环钻减容术联合早期放射治疗对多发性瘢痕疙瘩的临床效果

汤于瑱; 徐顺; 章一新; 张铮

doi:10.3760/cma.j.cn501225-20241226-00508

环钻减容术联合早期放射治疗对多发性瘢痕疙瘩的临床效果

doi: 10.3760/cma.j.cn501225-20241226-00508

汤于瑱¹,
徐顺²,
章一新¹,
张铮^1, ,

1.
上海交通大学医学院附属第九人民医院整复外科,上海　200011
2.
上海中医药大学附属第七人民医院烧伤整复外科,上海　200137

基金项目:

国家自然科学基金面上项目 82172222, 82272266

浦东新区卫生健康委员会高峰高原临床特色学科（烧伤整形创面修复）项目 PWYts2021-16

上海市教育委员会高峰高原学科建设计划-“研究型医师”项目 20152227

详细信息

通讯作者:
张铮,Email：zhangzheng958@163.com

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出版历程
- 收稿日期: 2024-12-26

Clinical efficacy of punch excision combined with early radiotherapy in multiple keloids

1.
Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
2.
Department of Burn and Plastic Surgery, Seventh People's Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200137, China

Funds:

General Program of National Natural Science Foundation of China 82172222, 82272266

The Featured Clinical Discipline Project of Shanghai Pudong PWYts2021-16

Shanghai Municipal Education Commission—Gaofeng Clinical Medicine Grant Support 20152227

More Information

Corresponding author: Zhang Zheng, Email: zhangzheng958@163.com

摘要

摘要: 目的评价环钻减容术联合早期放射治疗（PCR）对多发性瘢痕疙瘩的临床效果。方法该研究为回顾性队列研究。2022年11月—2023年12月,上海交通大学医学院附属第九人民医院整复外科收治32例符合入选标准的多发性瘢痕疙瘩患者,其中男20例、女12例,其年龄为16~74岁。对所有患者行PCR,术后1年,根据瘢痕疙瘩的症状、改善程度以及复发情况对32例患者进行疗效评估,并且计算治疗有效率和复发率。术前、术后6个月和术后1年,使用温哥华瘢痕量表（VSS）从色泽、厚度、柔软度、血管分布等方面对32例患者的瘢痕疙瘩进行评分。收集17例患者术前、术后6个月、术后1年经皮肤成像分析系统采集的图像及数据,进行瘢痕疙瘩血红素、黑色素和体积评分。结果术后1年,32例患者的疗效评估结果：显效者22例、改善者6例、无效者3例、复发者1例,治疗有效率为87.50%（28/32）,复发率为3.12%（1/32）。32例患者术后1年瘢痕疙瘩VSS总分及色泽、厚度、血管分布、柔软度评分均明显低于术前和术后6个月（t值分别为14.501、2.470、13.552、7.779、15.092和6.297、5.298、3.040、3.832、4.477,P<0.05）。17例患者术后1年瘢痕疙瘩体积评分明显低于术前和术后6个月（Z值分别为3.772、4.860,P值均<0.05）；术后1年瘢痕疙瘩黑色素评分、血红素评分与术前和术后6个月比较,差异均无统计学意义（P>0.05）。结论 PCR可显著缩小多发性瘢痕疙瘩体积、改善瘢痕疙瘩外观与柔软度,疗效确切、瘢痕疙瘩复发率低,是安全有效的临床治疗方案。
- 瘢痕 /
- 瘢痕疙瘩 /
- 放射疗法,高能 /
- 复发 /
- 环钻减容术
Abstract: Objective To evaluate the clinical efficacy of punch excision combined with early radiotherapy (PCR) in multiple keloids. Methods This study was a retrospective cohort study. From November 2022 to December 2023, 32 patients with multiple keloids who met the inclusion criteria were recruited from the Department of Plastic and Reconstructive Surgery of Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. Among them, 20 were male and 12 were female, aged 16 to 74 years. All patients underwent PCR. At one year after surgery, the efficacy of the treatment in 32 patients was evaluated based on the symptoms, the degree of improvement, and the recurrence of keloids. The treatment effectiveness rate and recurrence rate were calculated. The Vancouver scar scale (VSS) was used to score the keloids of 32 patients in terms of pigmentation, height, pliability, and vascularity before surgery, at 6 months and one year after surgery. The image and data from skin imaging analysis system of 17 patients were collected before surgery and at 6 months and one year after surgery. Then the hemoglobin, melanin, and volume of keloids were scored. Results At one year after surgery, the results of efficacy evaluation of 32 patients showed that 22 cases were markedly effective, 6 cases were improved, 3 cases were ineffective, and one case recurred. The treatment effectiveness rate was 87.50% (28/32), and the recurrence rate was 3.12% (1/32). The total score and scores of pigmentation, height, vascularity, and pliability of VSS of keloids of 32 patients at one year after surgery were significantly lower than those before surgery and at 6 months after surgery (with t values of 14.501, 2.470, 13.552, 7.779, 15.092 and 6.297, 5.298, 3.040, 3.832, 4.477, respectively, P<0.05). The volume score of keloids of 17 patients at one year after surgery was significantly lower than that before surgery and at 6 months after surgery (with Z values of 3.772 and 4.860, respectively, P values both <0.05). However, there were no statistically significant differences in hemoglobin or melanin scores of keloids between one year after surgery and before surgery or 6 months after surgery (P>0.05). Conclusions PCR can significantly reduce the volume of multiple keloids, improve appearance and pliability of keloids. It is a safe and effective clinical treatment plan with definite efficacy and low recurrence rate of keloids.
- Cicatrix /
- Keloid /
- Radiotherapy, high-energy /
- Recurrence /
- Punch excision
汤于瑱：研究设计、数据采集、文章撰写；徐顺：统计学分析；章一新：研究指导、经费支持；张铮：论文审阅、经费支持

