手术切除结合浅层X线治疗瘢痕疙瘩疗效评价

目的：评价手术切除结合改良浅层X线治疗瘢痕疙瘩的临床疗效。方法： 手术切除31例瘢痕疙瘩患者皮损,术后12～24 h和24～48 h分别给予浅层X线照射治疗,剂量为8 Gy。随访1年进行疗效评价。结果：31例患者中治愈26例,治愈率为83.9％;显效2例(6.5％),复发3例（9.6％）,总有效率为90.4％。结论：手术切除合并改良浅层X线放射治疗总有效率高,复发率低。     

微创手术结合浅层放疗治疗瘢痕疙瘩1 658例临床观察

目的对瘢痕疙瘩进行手术、瘢痕注射、浅层放疗等综合治疗,并着重对手术方法等进行改进,以获得更满意的临床疗效。方法对1 658例瘢痕疙瘩患者进行微创手术治疗,均采用平削植皮术和/或瘢痕核心切除。患者术后1～5 d进行浅层X线放射治疗,剂量为400 Rad,70～100 KV,照射范围严格控制在瘢痕皮损的范围内,每周1次共4次(总剂量16 Gry)。所有患者均持续观察至少2年。对于部分术后1年内复发患者,根据具体情况进行复合药物瘢痕内注射治疗(含糖皮质激素、5-氟尿嘧啶、玻尿酸酶等)及增加2～4次的浅层放疗。结果 1 658例瘢痕疙瘩患者中有1 602例患者临床治愈,术后2年无复发。52例2年内多次加强治疗,仍有轻度复发现象。4例因个人原因放弃治疗,电话随访有复发现象。结论瘢痕疙瘩患者需结合浅层放疗等综合治疗才能获得满意疗效,但仍有一定比例的复发率,通过改进的微创手术能明显减少瘢痕疙瘩的复发率。     

手术切除、糖皮质激素注射联合术后放疗治疗瘢痕疙瘩的疗效观察

瘢痕疙瘩是皮肤科常见疾病之一,其发病机制不明.现阶段治疗该病的主要方法包括糖皮质激素注射、外科手术切除、放射治疗、硅凝胶外用、压迫疗法、干扰素注射等.由于单一疗法的复发率较高,故多采用两种或两种以上方法的联合治疗,但仍然不能彻底解决瘢痕疙瘩的复发问题已成为长期困扰患者和医生的一个难题.2002年7月至2004年2月,我们收治了25例患者,共51处瘢痕疙瘩皮损,采用手术方法切除瘢痕疙瘩、术中即时注射糖皮质激素、术后浅表电子束照射三联疗法治疗,随访14-34个月效果满意.     

线粒体DNA控制区变异与瘢痕疙瘩的相关性研究

【摘要】 目的 探讨线粒体DNA（mtDNA）控制区D环（D-loop）的突变与瘢痕疙瘩的相关性。方法 收集2016—2019年昆明医科大学第一附属医院皮肤科门诊瘢痕疙瘩患者216例，提取患者外周血总DNA及25例患者的瘢痕疙瘩组织、瘢痕疙瘩旁正常组织的总DNA。以云南大学附属医院体检中心无瘢痕疙瘩的健康体检者299例外周血样本数据作为对照。对mtDNA D-loop区进行PCR扩增及Sanger测序，并与修正后的剑桥参考序列（rCRS）比对，获得每个样本的突变位点。根据Phylotree-mtDNA tree Build 17，对2组人群进行单倍型类群划分。比较瘢痕疙瘩组织、瘢痕疙瘩旁正常组织及自身外周血mtDNA的D-loop区突变。使用network 5.0软件制作中介网络图，采用二元logistic回归分析单倍型类群频率与瘢痕疙瘩发病的相关性，χ2、t及t′检验分析临床数据。结果 216例瘢痕疙瘩患者mtDNA可划分为10个单倍型类群：A、B、D、R9、G、M*、M7、M8、M9、N9，其中R9分布频率最高（21.3%，46/216），M9分布频率最低（0.9%，2/216）。瘢痕疙瘩患者的单倍型类群M7和N9的分布频率均显著低于对照人群（P = 0.040，OR = 0.248，95% CI：0.066 ~ 0.937；P = 0.048，OR = 0.191，95% CI：0.037 ~ 0.986）。中介网络图显示，瘢痕疙瘩患者和对照人群的单倍型类群M7具有不同的分布模式。单倍型类群M7患者的发病部位数比非M7患者少（P = 0.000 1），且发病年龄比非M7患者小（P = 0.045）。结论 单倍型类群M7与瘢痕疙瘩的发生具有相关性，可能是瘢痕疙瘩发生的潜在保护性因素。     

白癜风复发因素回顾性调查与统计分析

目的:总结与分析白癜风复发因素,为降低白癜风复发率提供数据支持。方法:回顾性分析治疗痊愈或稳定≥6个月白癜风患者的临床资料。采用单因素分析和多因素Logistic回归分析,筛选影响白癜风复发的相关危险因素。结果:回顾性分析空军特色医学中心1 780例门诊白癜风患者,共纳入207例,其中复发组67例,对照组140例,复发率32%。白癜风复发率与性别、年龄、发病年龄、皮损部位、病程、疾病活动性、皮损面积、诱因、临床分型及系统使用糖皮质激素均无相关性(P0.05)。非条件Logistic回归分析示并发自身免疫性疾病(OR=1.32)、焦虑状态(OR=1.24)、春季复发(OR=1.01)及重大手术史(OR=1.89)是白癜风的复发因素。结论:白癜风复发与并发自身免疫性疾病、春季复发、精神因素及重大手术史密切相关,与系统使用糖皮质激素、性别、病程及病情分期等临床特征均无关。临床上针对白癜风复发的高危因素采取必要的干预措施,可能有助于降低复发率。     

