VAC聯(lián)合郵票植皮修復(fù)兒童難愈性創(chuàng)面療效探討

張朦 章磊 杜琳

[摘要]目的：觀察負(fù)壓封閉引流技術(shù)（Vacuum-assisted closure，VAC）聯(lián)合郵票植皮修復(fù)早期不當(dāng)處理形成的難愈性創(chuàng)面的療效。方法：選取筆者醫(yī)院2016年2月-2020年2月因早期不當(dāng)處理致創(chuàng)面加深患兒60例為研究對象，依據(jù)非隨機臨床同期對照研究及患兒家屬自愿原則分為觀察組（n=32）、對照組（n=28），觀察組予以VAC+郵票植皮技術(shù)治療，對照組采用傳統(tǒng)打包結(jié)合郵票植皮技術(shù)治療，比較兩組植皮優(yōu)良率、治療結(jié)果（手術(shù)時間、術(shù)后換藥次數(shù)、住院時間、創(chuàng)面愈合時間）、植皮成活率、治療前后血清炎癥因子[白介素-1（IL-1）、白介素-6（IL-6）、腫瘤壞死因子-α（TNF-α）]、血管內(nèi)皮生長因子（VEGF）水平及患兒家屬滿意度。結(jié)果：觀察組植皮優(yōu)良率高于對照組，差異有統(tǒng)計學(xué)意義（P<0.05）。觀察組的手術(shù)時間、住院時間、創(chuàng)面愈合時間及術(shù)后換藥次數(shù)均較對照組少，差異有統(tǒng)計學(xué)意義（P<0.05）。觀察組治療后7d、14d植皮成活率高于對照組，差異有統(tǒng)計學(xué)意義（P<0.05）。觀察組治療后血清IL-1、IL-6、TNF-α水平明顯低于對照組，而VEGF水平較對照組高，差異有統(tǒng)計學(xué)意義（P<0.05）。觀察組患兒家屬治療后滿意度高于對照組，差異有統(tǒng)計學(xué)意義（P<0.05）。結(jié)論：早期不當(dāng)處理致創(chuàng)面加深后運用VAC聯(lián)合郵票植皮療效較好，可明顯提高植皮成活率，減少手術(shù)時間和術(shù)后換藥次數(shù)，并下調(diào)炎癥因子水平，有利于創(chuàng)面愈合。

[關(guān)鍵詞]難愈性創(chuàng)面;負(fù)壓封閉引流技術(shù);郵票植皮;療效;炎癥因子;血管內(nèi)皮生長因子

[中圖分類號]R622? ? [文獻(xiàn)標(biāo)志碼]A? ? [文章編號]1008-6455（2020）12-0082-04

Study on the Effect of VAC Combined with Stamp Skin Grafting on Refractory Wounds in Children

ZHANG Meng，ZHANG Lei，DU Lin

（Department of Burn and Plastic Surgery，Children's Hospital Affiliated to Nanjing Medical University，Nanjing 210000，Jiangsu，China）

Abstract： Objective? To observe the effect of vacuum-assisted closure（VAC） combined with stamp skin grafting in the repair of refractory wounds caused by improper treatment in the early stage. Methods? Sixty children with refractory wounds caused by improper treatment in the early stage in the hospital between February 2016 and February 2020 were selected as the research subjects. They were divided into the observation group （n=32） and the control group （n=28） according to the non-randomized clinical concurrent control study and childrens family members voluntary principles. The observation group was treated with VAC combined with stamp skin grafting， and the control group was treated with traditional packaging combined with stamp skin grafting. The excellent and good rate of skin grafting， treatment outcomes （operation time， frequency of postoperative dressing change， hospital stay， wound healing time）， survival rate of skin grafts， levels of serum inflammatory factors [interleukin-1 （IL-1）， interleukin-6 （IL-6）， tumor necrosis factor-α （TNF-α）] and vascular endothelial growth factor （VEGF） before and after treatment， and satisfaction of childrens family members were compared between the two groups. Results? The excellent and good rate of skin grafting in the observation group was higher than that in the control group， the difference was statistically significant （P<0.05）. The operation time， hospital stay and wound healing time of the observation group were shorter than those of the control group， and the frequency of postoperative dressing change was less than the control group （P<0.05）. The survival rates of skin grafts in the observation group at 7 days and 14 days after treatment were higher than those in the control group （P<0.05）. After treatment， levels of serum IL-1， IL-6 and TNF-α in the observation group were significantly lower than those in the control group， while the level of VEGF was higher than that in the control group （P<0.05）. The satisfaction of family members of the observation group after treatment was higher than those of the control group （P<0.05）. Conclusion? The application of VAC combined with stamp skin grafting in the repair of refractory wounds caused by improper treatment in the early stage can improve the survival rate of skin grafts significantly， reduce the operation time and the frequency of postoperative dressing change， and down regulate the levels of inflammatory factors， which is beneficial to wound healing.

