【作者】 李春；

【导师】 张舵；

【作者基本信息】 吉林大学 ， 外科学， 2012， 硕士

【摘要】 研究目的：本实验通过建立常规皮肤扩张的动物模型，在皮肤扩张过程中应用高压氧进行干预，探讨其对超长宽比例扩张后转移皮瓣存活情况的影响。实验方法：选取英国纯种白色短毛豚鼠16只，雌雄不限，体重约500g，随机分为AB两组，每组8只，A组：高压氧常规扩张组（实验组），B组：常规扩张组（对照组），所有动物均在皮下深层埋入相同型号30ml的矩形硅胶软组织扩张器。手术共分两期完成，一期：将扩张器植入皮下，术后AB两组每3天各注水一次，共注水8次（含术中一次）。A组每次注水2小时内即进行高压氧治疗，每天1次。B组扩张过程同A组，不进行高压氧治疗。注水完成后2周行二期手术：取出各扩张器，于各组皮肤扩张区形成2.0cm×6.0cm皮瓣，皮瓣原位缝合。术后即刻、3天、6天、9天分别对随意皮瓣进行大体观察及皮瓣术后第9天成活面积的测量，术后第9天处死动物，切取皮瓣标本，进行常规HE染色、CD34免疫组化方法法检测微血管密度（MVD）。上述结果采用病理图像软件进行分析，数据用SPSS12.0软件进行分析。实验结果：①大体观察：A组皮瓣外段有黑色干性坏死，术后第9天皮瓣成活面积比率为0.69±0.04，成活部分皮瓣质地较好，颜色红润，柔软度好，对照组B组皮瓣中外段出现黑色干性坏死，成活面积比率平均为0.43±0.05且皮瓣色泽、质地、柔软度明显不如A组，两组皮瓣坏死范围差异较大，A组皮瓣平均成活面积高于对照组（P=0.001<0.01），差异显著。②HE染色：A组成活皮瓣皮下组织有一定程度的水肿，间质较密集，表皮增生活跃，皮下组织真皮层有大面积肉芽组织增生，炎症细胞较少，大量新生毛细血管生成。B组成活皮瓣皮下水肿较明显，间质疏松，表皮增生不明显，肉芽组织较A组少，血管增生不明显，炎症细胞大量聚集。③血管密度检测（MVD）：以CD34免疫组化法对血管标记，检测微血管数量。术后第9日A组成活皮瓣真皮层断面血管分布密度为14.67/mm~2, B组8.00/mm~2，两组比较有显著差异（P=0.0001<0.01）。研究结论：在本实验条件下①在皮肤常规扩张过程中应用高压氧进行干预，可以降低豚鼠超长宽比例扩张后转移皮瓣坏死率，促进皮瓣成活。②在皮肤常规扩张过程中应用高压氧进行干预，能提高扩张后转移皮瓣中新生血管的数量。③在皮肤常规扩张过程中应用高压氧进行干预，能改善扩张后转移皮瓣的质地、色泽及柔软度。更多还原

【Abstract】 Objective: To study the application of hyperbaric oxygen throughestablishing conventional skin expansion models in animals, and then exploringeffects of hyperbaric oxygen on the survival rate of super long-wide flap.Methods: Choose UK pure white guinea pigs16,were randomly dividedinto AB groups, each group8, group A: hyperbaric oxygen expansion(experimental group), group B: conventional expansion group (control group).All animals were implanted the soft tissue of the same model30ml rectangularsilicone expander under deep skin. Operation carried out in two phases, firstphase： implanted the expander under the deep skin, AB groups were injectedwater every3days, the total of8injection times(including surgery). Group Awere using HBO therapy after injecting water. Two weeks later, two phaseoperation: remove all expanders, and made an size of2.0cm×6.0cm flap, thensuturing in the same position. To measure the size of these survival flaps in the9thday after surgery. Then cutting the flaps in that day,for giving HE staining,CD34immunohistochemistry method for measuring MVD. These results wereusing image analysis software, and the data were analyzed by using SPSSsoftware.Results:①general observation: Group A flap had a distal black drynecrotic area, the9thday after surgery flap survival rate is0.69±0.04, the color,elasticity and softness of the survival part of the flap is better than group Bflap,and group B survival rate is0.43±0.05(P<0.01).②HE staining: thesurvival part of the group A flap composed of a certain degree of edema,epidermal hyperplasia is active. The epidermis and dermis shallow had a largearea of granulation tissue formation and generated a large number of new blood capillaries. Group B survival flap were taken on subcutaneous edemaapparently, and the granulation tissue was less than group A, angiogenesis wasnot obvious.③Vascular density detection（MVD）：to use CD34marker todetect the number of blood vessels. Vascular density in the9thday after surgeryis: group A14.67/mm~2, group B8.00/mm~2, the two group were significantlydifferent(P<0.01).Conclusion:Under the experimental conditions①To use HBO to intervene conventional skin expansion process, HBOcan reduce the expanded super long-wide flap necrosis rate in guinea pig.②To use HBO to intervene conventional skin expansion process, HBOcan increase the number of new blood vessels in the expanded flap③To use HBO to intervene conventional skin expansion process, HBOcan improve the texture,color and elasticity of the expansion flap.更多还原