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1、細(xì)胞的生長和調(diào)控纖維母細(xì)胞纖維細(xì)胞原始間葉細(xì)胞轉(zhuǎn)化為纖維母細(xì)胞產(chǎn)生膠原纖維并轉(zhuǎn)化為纖維細(xì)胞模式圖 原始間葉細(xì)胞 毛細(xì)血管再生模式圖1.基底膜分解，內(nèi)皮細(xì)胞肥大、增生，形成幼芽2.內(nèi)皮細(xì)胞向前移動，其后的內(nèi)皮細(xì)胞分裂增生，靠近血管處的內(nèi)皮細(xì)胞先分化成熟，并有新的基底膜形成正常神經(jīng)纖維神經(jīng)纖維斷離，遠(yuǎn)端及近端的一部分髓鞘及軸突崩解神經(jīng)纖維再生模式圖 神經(jīng)膜細(xì)胞增生，軸突生長 神經(jīng)軸突達(dá)末梢，多余部分消失 神經(jīng)纖維再生模式圖 肉芽組織鏡下結(jié)構(gòu)模式圖 大量由內(nèi)皮細(xì)胞增生形成的實性細(xì)胞索及擴張的毛細(xì)血管，向創(chuàng)面垂直生長，并以小動脈為軸心，在周圍形成袢狀彎曲的毛細(xì)血管網(wǎng)。 毛細(xì)血管周圍有許多新生的纖維母細(xì)
2、胞 。常有大量滲出液及炎性細(xì)胞。炎性細(xì)胞常以巨噬細(xì)胞為主，也有多少不等的中性粒細(xì)胞及淋巴細(xì)胞。 圖注：新生的毛細(xì)血管呈出芽狀互相聯(lián)絡(luò)，內(nèi)皮細(xì)胞腫脹。纖維母細(xì)胞增生（f），并可見嗜中及嗜酸性粒細(xì)胞浸潤，漿細(xì)胞浸潤。肌纖維母細(xì)胞：核胖、核仁明顯 圖注：右手燙傷累及組織較深，壞死組織脫落后由肉芽組織增生取代，最后成為瘢痕組織。瘢痕組織較硬，缺乏彈性，由于瘢痕的攣縮，皮膚成皺縮狀。 fibrin-clotted blooddehydration of surface scabneutrophilsDay 1: neutrophils migrate from the incision margin t
3、oward the fibrin clot.basal cells at the cut edge of the epidermis undergo mitosis. within 24-48 h, epithelial cells from both edges have begun to migrate and proliferate along the dermis, depositing basement membrane components as they progress. The cells meet in the midline beneath the surface sca
4、b, yielding a thin but continuous epithelial layer.24 hours3-7 daysDays 2-3: neutrophils have been largely replaced by macrophagesgranulation tissue progressively invades the incision spacecollagen fibers develop at the incision marginsepithelial cell proliferation continues, yielding a thickened ep
5、idermal covering layerDays 4-5: neovascularization reaches its peak as granulation tissue fills the incision collagen fibrils become more abundant and begin to bridge the incision.the epidermis recovers its normal thickness, yielding a mature epidermal architecture with surface keratinizationSecond
6、week: continued collagen accumulation and fibroblast proliferation leukocyte infiltrate, edema, and increased vascularity are substantially diminishedFirst month: the unconspicuous scar comprises a cellular connective tissue largely devoid of inflammatory cells and covered by an essentially normal epidermis. 1創(chuàng)緣整齊，組織破壞少 2經(jīng)縫合，創(chuàng)緣對合，炎癥反應(yīng)輕 3表皮再生，少量肉芽組織從傷口緣長入4愈合后少量疤痕形成創(chuàng)傷一期愈合模式圖創(chuàng)傷二期愈合模式圖1創(chuàng)口大，創(chuàng)緣不整，組織破壞多2傷口收縮，炎癥反應(yīng)重3.肉芽組織從傷口底部及邊緣將傷口填平，然后表皮再生4.愈合后形成疤痕大24hours3-7 daysweeks
臨床病理學(xué)課件：第二章 損傷的修復(fù)
