摘要
目的通过对临床病人及犬的开颅手术,观察应用自主创新人工硬脑膜的预后,并与应用美国进口同类产品(脑膜卫士)比较。方法选择临床手术病人39例,24例应用自创材料,15例应用脑膜卫士修补硬脑膜;选择犬10只,分为5组,分别为1、6、12、24个月及更长时间,每组犬各2只,每只犬于左右头顶分别应用自创材料与脑膜卫士修补硬脑膜。手术后对比观察不同修补材料的效果。结果犬解剖显示,应用自创材料的外表面与颅骨膜有少许丝状粘连、易分离,与周边缝合的硬脑膜已完全愈合,不可分辨,不能分离。从自创材料及脑膜卫士两种修补材料内表面来看,前者生长更接近硬脑膜,与脑表面无粘连或偶有丝状粘连。组织学镜下显示,两种修补材料与硬脑膜之间无嗜中性粒细胞、淋巴细胞等炎症细胞反应,无囊壁形成。自创材料内表面可见上皮细胞覆盖,上皮下可见纤维组织增生,纤维母细胞增生,该材料被降解,总量明显减少,内部可见毛细血管。结论用自创材料做硬脑膜修补手术后,该型材料的特性使其能产生上皮,不形成与脑组织的粘连,并逐渐被自体组织替代,达到具有实际意义的硬脑膜重建。
Objective To observe and compare the prognosis of the reparation of the injured dura with the innovative homemade artificial dura mater or with the the same kind of product named Dura-Guard imported from USA. Methods Clinically 39 patients, 24 underwent the skull surgical operations of replacing the orthotopic dura mater with the homemade material, and 15 with the Dura-Guard. In laboratory, 10 dogs were divided into 5 groups with 2 in each group according to the observation time （1, 6, 12, 24 months or longer respectively）. The dura mater of each dog on both the right and left top of its head was replaced by implanting respectively the homemade material and the Dura-Guard. After the operation, the prognosis of the different implantations in the animals in each group was observed. Results The anatomy of the dogs showed a little bit easily detachable adhesion of the outer surface of the homemade material to the skull periosteum. The dog＇s orthotopic dura mater sutured around got cured completely, without visible interface between the implanted dura and the orthotopic dura mater. The inner surface of the homemade material and the Dura-Guard showed that the growth of the former is much closer to the orthotopic dura mater, with no adhesion or occasional filamentous adhesion to the brain surface. Histological and microscopic observations of both implantations did not show inflammatory cells such as neutrophil cells, lymphoid cells, and so on, and cyst wall at the interface between them and the dura mater. The inner surface of the homemade material was seen to be covered with epithelial cells. The proliferations of the fibrous tissues and fibroblasts were seen under the epithelia. The implanted homemade material was degraded with a distinct reduction in its total amount. Capillaries were seen inside the material. Conclusion After the operation of the homemade dura mater reparation, we found that the nature of this artificial duramater allowed epithelial cells to grow as well as avoided the adhesion to the brain tissues and would gradually be encroached, degraded and replaced by the recipient＇s autologous tissues so that the dura mater could be reconstructed in a practical way.
出处
《中华神经医学杂志》
CAS
CSCD
2006年第10期997-1000,共4页
Chinese Journal of Neuromedicine
基金
广东省科技厅科研基金(2004B33801007)
广州市科技局科研基金(2004Z2-E0181)
关键词
人工硬脑膜
手术对比
硬脑膜修补
Artificial duramater
Operation comparison
Duramater reparation
