ,对照组涂抹不含辣椒素的霜剂 ,3次 d,使用 6周。观察用药前后的瘙痒情况和药物不良反应 ,并采用常规病理、免疫组化和胶原纤维染色等方法观察辣椒素的止痒作用以及对瘢痕增生的影响。　结果　辣椒素具有明显的止痒作用 ,其作用与P物质的减少有关 ,但用药后两组在瘢痕的色泽、软硬度、厚度及胶原纤维的形态分布上 ,未见有明显差异。　结论　辣椒素可用于增生性瘢痕的止痒 ,效果好 ,无明显不良反应 ,但其抑制瘢痕增生的作用不显著。