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中华损伤与修复杂志(电子版) ›› 2024, Vol. 19 ›› Issue (03) : 215 -222. doi: 10.3877/cma.j.issn.1673-9450.2024.03.006

论著

采用不同方法联合放射治疗修复薄型瘢痕疙瘩的临床疗效分析
陈向军1, 于丽2, 王星3, 梁俊青4, 吴迪1, 李志军3,()   
  1. 1. 010010 呼和浩特,内蒙古医科大学研究生院 内蒙古医科大学附属肿瘤医院 北京大学肿瘤医院内蒙古医院整形外科
    2. 010051 呼和浩特,中国人民解放军联勤保障部队第九六九医院
    3. 010110 呼和浩特,内蒙古医科大学基础医学院人体解剖学教研室
    4. 010010 呼和浩特,内蒙古医科大学附属肿瘤医院 北京大学肿瘤医院内蒙古医院乳腺中心
  • 收稿日期:2024-01-14 出版日期:2024-06-01
  • 通信作者: 李志军

Clinical efficacy study of different methods combined with radiotherapy in the repair of thin keloid

Xiangjun Chen1, Li Yu2, Xing Wang3, Junqing Liang4, Di Wu1, Zhijun Li3,()   

  1. 1. Department of Plastic Surgery, Inner Mongolia Medical University Graduate School, Inner Mongolia Medical University Affiliated Cancer Hospital, Peking University Cancer Hospital Inner Mongolia Hospital, Hohhot 010010, China
    2. 969th Hospital of the Joint Logistics Support Force of the People′s Liberation Army, Hohhot 010051, China
    3. Department of Human Anatomy, School of Basic Medicine, Inner Mongolia Medical University, Hohhot 010110, China
    4. Inner Mongolia Medical University Affiliated Cancer Hospital Peking University Cancer Hospital Inner Mongolia Hospital Breast Center, Hohhot 010010, China
  • Received:2024-01-14 Published:2024-06-01
  • Corresponding author: Zhijun Li
引用本文:

陈向军, 于丽, 王星, 梁俊青, 吴迪, 李志军. 采用不同方法联合放射治疗修复薄型瘢痕疙瘩的临床疗效分析[J/OL]. 中华损伤与修复杂志(电子版), 2024, 19(03): 215-222.

Xiangjun Chen, Li Yu, Xing Wang, Junqing Liang, Di Wu, Zhijun Li. Clinical efficacy study of different methods combined with radiotherapy in the repair of thin keloid[J/OL]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2024, 19(03): 215-222.

目的

对比不同方法联合放射治疗(RT)修复薄型瘢痕疙瘩的临床疗效和安全性。

方法

回顾性分析2019年10月至2022年10月内蒙古医科大学附属肿瘤医院整形外科接诊的38例胸部瘢痕疙瘩患者(64个瘢痕疙瘩)及解放军联勤保障部队第九六九医院烧伤整形科接诊的16例胸部瘢痕疙瘩患者(35个瘢痕疙瘩),根据治疗方法不同分为RT组(n=18)、手术联合放射治疗(SCR)组(n=19)、CO2点阵激光联合放射治疗(LCR)组(n=17),3组患者的瘢痕疙瘩数量分别为34、33、32个。分别于治疗前、治疗后6、12个月,采用温哥华瘢痕量表(VSS)及患者和观测者双向瘢痕评估量表(POSAS)评估瘢痕改善程度和临床疗效,采用李克特量表评价满意度,线上问卷评价不良反应和复发率,并记录治疗相关指标。

结果

RT组、SCR组及LCR组患者治疗后6、12个月时的POSAS总分和VSS评分均低于治疗前(P<0.01)。RT组治疗后12个月时的POSAS总分和VSS评分相较于治疗后6个月有所升高,SCR组和LCR组治疗后12个月时的POSAS总分和VSS评分相较于治疗后6个月均下降。其中治疗后12个月时,LCR组POSAS总分和VSS评分最低,SCR组次之,RT组最高。SCR组和LCR组有效率与RT组比较差异有统计学意义(χ2=19.304,P<0.01),SCR组与LCR组比较,差异无统计学意义;RT组有效率为27.78%,SCR组有效率为78.95%,LCR组有效率为94.12%。SCR组和LCR组满意度与RT组比较差异有统计学意义(χ2=10.41,P<0.01),SCR组与LCR组比较,差异无统计学意义;RT组满意度为52.94%,SCR组为84.21%,LCR组为94.12%。RT组治疗12个月后复发率为72.22%,SCR组复发率为21.05%,LCR组复发率为5.88%,1年复发率比较差异有统计学意义(χ2=19.30,P<0.01)。

