采用SRT-100放射治疗儿童增生性瘢痕的临床疗效初探  

Preliminary exploration of the clinical effects of radiation therapy with SRT-100 on hypertrophic scars in children

作　　者：蒙礼娟 麻艺群 王璐[1] 张梦思 范鑫 许水淋 杨丽红 朱辉 付晋凤 Meng Lijuan;Ma Yiqun;Wang Lu;Zhang Mengsi;Fan Xin;Xu Shuilin;Yang Lihong;Zhu Hui;Fu Jinfeng(Department of Burns and Plastic Surgery,Kunming Children′s Hospital,Children′s Hospital Affiliated to Kunming Medical University,Kunming 650031,China)

机构地区：[1]昆明市儿童医院昆明医科大学附属儿童医院烧(创)伤整形外科,650031

出　　处：《中华损伤与修复杂志（电子版）》2024年第1期16-23,共8页Chinese Journal of Injury Repair and Wound Healing(Electronic Edition)

基　　金：云南省教育厅科学研究基金项目(2023J0294)。

摘　　要：目的观察SRT-100皮肤浅层X线放射治疗系统治疗儿童增生性瘢痕的临床疗效。方法回顾性分析昆明市儿童医院烧(创)伤整形外科2020年9月至2023年5月治疗的27例患儿病历资料,共42处增生性瘢痕。根据治疗方法分为常规治疗组21例,行常规抗瘢痕治疗(外用抗瘢痕药物、压力套);联合放射治疗组21例,行常规抗瘢痕治疗(外用抗瘢痕药物、压力套)联合SRT-100皮肤浅层X线放射治疗。增生性瘢痕于创面愈合后1~3个月开始放射治疗,每周1次,4次后间隔1~2个月视瘢痕增生情况确定是否继续治疗,一个疗程4~8次。管电压50~70 kV,单次剂量350~400 cGy,总剂量不超过30 Gy,照射时间30~60 s/次。照射时瘢痕周围正常皮肤用铅片保护,腺体部位禁止照射。2组在治疗前(瘢痕病程2个月内)和治疗后(瘢痕病程6个月,常规治疗组为接受常规治疗的第4~5个月,联合放射治疗组为接受4次放射后3~4个月或者8次放射后1~2个月)分别采用温哥华瘢痕量表(VSS)进行评分,记录疗效、患儿家属满意度。治疗后随访6~24个月,观察不良反应。数据比较采用独立样本t检验、χ^(2)检验、秩和检验。结果常规治疗组治疗前后VSS评分为(11.9±1.2)分和(9.7±1.7)分,差异有统计学意义(t=10.869,P<0.001);其中显效0例,有效18例,无效3例,有效率为85.7%,显效率为0;患儿家属非常满意0例,比较满意2例,一般满意16例,不满意3例,总体满意率85.7%;不良反应为色素沉着和皮肤干燥,无瘢痕破溃及皮炎发生。联合放射治疗组治疗前后VSS评分为(11.2±1.2)分和(4.7±0.8)分,差异有统计学意义(t=24.726,P<0.001),且联合放射治疗组的降低幅度明显大于常规治疗组(t=12.805,P<0.001);其中显效14例,有效7例,无效0例,有效率为100%,显效率为66.7%;患儿家属非常满意14例,比较满意7例,一般满意0例,不满意0例,总体满意率100%;4例患儿出现放射性皮炎,表皮破溃、湿疹,予常规换药治疗后愈Objective To investigate the clinical effects of X-ray radiation on superficial layer of skin with SRT-100 equipment in the treatment of hypertrophic scars in children.Methods Data of 27 children with 42 hypertrophic scars treated in Kunming Children′s Hospital from September 2020 to May 2023 were analyzed retrospectively and divided into the routine treatment group(n=21)and combination with radiotherapy group(n=21).The children in the routine treatment group only received conventional anti-scar treatment(external use of ant-scar drugs and pressure therapy).The children in the combination with radiotherapy group received X-ray radiation on superficial layer of skin with SRT-100 equipment on the basis of conventional anti-scar treatment.Hypertrophic scars started to be irradiated 1-3 months after wound healing,once a week for 4 times and later continuation or not depending on visual scar hyperplasia conditions after an interval of 1-2 months,and 4-8 times as a course of treatment.The parameters were set as 50-70 kV,single dose of 350-400 cGy,the total dose of no more than 30 Gy and irradiation time of 30-60 seconds once.Protecting normal skin around scars with lead sheets during irradiation and the glandular sites were prohibited from irradiation.Before treatment(scar progression within 2 months)and after treatment(scar progression for 6 months:the routine treatment group received routine treatment for 4-5 months,while the combined with radiotherapy group received four doses of radiation and then three or four months later,or one to two months after eight doses of radiation),the Vancouver scare scale(VSS)was used to score,and the effectiveness of treatment and the satisfaction of children′s family were recorded.All children were followed up for 6-24 months,during which the adverse reactions were observed.The data were comparied by t-test,chi-square test and wilcoxon test between the two groups.Results The VSS scores were(11.9±1.2)points and(9.7±1.7)points before and after the routine treatment,and the differ

关 键 词：SRT-100 X线放射治疗 皮肤浅层 儿童 增生性瘢痕 

分 类 号：R622[医药卫生—整形外科]