烧伤后化脓性肉芽肿与经典的化脓性肉芽肿相比较具有独特的临床表现和组织学特点。目前烧伤后化脓性肉芽肿国内外诊治方法尚不规范,因此不同方法治疗效果差异很大。经过文献检索发现:烧伤后化脓性肉芽肿病因尚未明确,它是发生在II度烧伤后以角质细胞和毛细血管急性增生为主要组织学特点良性病变,其诊断依赖于病史、临床表现和组织学检查。因为该病有自愈倾向和手术后并发症两方面的原因,其治疗过程,宜首选保守治疗方案,必要时结合手术治疗。<br/>Pyogenic granuloma after burns is different from classic pyogenic granuloma for its clinical features and histological characteristics. Therapy plans of pyogenic granuloma are so different that outcomes of pyogenic granuloma are various. The etiology of pyogenic granuloma is still unknown. It is the benign lesion with the obvious proliferation of keratinocyte and capillary. The diagnosis of pyogenic granuloma is based on the case history, clinical features and the histological examination. Because the disease has a tendency to self heal and complications after the surgery. Conservative plan should be chose to treat cases with pyogenic granuloma after burns firstly.
烧伤,化脓性肉芽肿,手术,植皮,并发症, Burn Pyogenic Granuloma Surgery Graft Complication烧伤后化脓性肉芽肿临床研究进展
烧伤后化脓性肉芽肿(pyogenic granuloma after burns, PGB)最早为阿根廷学者在1978年报道并被治愈,近年来国内外临床病例报道逐渐增多(表1),众多研究发现它既有毛细血管增生的病理特点,又有与经典的化脓性肉芽肿有许多不同的的独特临床表现[12] -[25] 。至今国内外对其临床诊治方法尚未规范,造成很多问题,其中最重要的是一些观点认为PGB应当首选手术治疗,而另一些观点认为该病可以经保守治疗后自愈,这矛盾的观点给临床实践带来很多困惑,为此笔者就PGB诊断和治疗等内容进展进行综述,希望对临床医生将来的诊治有所帮助。
2. 检索策略
英文主要资料库包括:PubMed、Cochrane图书馆、EMBASE和Web of science。检索策略:pyogenic granuloma and burns,语种为英语的文章,不包括综述。中文资料库包括:中文生物医学文献数据库、中国期刊全文数据库、中文科技期刊数据库、中国优秀博硕士学位论文全文数据库。检索策略:化脓性肉芽肿和烧伤,检索时间段至2014年12月,无发表类型限制。纳入标准:烧伤后化脓性肉芽肿患者,并有病理诊断结果。检索结果:中文:4篇,英文:10篇(表1)。
文献报道发病年龄最小8个月,最大56岁,男女比例为21:10。烧伤原因依次为热液,火焰和电烧伤(见表1)。PGB发病部位包括头、面、颈部,四肢、躯干等部位均有报道,单发或者弥漫分布,大小不等,分布不均,病变主要局限在浅或深II度烧伤区域。该病发病急,出现时间为烧伤2~27天,病变最大者直径6 cm [19] 。
烧伤后PGB临床表现为发生在烧伤II度创面的急性增生和逐渐消退过程,这与经典化脓性肉芽肿罕见自愈特点明显不同。首先PGB大多数发生于II度烧伤创面,或者已经愈合烧伤创面,并局限在创面范围内,目前报道的仅有1例发生于烧伤后的瘢痕区域(表1)。临床表现为急性增生过程,而非慢性刺激过程,增殖局限在烧伤区域,在烧伤3 d ~ 12 d后局部烧伤区长出小米大小的红疹,并迅速长大,有的互相融合成片高出皮肤(图1),表面高低不平,色暗红,有的被覆一层上皮,表面有渗出物,破后流出血性渗出物,质较脆,易出血,创周炎症反应明显。经历增生高峰后逐渐消退的临床过程表现为肿物停止增大,并逐渐缩小。创面干燥,肿物创面周围炎症反应明显可以完全消退,恢复皮肤的正常结构。
赵洪良,赵连魁,孙卫海,杨高松,贾黎静,张翠萍, (2015) 烧伤后化脓性肉芽肿临床研究进展Clinical Research Progress of Pyogenic Granuloma after Burns. 亚洲外科手术病例研究,01,1-6. doi: 10.12677/ACRS.2015.41001
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