再論焦痂薄化術(shù)在燒傷再生療法中的應(yīng)用前景

摘要： "燒傷再生療法"的前身是"燒傷濕性醫(yī)療技術(shù)(MEBT/MEBO)",它由燒傷濕潤(rùn)暴露療法(MEBT)和濕潤(rùn)燒傷膏(MEBO)組成,1991年被列入國(guó)家"十年百項(xiàng)"成果首批十項(xiàng)推廣技術(shù)之一。為了加速創(chuàng)面壞死組織早期液化過程,附加了"耕耘療法"等項(xiàng)技術(shù),初步形成了具有中國(guó)特色的燒傷醫(yī)療體系。因?yàn)檫@種療法能夠激活自身成體細(xì)胞,使創(chuàng)面實(shí)現(xiàn)生理性愈合,又被稱為"皮膚原位再生復(fù)原技術(shù)",目前已成為我國(guó)治療燒傷的主體技術(shù)。為了總結(jié)"燒傷再生療法"治療深度燒傷的臨床經(jīng)驗(yàn),探討加速創(chuàng)面壞死組織液化和縮短再生修復(fù)過程的有效方法,作者復(fù)習(xí)了與之有關(guān)的文獻(xiàn)。結(jié)果發(fā)現(xiàn),耕耘療法能促進(jìn)深Ⅱ度深型創(chuàng)面壞死組織液化,使這些創(chuàng)面實(shí)現(xiàn)原位再生修復(fù);用其處理Ⅲ度創(chuàng)面,焦痂液化期偏長(zhǎng),從而也延長(zhǎng)了燒傷皮膚再生愈合過程。Ⅲ度創(chuàng)面若附以"焦痂薄化術(shù)"處理,可有效地縮短液化期,在MEBT/MEB()培植的肉芽組織上移植自體皮膚很容易成活。同時(shí)觀察到愈合后的皮膚形態(tài)近似于正常,組織病理學(xué)檢查到具有類似于真皮組織的結(jié)構(gòu)。據(jù)此認(rèn)為,"焦痂薄化術(shù)"在"燒傷再生療法"中應(yīng)用前景十分廣闊。
"Moist Exposed Bum Therapy/Moist Exposed Burn Ointment(MEBT/MEBO) is the precursor to "Burn Regenerative Therapy",and is composed of Moist Exposed Bum Therapy(MEBT) and Moist Exposed Burn Ointment (MEBO) which was included in the first batch of ten techniques in the ' Ten Years,Hundred Techniques program in 1991 by the Ministry of Health of the People' s Republic of China.The " skin incision and tension reliving" technique is combined with MEBT/MEBO in order to accelerate the early liquefaction of necrotic tissue.And initially a system of bum treatment with Chinese characteristics was formed on the basis of MEBT/MEBO.MEBT/MEBO is also called "In Situ Skin Regenerative Restoration Technique" because it can activate adult somatic cells and achieve physiological wound healing which has been the mainstream technique of burn treatment in China.The author reviewed related articles in order to summarize the experience of "burn regenerative therapy" in the treatment of deep bums and explore the effective approaches to accelerate necrotic tissue liquefaction and shorten the process of regenerative restoration.It was found that the ' skin incision and tension reliving' technique can be applied to promote the liquefaction of necrotic tissue on deep type of deepⅡdegree bums and thus in situ regenerative restoration can be achieved.But the liquefaction stage and the regenerative healing process of burnt skin is prolonged if the ' skin incision and tension reliving' technique is adopted in the treatment ofⅢdegree bums.The liquefaction stage can be effectively shortened in the treatment of ID degree burns if the ' Eschar Thinning Technique' is combined with MEBT/MEBO.The autologous grafted skin slices can more easily survive on the granulation tissue that has been cultivated by MEBT/MEBO.The histopathological examination revealed that the dermis found in skin tissue treated with MEBT/MEBO had normal morphology.Thus,it is believed that the prospective application of ' Eschar Thinning Technique' is promising in " Burn Regenerative Therapy".