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目的:观察应用异种脱细胞真皮基质补片(ADM)对口腔黏膜扁平苔藓术后缺损修复情况。方法:选择行手术切除口腔黏膜扁平苔藓35例,黏膜缺损同期采用ADM修复。根据黏膜缺损大小及形状选择规格适宜的ADM,适当修剪;将AMD基底膜面接触黏膜缺损区,采用缝线固定、反包扎的方式覆盖于黏膜缺损区。术后7~10天拆除碘仿纱包。随访1个月、3个月、10个月,观察ADM成活及收缩情况,评估患者张口度、术区黏膜颜色质地及冷热觉和触觉。结果:本组35例手术过程均顺利,术后恢复良好;术后前3天术区局部轻度水肿,有轻度疼痛、不适感,无明显并发症,无一例发生排斥反应,无感染和坏死脱落。ADM完全成活31例,占88.6%;部分成活4例,占11.4%;无一例失败。术后2~4周,6例术区小部分收缩;术后3个月,所有患者术区均无瘢痕挛缩,张口度正常,术区组织形态与正常黏膜相比差异不显著,无疼痛或异物感;术后6个月,所有患者术区均完全恢复冷热觉及触觉。术后10个月,病灶复发1例,再次采取手术切除治疗。结论:应用ADM修复口腔黏膜扁平苔藓术后缺损效果满意,可推荐作为口腔黏膜浅层缺损修复的理想材料。
Objective: To observe the application of heterologous acellular dermal matrix patch (ADM) to repair the defect of oral mucosa after oral lichen planus. Methods: Surgical resection of oral lichen planus in 35 cases, mucosal defects over the same period with ADM repair. According to the size and shape of the mucosal defect select appropriate ADM, appropriate pruning; the AMD basement membrane surface contact mucosal defect area, the use of suture fixation, anti-bandaging covering the mucosal defect area. 7 to 10 days after the removal of iodoform gauze package. The patients were followed up for 1 month, 3 months and 10 months. Survival and contractions of ADM were observed. The mouth opening degree, mucosal color texture, cold, heat and tactile sensation were evaluated. Results: All the 35 cases underwent surgery in this study. All the patients recovered well after surgery. In the first 3 days postoperatively, there were mild local edema, slight pain and discomfort, no obvious complication, no rejection and no infection Necrosis. ADM fully survived in 31 cases, accounting for 88.6%; some survived in 4 cases, accounting for 11.4%; and none of them failed. At 2 to 4 weeks postoperatively, a small part of 6 cases contracted. At 3 months after operation, all patients had no scar contracture and normal mouth opening. There was no significant difference in histological morphology between the two groups Foreign body sensation; 6 months after operation, all patients were completely cold and heat recovery surgery and touch. After 10 months, one case of recurrent lesions was treated by surgical resection. Conclusion: The application of ADM to repair the defect of oral lichen planus is satisfactory and can be recommended as an ideal material for the repair of oral mucosal shallow defects.