脱细胞异体真皮基质治疗肛瘘的愈合机制研究

目的应用脱细胞异体真皮基质（ADM）治疗动物模型肛瘘,探讨ADM治疗肛瘘的愈合机制。方法建立长白猪肛瘘动物模型（14头）,应用ADM填塞治疗。ADM治疗后12h、24h、72h、7d、14d、28d和60d分别取肛瘘治疗标本（每组2头）行苏木精-伊红染色及免疫组织化学染色检查肛瘘组织恢复情况。结果术后12hADM边缘可见炎性细胞浸润．并可见成纤维细胞长入。术后7d浸润细胞密度较术后12h显著升高（998．7±128．0比218．2±58．2,P〈0．01）：术后7～28d．密度逐渐下降。术后7d,在ADM边缘可见成熟新生血管和肌成纤维细胞;术后14d血管密度（30．5±5．2）较术后7d（11．2±3．3）增加（P〈0．01）,肌成纤维细胞的密度也较术后7d增加（6．8±0．4比3．8±0．8,P〈0．01）。术后60d可见规则排列的肌肉组织长入。结论脱细胞异体真皮基质植人体内后的血管化和被宿主细胞的再塑形可能在肛瘘愈合中起重要作用。ADM可成功用于治疗动物模型肛瘘．并可能进一步用于其他慢性感染创面的治疗。

Study of healing mechanism of acellular dermal matrix in the treatment of anal fistula

Objective To evaluate the efficacy of acellular dermal matrix(ADM) in the closure of anal fistula in an experimental porcine model,and to explore its healing mechanism.Methods The fistula-in-ano model was created and treated with ADM in the porcine model (n=14).Fistula specimens were obtained at hour 12,24 and day 3,7,14,28,60 respectively with 2 pigs in each time point.Hematoxylin and eosin staining and immunohistochemical staining for the alpha smooth muscle actin(α-SMA) were performed.Results At 12 hours after implantation,neutrophils and scattered cells with a fibroblastic appearance were present at the interface and began to infiltrate into the ADM.The cell density increased from hour 12 (218.2±58.2)to day 7 (998.7±128.0) (P＜0.01),and decreased from day 7 to day 28.Mature vessels and myofibroblasts stained with α-SMA were identified at the edge of ADM at day 7.The density of vessels (11.2±3.3 vs.30.5±5.2,P＜0.01) and myofibroblasts (3.8±0.8 vs.6.8±0.4,P＜0.01) increased from day 7 to day 14.Partially organized bundles of muscle were found at day 60.Conclusions ADM is a reasonable new option for the closure of anal fistula.The ability of ADM to become vascularized and remodeled by autologous cells may be advantageous for anal fistula healing and other chronic septic wound.