[5]張永光，孫婷婷，盛青松，等.VSD負(fù)壓吸引輔助Meek植皮技術(shù)在皮膚創(chuàng)面修復(fù)中的臨床研究[J].中國美容整形外科雜志，2018，29（6）：350-352.

[6]肖昌明，銀西洋，鄒杰.三種植皮方式修復(fù)大面積燒傷創(chuàng)面的臨床效果對照研究[J].解放軍醫(yī)藥雜志，2017，29（3）：84-86，90.

[7]Latouche V，Devillers H.Benefits of negative pressure wound therapy with instillation in the treatment of hard-to-heal wounds： a case series[J].J Wound Care，2020，29（4）：248-253.

[8]Martino A，Re FD，F(xiàn)alcetta G，et al.Sternal wound complications：results of routine use of negative pressure wound therapy[J].Braz J Cardiovasc Surg，2020，35（1）：50-57.

[9]Khurram MF，Sarfraz Ali S，Yaseen M.Vacuum-assisted wound closure therapy in pediatric lower limb trauma[J].Int J Low Extrem Wounds，2019，18（3）：317-322.

[10]秦芹，姚廣東.局部皮瓣加植皮術(shù)結(jié)合創(chuàng)面負(fù)壓治療頸部中重度瘢痕攣縮畸形15例[J].安徽醫(yī)藥，2019，23（5）：959-960，后插4.

[11]鐘文龍，楊思敏，郭再冉，等.負(fù)壓封閉引流聯(lián)合郵票植皮治療軟組織感染伴缺損24例[J].河北醫(yī)科大學(xué)學(xué)報，2018，39（11）：1296-1299.

[12]蔡建華，申傳安，庹曉曄，等.負(fù)壓封閉引流技術(shù)在燒傷患兒頸部及軀干創(chuàng)面植皮術(shù)中的應(yīng)用[J].中華燒傷雜志，2017，33（1）：43-45.

[13]王偉，潘朝暉，趙玉祥.負(fù)壓封閉引流與傳統(tǒng)的打包加壓技術(shù)在治療足部皮膚撕脫傷中的臨床效果比較[J].河北醫(yī)學(xué)，2017，23（7）：1113-1118.

[14]Sousa M，Campos MA，Sousa AC，et al.Extensive refractory perineal pyoderma gangrenosum treated with infliximab，fecal diversion，and negative-pressure wound therapy[J].GE Port J Gastroenterol，2020，

27（2）：128-131.

[15]劉昱星，陳振雨，冷向峰，等.封閉負(fù)壓引流與打包加壓植皮成活效果的比較[J].青島大學(xué)醫(yī)學(xué)院學(xué)報，2015，51（1）：42-44.

[16]劉巖，徐英華，耿艷俠，等.VSD聯(lián)合游離皮片植皮治療糖尿病足感染的應(yīng)用效果研究[J].河北醫(yī)學(xué)，2016，22（6）：991-993.

[17]鄭敏，殷學(xué)利，簡華剛，等.封閉負(fù)壓引流技術(shù)干預(yù)四肢植皮創(chuàng)面量效關(guān)系研究[J].重慶醫(yī)科大學(xué)學(xué)報，2016，41（2）：209-213.

[18]王瑩，代彥麗，樸金龍，等.炎癥因子、生長因子以及凋亡因子在壓瘡慢性難愈合性創(chuàng)面中的表達(dá)及作用[J].中國應(yīng)用生理學(xué)雜志，2017，33（2）：181-184，188.

[19]汪漣，郭菲，閔定宏，等.炎癥與修復(fù)相關(guān)細(xì)胞因子基因在臨床慢性難愈性創(chuàng)面中差異表達(dá)的分析[J].中華燒傷雜志，2019，35（1）：18-24.

[20]徐麗紅.VSD技術(shù)聯(lián)用表皮生長因子對深度燒傷創(chuàng)面愈合及炎癥應(yīng)激反應(yīng)的影響[J].中國美容醫(yī)學(xué)，2017，26（9）：19-22.

[21]Seidel D，Storck M，Lawall H，et al.Negative pressure wound therapy compared with standard moist wound care on diabetic foot ulcers in real-life clinical practice：results of the German DiaFu-RCT[J].BMJ Open，2020，10（3）：e026345.

[22]Ni J，Liu H，Liu X，et al.Vacuum sealing drainage as treatment of severe buttocks and perianal infection： a case report and review of the literature care-compliant[J].Medicine（Baltimore），2015，

94（43）：e1766.

[收稿日期]2020-03-30

本文引用格式：張朦，章磊，杜琳.VAC聯(lián)合郵票植皮修復(fù)兒童難愈性創(chuàng)面療效探討[J].中國美容醫(yī)學(xué)，2020，29（12）：82-86.