脱细胞异体真皮基质修复口腔上皮缺损的临床评价

目的：评价脱细胞异体真皮基质（acellular dermal matrix，ADM）修复口内上皮缺损的临床效果。方法：收集2002年7月～2005年12月应用ADM修复口内黏膜缺损和移植组织瓣上皮不足的52例患者的病例资料．并追踪随访1～12个月．对近期效果和远期效果进行分析。结果：以ADM修复口腔黏膜缺损51例，除1例发生基质溶解外，其余ADM全部成活。修复后2周左右，修复区色泽与周同组织相近。随访发现，修复舌缺损近期效果好，舌活动度佳，1～2个月后可见修复区组织收缩．3个月后最明显，舌活动度受影响；颊部修复区可见类似结果；修复前庭沟可见前庭沟变浅．累及唇部．可出现轻度活动受限。用于牙槽突、硬腭等骨性创面修复，则远期效果良好、另以ADM修复髂骨肌皮瓣移植后皮岛面积不足1例，临床效果与骨性创面类似：结论：ADM修复口内上皮缺损成活率高，植盖创面效果好，无瘢痕形成，是较理想的口腔上皮缺损修复材料，但应考虑修复后局部收缩对软组织活动度的影响。

Clinical evaluation of repairing oral epithelial defects by acellular dermal matrix

PURPOSE: To evaluate the clinical effect of acellular dermal matrix (ADM) in repairing epithelial defects of oral cavity. METHODS: The clinical data of patients who underwent operation of oral epithelial defects repair by ADM between July 2002 and December 2005 were recorded and reviewed. The patients were followed up for 1 to 12 months. The short-term and long-term results of reconstruction were assessed. RESULTS: 51 patients with oral mucosal defects underwent transplantation of ADM. All grafts survived well, except 1 case who had matrix breakdown. The color of the grafts was similar to the surrounding mucosa about 2 weeks postoperatively. Excellent tongue mobility was observed in short-term follow up. But long-term follow up revealed mucosa contraction in ADM transplanted area and the degree of tongue mobility decreased. Similar contraction occurred in buccal and lip defects repaired by ADM. However, a stable long-term clinical result was presented when using ADM in alveolar process and hard palate defects. A case with insufficient skin paddle after transplantation of iliac osteomyocutaneous flap was repaired by ADM and achieved good result. CONCLUSIONS: Acellular dermal matrix is a valuable biomaterial for oral epithelial defects repair. But contraction after surgery should be taken into consideration.