联合“八步法”减轻颈部瘢痕增生的临床应用研究  

Clinical application of combined “eight-step method” to reduce neck scar hyperplasia

作　　者：乔梦祥 李成伟 刘先富[1] 唐经纬[1] 刘元[1] 金功圣[1] QIAO Mengxiang;LI Chengwei;LIU Xianfu;TANG Jingwei;LIU Yuan;JING Gongsheng(Department of Oncological Surgery,The First Affiliated Hospital of Bengbu Medical College,Bengbu 233000,China)

机构地区：[1]蚌埠医学院第一附属医院肿瘤外科(甲乳病区),安徽省蚌埠市233000

出　　处：《组织工程与重建外科》2022年第2期138-143,共6页Journal of Tissue Engineering and Reconstructive Surgery

基　　金：安徽省重点研究与开发计划项目(202004j07020009);蚌埠医学院研究生科研创新计划(Byycx20092)。

摘　　要：目的探讨经颈前弧形切口入路行甲状腺切除术时采用自研式切缘保护撑开装置联合“八步法”进行干预,抑制瘢痕增生的临床价值。方法选取我院2020年6月至2020年12月期间,经颈前切口入路行单侧甲状腺腺叶切除伴峡部切除+单侧Ⅵ区淋巴结清扫的患者,按照随机数字表法分为两组,观察组采用自研式切缘保护撑开装置联合“八步法”处理切口,对照组则采用传统缝合方法。设定术后3~4个月为首次随访期、术后6~8个月为二次随访期,通过国际版温哥华瘢痕评价量表(Vancouver scar scale,VSS),以及患者和观测者瘢痕评价量表(Patient and observer scar assessment scale,POSAS),统计两组患者术中及术后各项数据,进行统计学分析。结果两组患者性别、年龄、身体质量指数(Body mass index,BMI)、手术时间、中央区淋巴结清扫数量及术后并发症发生率无明显差异(P>0.05);首次随访期VSS、POSAS得分观察组多项指标与对照组相比无明显差异(P>0.05),二次随访期VSS、POSAS得分观察组多项指标优于对照组,差别有统计学意义(P<0.05)。结论自研式切缘保护撑开装置对颈部形成的高张力线性瘢痕具有术中减张和保护皮瓣的作用;“八步法”通过多种手段联合,可实现尽早干预,抑制术后瘢痕增生。Objective To explore the clinical value of using a self-initiated margin protection spacer device combined with the“eight-step method”in inhibiting scar hyperplasia during thyroidectomy via the anterior cervical incision approach.Methods Patients who underwent unilateral thyroid lobectomy with isthmus resection+unilateral VI lymph node dissection via anterior cervical incision from June 2020 to December 2020 were randomly divided into two groups according to random number table method.The observation group was treated with a self-initiated margin protection spacer device combined with“eight-step method”to deal with incision,while the control group was treated with traditional suture method.The first follow-up period was set as 3 to 4 months after surgery,and the second follow-up period was set as 6 to 8 months after surgery.The Vancouver scar scale(VSS)and the Patient and observer scar assessment Scale(POSAS)were used to collect intraoperative and postoperative data of the two groups for statistical analysis.Results There were no significant differences between the two groups in terms of gender,age,Body mass index(BMI),operation time,number of lymph node dissection in the central area and postoperative complication rate(P>0.05);During the first follow-up period,there were no significant differences in VSS and POSAS scores between the observation group and the control group(P>0.05),while during the second follow-up period,VSS and POSAS scores of the observation group were better than the control group,with statistically significant differences(P<0.05).Conclusion The self-initiated margin protection spacer device can reduce the intraoperative tension and protect the flap for high-tension linear scars formed in the neck;The"eight-step method"combines various means to intervene as early as possible and inhibit scar hyperplasia.

关 键 词：八步法 自研式切缘保护撑开装置 瘢痕增生 瘢痕评估 

分 类 号：R619.6[医药卫生—外科学]