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图 1 采用环钻减容术治疗1例患者的胸部多发性瘢痕疙瘩。1A.术前瘢痕疙瘩散在分布,色红,明显凸出于皮肤表面；1B.术中瘢痕疙瘩组织达到视觉上的平整效果

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图 2 对胸部多发性瘢痕疙瘩患者行环钻减容术联合早期放射治疗的效果。2A.术前瘢痕外观；2B.术前皮肤成像分析系统采集的血红素吸收光谱图,瘢痕处充血,可见粗壮血管；2C.术前皮肤成像分析系统采集的黑色素吸收光谱图,瘢痕处色素沉着；2D.术前皮肤成像分析系统采集的三维图像,瘢痕凸起；2E.术后6个月瘢痕外观,较图2A变平；2F.术后6个月皮肤成像分析系统采集的血红素吸收光谱图,瘢痕炎症较图2B减弱；2G.术后6个月皮肤成像分析系统采集的黑色素吸收光谱图,瘢痕色素沉着较图2C改善；2H.术后6个月皮肤成像分析系统采集的三维图像,瘢痕体积较图2D显著缩小；2I.术后1年瘢痕外观,较图2E改善；2J.术后1年皮肤成像分析系统采集的血红素吸收光谱图,瘢痕炎症较图2F轻度减弱或维持；2K.术后1年皮肤成像分析系统采集的黑色素吸收光谱图,瘢痕色素沉着较图2G改善；2L.术后1年皮肤成像分析系统采集的三维图像,瘢痕体积较图2H缩小,几乎与体表齐平

注：黑色方框内区域为该患者Antera 3D^®相机拍摄区域

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Table 1. 行环钻减容术联合早期放射治疗的32例多发性瘢痕疙瘩患者各时间点瘢痕疙瘩温哥华瘢痕量表评分比较（分,x¯±s）

时间点	色泽	厚度	血管分布	柔软度	总分
术前	1.8±1.2	2.8±0.8	2.5±0.6	2.7±0.6	9.9±2.6
术后6个月	2.2±0.7	1.7±0.8	2.2±0.7	1.6±0.7	7.6±2.3
术后1年	1.5±1.0	1.2±0.9	1.8±0.7	1.1±0.9	5.6±2.6
t₁值	2.470	13.552	7.779	15.092	14.501
P₁值	0.019	<0.001	<0.001	<0.001	<0.001
t₂值	5.298	3.040	3.832	4.477	6.297
P₂值	0.005	0.001	<0.001	<0.001	<0.001
注：t₁值、P₁值为术后1年与术前各指标比较所得；t₂值、P₂值为术后1年与术后6个月各指标比较所得

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Table 2. 行环钻减容术联合早期放射治疗的17例多发性瘢痕疙瘩患者各时间点瘢痕疙瘩血红素和黑色素及体积评分比较[分,M（Q₁,Q₃）]

时间点	血红素	黑色素	体积
术前	28.7（22.4,34.4）	61.4（56.9,64.1）	149.5（76.6,330.0）
术后6个月	27.5（24.1,29.0）	64.5（59.2,66.6）	78.6（25.7,118.6）
术后1年	27.1（23.0,32.1）	62.5（56.9,63.8）	46.9（16.1,65.4）
Z₁值	0.844	0.758	3.772
P₁值	0.399	0.448	<0.001
Z₂值	0.431	1.602	4.860
P₂值	0.667	0.109	<0.001
注：Z₁值、P₁值为术后1年与术前各指标比较所得；Z₂值、P₂值为术后1年与术后6个月各指标比较所得