耳部瘢痕疙瘩的个性化治疗  

Individualized therapy for keloid in aural region

作　　者：王春梅[1] 张继[1] 归来[1] 周振山[2] 

机构地区：[1]中国医学科学院 [2]解放军第三○七医院放射科,北京市100000

出　　处：《中国临床康复》2006年第16期23-25,i0001,共4页Chinese Journal of Clinical Rehabilitation

摘　　要：目的:探讨耳部瘢痕疙瘩多种外科手术方法结合辅助疗法的治疗效果,摸索一套以外科手术为主的个性化的综合治疗体系。方法:选择2002-01/2004-07中国协和医科大学整形外科医院瘢痕中心收治耳部瘢痕疙瘩患者40例56耳,男9例,女31例;年龄8～60岁,平均30.17岁;发病时间1～15年;单耳24例,双耳16例;发病原因:穿耳孔28例,创伤4例,耳部手术5例,局部破溃感染2例,无诱因1例;瘢痕疙瘩0.7cm×0.7cm×0.5cm～10cm×5cm×3cm;球形、哑铃状或葫芦状等形状不一,边界清楚,部分伴有疼痛、瘙痒。根据耳部瘢痕疙瘩的大小、位置、浸润范围、与耳郭及周围器官的关系,实施不同的手术方案,手术方法遵循无张力缝合,局部无继发畸形以及保持良好的耳郭形态的原则。①直径<1cm的瘢痕疙瘩,采用完全切除,直接拉拢缝合。②直径>1cm的瘢痕疙瘩,切除后直接缝合后张力较大,多采用局部旋转皮瓣或推进皮瓣修复。③巨大瘢痕疙瘩,采用瘢痕疙瘩部分切除或保留瘢痕表皮的瘢痕组织摘除法。④术后第1天开始进行电子线照射,连续3d,1次/d,5Gy/次,总剂量为15Gy。伤口拆线后2周局部外用瘢痕敌(施乐辉有限公司生产,批号:0538)持续贴敷,维持3～6个月,适度加压。⑤长期随访,加强患者自我管理意识,并对有复发倾向者及时治疗。局部注射激素类抗瘢痕药物,曲安奈德+透明质酸酶+20g/L利多卡因注射液瘢痕内注射,混合液具体配方及用法:曲安奈德40mg,透明质酸酶500U,20g/L利多卡因注射液1mL瘢痕内均匀注射,每次用量视瘢痕疙瘩体积适当调整,1次/周,4周后将混合液用利多卡因稀释1倍,1次/2周注射,以后视瘢痕疙瘩消退情况逐渐撤药。结果:纳入患者40例,均进入结果分析。术后随访1年以上,除1例复发,3例有复发倾向者(及时采用局部激素注射等非手术方法治疗后有效),其余均未见复发,且无明显的瘢痕增生,耳郭和耳垂的�AIM： To investigate the effectiveness of multiple surgical operations combined with adjuvant therapy on the treatment of keloids, in order to fumble for an individualized integrated therapeutic system, mainly with surgical operations. METHODS： Totally 56 aural keloids （24 unilateral and 16 bilateral ears） from 40 patients including 9 males and 31 females aged from 8 to 60 years old treated in the Center of Scar of the Plastic Surgery Hospital, Peking Union Medical College were selected from January 2002 to July 2004. The coupe of disease lasted from 1 to 15 years, and the causes of disease included： earhole piercing （n=28）, ear trauma （n=4）, postoperative hyperplasia （n=5）, regional infection （n=2） and no predisposing cause （n=1）; the dimensions of keloids ranged from 0.7 cm×0.7 cm×0.5 cm to 10 cm × 5 cm×3 cm with globular, collar-button, cucurbit and other shapes; the lesions had distinct boundaries and accompanied by pain and pruritus. According to the size, location, infiltration range and relation with auricle and peripheral organs, different operation programs were performed on the patients, which followed the rules of no tension, no secondary deformity and keeping satisfactory auricular contour. ①The keloids with diameter 〈 1 cm, could be completely removed and sutured directly. ②Those with diameter 〉 1 cm were often treated with local totating or advanced skin flap, but not sutured directly after removal because of the hypertension. ③ The huge keloids were removed locally or the scar tissues were excised with the preservation of epiderm. ④Tbe wounds were given electron beam radiation on the first day after the operation once a day with 5 Gy each time 15 Gy in total for 3 days, and were stuck consistently with Cica-Care （Smith and Nephew, No.0538） two weeks after sutured out for 3-6 months. ⑤ A long-term follow-up was carried out to strengthen the self-control consciousness of the patients and an immediate treatment was performed to the patients who had

关 键 词：癜痕疙瘩 修复外科手术 外耳 

分 类 号：R619.6[医药卫生—外科学]