结论

LCR有操作简便高效、便于护理、创伤小、疗效好、安全性高的特点,患者容易接受,尤其适用于多发性或较大面积的薄型瘢痕疙瘩、有明显手术禁忌证或不愿接受手术治疗的患者。单纯的RT主要用来改善疼痛、瘙痒等主观症状,SCR更适合孤立或数量较少的中、大型瘢痕疙瘩的治疗,临床上应根据实际情况灵活选用。

Objective

To explore and compare the clinical efficacy and safety of different methods combined with radiation therapy (RT) for repairing thin scar tissue.

Methods

A retrospective analysis was conducted on 38 patients with chest scars (64 scars) admitted to the Department of Plastic Surgery in Inner Mongolia Medical University Affiliated Cancer Hospital from October 2019 to October 2022, as well as 16 patients with chest scars (35 scars) admitted to the Department of Burn and Plastic Surgery in 969th Hospital of in the Joint Logistics Support Force of the People′s Liberation Army. According to different treatment methods, they were divided into radiotherapy (RT) group (n=18), surgery combined with radiotherapy (SCR) group (n=19), and CO2 dot array laser combined with radiotherapy (LCR). The combined with radiosurgery (LCR) group (n=17) had 34, 33, and 32 scars in the three groups of patients, respectively. Before treatment, 6 months and 12 months after treatment, the Vancouver scar scale (VSS) and patient and observer scar assessment scale (POSAS) were used to evaluate the degree of scar improvement and clinical efficacy. The Likert scale was used to evaluate satisfaction, and an online questionnaire was used to evaluate adverse reactions and recurrence rates. Treatment related indicators were recorded.

Results

The total POSAS score and VSS score of patients in the RT group, SCR group, and LCR group were lower than before treatment at 6 and 12 months after treatment (P<0.01). The total POSAS score and VSS score of the RT group increased compared to 6 months after treatment, while the total POSAS score and VSS score of the SCR and LCR groups decreased compared to 6 months after treatment. At 12 months after treatment, the LCR group had the lowest total POSAS score and VSS score, followed by the SCR group, and the RT group had the highest score. There was a significant difference in the effective rate between the SCR group and the LCR group compared to the RT group( χ2=19.304, P<0.01), there was no significant difference between the SCR group and the LCR group. The effective rate of the RT group was 27.78%, the SCR group was 78.95%, and the LCR group was 94.12%. There was a significant difference in satisfaction between the SCR group and the LCR group compared to the RT group( χ2=10.41, P<0.01), there was no significant difference between the SCR group and the LCR group. The satisfaction rate of the RT group was 52.94%, the SCR group was 84.21%, and the LCR group was 94.12%. After 12 months of treatment, the recurrence rate in the RT group was 72.22%, the SCR group had a recurrence rate of 21.05%, and the LCR group had a recurrence rate of 5.88%. There was a significant difference in the one-year recurrence rate( χ2=19.30, P<0.01).

Conclusion

LCR has the characteristics of simple and efficient operation, easy nursing, minimal trauma, good therapeutic effect, and high safety. It is easy for patients to accept, especially suitable for patients with multiple or large areas of thin scars, obvious surgical contraindications, or unwillingness to receive surgical treatment. Simple RT is mainly used to improve subjective symptoms such as pain and itching, while SCR is more suitable for the treatment of isolated or small amounts of medium and large scars. In clinical practice, it should be flexibly selected according to the actual situation.

表1 患者一般情况
表2 3组瘢痕疙瘩患者治疗前后POSAS评分
表3 3组患者治疗前后VSS评分(分,±s)
表4 3组瘢痕疙瘩患者修复临床疗效比较[例(%)]
表5 三组瘢痕疙瘩患者不良反应发生率及复发率比较
图1 RT治疗胸腹部瘢痕疙瘩治疗效果。A示治疗前瘢痕;B示治疗后6个月效果;C示治疗后12个月效果
图2 SCR治疗胸部瘢痕疙瘩治疗效果。A示治疗前瘢痕;B示治疗后6个月效果;C示治疗后12个月效果
图3 LCR治疗胸部多发性瘢痕疙瘩治疗效果。A示治疗前瘢痕;B示治疗后6个月效果;C示治疗后12个月效果
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