增生性瘢痕防治的研究进展与方向

doi:10.3877/cma.j.issn.1673-9450.2017.04.002

增生性瘢痕是常见的病理性瘢痕，是深度烧创伤后组织过度修复、细胞外基质沉积紊乱的结果，常引起患者瘙痒、疼痛，可能的外观毁损和功能受限，严重影响患者的生活质量。目前增生性瘢痕的防治措施包括非手术方法和手术治疗两类。非手术防治措施大体可分为无创治疗、注射治疗、放射治疗、微针治疗、光电声治疗和脂肪移植等。增生性瘢痕形成早期非手术治疗干预是目前发展的主流方向，多种非手术治疗方法的联合应用可能是治疗增生性瘢痕的有效手段，而手术治疗则是治疗增生性瘢痕的最后保障。增生性瘢痕防治的发展方向包括增生性瘢痕动物模型和客观评估方法的发展，烧伤创面深度和瘢痕严重性客观评估的技术发展，组织工程化皮肤和干细胞治疗技术的发展，以及多中心、随机、对照的临床试验研究的开展。总之，对于大面积烧创伤患者，不要等增生性瘢痕形成后才去治疗，应该在创面愈合阶段，树立预防为主、防治结合的理念，把预防增生性瘢痕形成放在比治疗增生性瘢痕更重要的位置。

关键词: 瘢痕, 病理过程, 生理过程, 预防, 治疗

Hypertrophic scar is one of the widespread pathological scars, which results from tissues over-restoration and extracellular matrix disorderly deposition after deep burn injury. It often causes itching, pain, possible appearance damage and functional limitation, seriously affecting the quality of patients′ life. The current prevention and treatment of hypertrophic scars include non-surgical methods and surgical treatment. Non-surgical techniques include noninvasive therapy, injection therapy, radition therapy, microneedle treatment, photoelectric acoustic therapy and fat transplantation. Non-surgical treatment is the main application technology in the early formation of hypertrophic scar, the combined application of several non-surgical treatment may be an effective way for treating hypertrophic scar, and surgical treatment is the ultimate safeguard of hypertrophic scar. The development directions of prevention and treatment in hypertrophic scar include the development of hypertrophic scar animal models and objective assessment methods, the development of burn wound depth and objective assessment of the seriousness of scar, the development of technical tissue engineering skin and stem cell therapy, as well as multi-center, random, controlled clinical trials. In short, A concept should be established that prevention-based, prevention combined with treatment in the wound healing stage for large area burn trauma patients, rather than treating hypertrophic scar after its formation.

Key words: Cicatrix, Pathologic processes, Physiological processes, Prevention, treatment

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