皮肤创伤后形成假性上皮瘤样肉芽肿的病因分析--附11例报告

目的探讨皮肤创伤后发生假性上皮瘤样肉芽肿(PEG)的原因，临床、病理学特征及防治方法。方法回顾分析11例PEG患者的临床资料、治疗效果，并对组织样本进行微生物检查和组织学观察。结果PEG组织内培养出耐甲氧苯青霉素金黄色葡萄球菌、绿脓杆菌、B型溶血性链球菌、粪链球菌等，多数耐受甲氧苯青霉素而对万古霉素敏感。彻底清创后采用游离植皮或皮瓣覆盖创面，配合局部注射万古霉素可预防病变复发。组织学观察到很长的上皮脚呈蜂窝状包裹肉芽组织，其间有丰富的毛细血管、巨噬细胞和肥大细胞浸润生长，胶原纤维等细胞外基质相对较少，符合PEG病变特征。结论早期创面处理不当和耐药菌感染是PEG发生的主要原因，外科清创一植皮手术和万古霉素局部注射控制感染可能是积极有效的治疗措施。

Analysis of etiological factors of pseudoepitheliomatous granuloma after cutaneous wound healing:a report of 11 cases of patients with this lesion

Objective To explore the pathogenetic mechanism, clinical and pathological characteristics, and prevention and treatment of pseudoepitheliomatous granuloma after skin wound healing. Methods The clinical information and the treatment results of pseudoepitheliomatous granuloma occurring in 11 patients (age 167 years) were reviewed and analyzed, their tissue specimens were used for microbial examination and histological observation. Results Some bacteria such as Staphylococcus aureus, Pseudomonas pyocynea , Streptococcus hemolyticus B, and Streptococcus feacalis could be found in the culture of pseudoepitheliomatous granuloma. The majority of these bacteria was tolerant to celbenin but sensitive to vancomycin. The lesions were excised, and the wounds were covered with skin grafting or skin flap, supplemented by local of vancomycin to prevent recurrence of the lesion. Histological examination revealed in pseudoepitheliomatous granuloma with long epithelial peduncle encapsulating granulation tissue like honeycomb, in which there were many capillaries, macrophages, lymphocytes and mast cells, with only a small amount of extracellular matrix. Conclusion The main pathogenesis of pseudoepitheliomatous granuloma formation might be improper treatment of wound in earlier period and infection of drug resistant bacteria. Surgical debridement followed by skin coverage and local injection of vancomycin could be effective and curative.