【摘要】 目的:观察封闭负压引流技术对失神经支配创面愈合过程中血管生成的影响,寻求促进创面愈合的方法。方法:实验于2004-01/2005-12在解放军第四军医大学唐都医院和武装警察部队总医院烧伤整形实验室完成。选取80只SD大鼠随机分成4组,即失神经支配+负压引流组、失神经支配组、有神经支配+负压引流组、有神经支配组,每组20只。在失神经支配+负压引流组和失神经支配组大鼠的脊柱上作一个2cm×2cm的矩形全层皮肤缺损,切断0.5cmT11～L2神经,有神经支配+负压引流组和有神经支配组大鼠只做同样的皮肤缺损,但不阻断神经。对各组大鼠损伤创面进行清洁消毒,并在失神经支配+负压引流组和有神经支配+负压引流组创面上应用持续性封闭负压引流技术进行治疗,分别于治疗3,6,9,12,15d后取创周皮肤和创面内肉芽组织,检测各组创面血管内皮生长因子、增殖细胞核抗原的表达和标记指数。结果:80只SD大鼠全部纳入结果分析。①大体观察失神经支配+负压引流组和有神经支配+负压引流组无明显感染,分泌物少,随负压引流作用时间的延长,肉芽组织鲜红,呈细颗粒状;失神经支配组和有神经支配组创面均有感染。②失神经支配+负压引流组和有神经支配+负压引流组创面肉芽组织明显增厚,毛细血管内皮细胞、成纤维细胞的胞核中可见大量增殖细胞核抗原阳性表达,与失神经支配组和有神经支配组相比,差异有显著性意义(P<0.001)。③有神经支配+负压引流组和有神经支配组血管内皮生长因子、增殖细胞核抗原表达及标记指数明显高于失神经支配+负压引流组和失神经支配组。结论:封闭负压引流技术能够明显促进失神经支配创面血管内皮生长因子、增殖细胞核抗原标记指数升高,刺激创面的血管生成和肉芽组织生长,加速创面愈合。更多还原

【Abstract】 AIM: To study the effect of vacuum-assisted closure on angiogenesis dur-ing denervation rat wound, so as to investigate the method of acceleratingwound healing.METHODS: The experiment was completed in the laboratory of Depart-ment of Burn and Plastic Surgery, Tangdu Hospital of the Fourth MilitaryMedical University of Chinese PLA and the General Hospital of ChinesePeople’s Armed Police Forces from January 2004 to December 2005.Eighty Sprague-Dawley rats were randomly divide into 4 groups with 20rats in each group, denervation+ vacuum-assisted closure group, denerva-tion group, innervation+ vacuum-assisted closure group and innervationgroup. In the denervation+ vacuum-assisted closure group and denervationgroup, the full thickness skin of the back of rats were excised in rectangleshape with the size of 2 cm×2 cm, 0.5 cm T11- L2 spinal nerve was amputat-ed. In the innervation+ vacuum-assisted closure group and innervationgroup, the rats were only treated with the same cutaneous deficiency, butnerve was not blocked. The injured wounds were cleaned and disinfectedin all the groups, and those in the denervation+ vacuum-assisted closuregroup and denervation group were also treated with the technique of con-tinuous vacuum-assisted closure. At 1, 3, 6, 9, 12 and 15 days after vacu-um-assisted closure, the tissue around the wounds were excised to detectthe expressions and labeling index of vascular endothelial growth factor(VEGF) and proliferating cell nuclear antigen by immunohistochemicalmethod.RESULTS: All the 80 SD rats were involved in the analysis of results. ①The gross observation showed that there were no obvious infections andfewer secretions in the denervation+ vacuum-assisted closure group and in-nervation+ vacuum-assisted closure grouph With the prolongation of vacu-um-assisted closure, granular tissue were more fresher and showed granulelikeh There were infections in the denervation group and innervation group.② The granulation tissue on the wound surface was obviously thickened inthe denervation+ vacuum-assisted closure group and innervation+ vacuum-assisted closure group, and plenty of positive expressions of proliferatingcell nuclear antigen were observed in blood capillary endothelium, whichwere significantly different from those in the denervation group and inner-vation group (P < 0.001). ③ The expressions and labeling index of VEGFand proliferating cell nuclear antigen were obviously higher in the innerva-tion+ vacuum-assisted closure group and innervation group than in thedenervation+ vacuum-assisted closure group and denervation.CONCLUSION: The technique of vacuum-assisted closure might obvious-ly facilitate the proliferation of vascular endothelial cell and made the la-beling index of proliferation cell nuclear antigen increased, activate theangiogenesis of denervted rat wounds and the growth of the granular tissuein wound, accelerate the wound healing.更多还原