“核心剥离式”瘢痕疙瘩修薄术联合放疗的疗效分析  

Efficacy analysis of‘core stripping’keloid thinning surgery combined with radiotherapy

作　　者：武晓莉[1] 班耀林 陈立彬 谢春晖 马倩玉 王文波[1] WU Xiaoli;BAN Yaolin;CHEN Libin;XIE Chunhui;MA Qianyu;WANG Wenbo(Department of Plastic Surgery,Shanghai Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200011,China;Department of Burn and Plastic Surgery,Anshan Hospital,The First Affiliated Hospital of China Medical University,Anshan 114000,China;Department of Cosmetic Surgery,Beauthrie Medical Cosmetic Clinic,Shanghai 200030,China;Burns Department,First Hospital of Jilin University,Changchun 130021,China)

机构地区：[1]上海交通大学医学院附属第九人民医院整复外科,上海市200011 [2]中国医科大学附属第一医院鞍山医院烧伤整形外科,辽宁省鞍山市114000 [3]伯思立医疗美容门诊部美容外科,上海市200030 [4]吉林大学第一医院烧伤与皮肤创面修复外科,吉林省长春市130021

出　　处：《组织工程与重建外科》2023年第1期22-27,共6页Journal of Tissue Engineering and Reconstructive Surgery

基　　金：上海市科委项目(上海市整形与修复重建临床医学研究中心,22MC1940300)。

摘　　要：目的探究“核心剥离式”瘢痕疙瘩修薄术联合放疗对于瘢痕疙瘩治疗的效果。方法采取回顾性研究以及自身前后对照,选取2020年1月—2020年12月收治的43例边缘呈坡形的瘢痕疙瘩患者,共326处瘢痕疙瘩病灶,行“核心剥离式”瘢痕疙瘩修薄术,在保留约1 mm厚度瘢痕皮片情况下剥离并切除瘢痕核心组织,保留真皮网状层,以“改良褥式缝合法”缝合固定瘢痕皮片。术后采用6 MeV电子线放射治疗2次,第1次放疗于术后24 h内完成,7 d后进行第2次放疗,单次照射剂量为9 Gy。治疗结束后6个月、12个月及18个月时随访。采用患者与观察者瘢痕评估量表(The patient and observer scar scale,POSAS)分析治疗结果,统计治疗有效率及治疗后18个月患者满意度。结果治疗后POSAS总分、患者总分、观察者总分均较治疗前显著降低。部分患者出现不同程度的色素沉着、脱失,局部毛发脱落,及短暂的皮炎、神经炎表现,后均自行改善。治疗结束后18个月的总复发率为30.23%。43例瘢痕疙瘩中,17例(39.53%)患者对疗效非常满意,22例(51.62%)患者对疗效满意,4例(9.3%)患者对疗效不满意,总体满意率为90.7%。结论“核心剥离式”瘢痕疙瘩修薄术是一种快速有效的瘢痕疙瘩减容手术,配合术后放疗具有良好的治疗效果。Objective To explore the effect of"core stripping"keloid thinning surgery combined with radiotherapy in the treatment of keloid.Methods From January 2020 to December 2020,43 patients with slope keloid and 326 keloid lesions were selected by retrospective study and self-control.The"core stripping"keloid thinning surgery was used to separate and remove the core tissue of keloid while retaining the scar skin with a thickness of about 1 mm.The reticular dermis was retained,and the scar skin was sutured and fixed by the"modified mattress suture method".After surgery,6 Mev electron radiotherapy was performed twice.The first radiotherapy was completed within 24 hours after operation,and the second radiotherapy was performed 7 days later.The single dose of radiotherapy was 9 Gy.Follow-up was performed at 6 months,12 months and 18 months after the end of treatment.The patient and observer scar scale(POSAS)was used to analyze the treatment outcomes,and the treatment response rate and patients'satisfaction at 18 months after treatment were statistically analyzed.Results The total score of POSAS,total score of patients,and total score of observers were significantly lower after treatment than before treatment.Some patients had different degrees of hyperpigmentation,hypopigmentation,local hair loss,transient dermatitis and neuritis,which improved spontaneously.The total recurrence rate at 18 months after treatment was 30.23%.Among 43 keloid patients,17 patients(39.53%)were very satisfied with the treatment outcome,22 patients(51.62%)were satisfied,and 4 patients(9.3%)were not satisfied.The overall satisfaction rate was 90.7%.Conclusion The"core stripping"keloid thinning surgery is a rapid and effective keloid volume reduction surgery,which has a good therapeutic effect when combined with postoperative radiotherapy.

关 键 词：瘢痕疙瘩 外科手术 放射疗法 

分 类 号：R619.6[医药卫生—外科学] R815[医药卫生—临床医学]