剖宫产瘢痕妊娠患者术后复发风险及危险因素的Logistics分析

目的观察剖宫产瘢痕妊娠患者术后复发情况,探讨影响剖宫产瘢痕妊娠患者术后复发的危险因素。方法选取2012年1月至2017年1月南部战区总医院行手术治疗的178例剖宫产瘢痕妊娠患者作为研究对象。统计剖宫产瘢痕妊娠复发情况,行Logistic回归分析影响剖宫产瘢痕妊娠患者术后复发的危险因素。结果 178例剖宫产瘢痕妊娠患者术后复发24例,复发率13.48%。剖宫产瘢痕妊娠术后复发孕妇分型为Ⅰ型1例(4.17%),Ⅱ型16例(66.67%),Ⅲ型7例(29.17%)。剖宫产瘢痕妊娠术后复发患者与未复发患者在体重指数、孕囊体积、首次剖宫产瘢痕妊娠分型、年龄、贫血、孕次、剖宫产次数、早孕期阴道流血、流产次数、胎盘粘连史、胎盘早剥史、治疗方式等方面比较,差异具有统计学意义(P0.05);距上次剖宫产时间、盆腹腔手术史、前置胎盘史、胎盘植入史、人工胎盘剥离术史等方面比较,差异无统计学意义(P0.05)。首次剖宫产瘢痕妊娠分型、剖宫产次数2次、流产次数2次、治疗方式选择均是影响剖宫产瘢痕妊娠患者术后复发的危险因素(P0.05)。结论剖宫产瘢痕妊娠患者术后复发风险高,危险因素包括首次剖宫产瘢痕妊娠分型、剖宫产次数2次、流产次数2次、治疗方式选择,应予以个体化的治疗与预防举措。     

5-氨基酮戊酸光动力疗法联合二氧化碳激光治疗女性尖锐湿疣疗效观察

目的：观察5-氨基酮戊酸光动力疗法（ALA—PDT）联合二氧化碳激光治疗女性尖锐湿疣的临床疗效。方法：选取98例患者,随机分为治疗组和对照组各49例。其中对照组仅采用CO,激光治疗,而治疗组在此基础上增加ALA-PDT联合治疗,随访12周观察皮疹复发情况及不良反应。结果：治疗组和对照组在12周随访时临床复发率分别为10．20％及28．57％,治疗组复发率明显低于对照组（X^2=5．29,P〈0．05）;不良反应：治疗组中1例患者局部出现浅表瘢痕,对照组5例出现不同程度的瘢痕。结论：ALA—PDT联合二氧化碳激光治疗女性尖锐湿疣具有较好的疗效,复发率较低,安全性高,患者的耐受性好,值得临床推广。     

微型环钻切除术联合电子线治疗下颌瘢痕疙瘩36例疗效观察

【摘要】 目的 探讨微型环钻切除术联合电子线在下颌瘢痕疙瘩中的疗效。方法 回顾性分析2017年9月至2019年3月于第四军医大学西京皮肤医院进行微型环钻切除术联合电子线治疗的下颌瘢痕疙瘩患者36例,男16例、女20例,平均年龄23.80岁,中位病程32个月。分别于术前和术后12个月评估瘢痕疙瘩严重程度评分,采用配对t检验比较治疗前后瘢痕疙瘩评分。结果 36例患者伤口均为一期愈合,术前瘢痕疙瘩严重程度评分（7.11 ± 1.46）分,术后12个月为（2.33 ± 0.47）分,治疗前后比较,t = 13.85,P = 0.008。治疗后12个月,治愈15例,显效17例,无效4例,治疗有效率为88.89%。结论 微型环钻切除术联合电子线可有效治疗下颌瘢痕疙瘩。     

尖锐湿疣反复发作的危险因素探索

目的：研究尖锐湿疣（CA）患者复发存在的危险因素,同时探讨合理的预防措施。方法：回顾分析我院自2010年5月至2012年10月以来,于我科治疗的276例CA患者临床资料,统计一般情况与个人行为,以及皮损情况和复发情况,对CA复发存在的危险因素进行归纳总结,并依据治疗方式将患者分为两组,对比临床效果。结果：嗜酒（95％CI值为1.319～2.004,OR值为1.658）、熬夜（95％CI值为1.715～21.658,OR值为6.336）、皮损出现于肛周（95％CI值为0.608～1.049,OR值为0.752）、患者皮损的HPV型别呈16型（95％CI值为1.031～2.524,OR值为1.428）、患者皮损的HPV型呈复合型（95％CI值为2.058～6.082,OR值为3.539）,均为CA复发最主要的促进因素。经治疗后,患者疣体经激光烧灼,均结痂脱落,达到临床治愈,并且创面能够自行恢复,未出现瘢痕,A 组患者再次复发率同 B 组相比较,差异显著（P＜0.05）。结论：影响CA复发的危险因素较多,患者应用激光、干扰素与斯奇康联合治疗,能够有效降低复发率,应予推广。     

手术切除联合注射得宝松加放疗治疗瘢痕疙瘩的疗效观察

目的评估手术切除联合术中注射得宝松加术后早期放射治疗瘢痕疙瘩的疗效。方法 125例患者随机分为对照组和治疗组,对159处瘢痕疙瘩全部行手术切除,治疗组术中在切缘处皮肤真皮内注射得宝松,术后24 h内对手术部位行放射治疗。结果术后切口均为Ⅰ期愈合,术后随访12~24个月,治疗组显效率为86.2%,与对照组58.3%相比较差异有统计学意义P0.05。结论手术切除瘢痕疙瘩,术中注射得宝松加早期术后放疗能够有效提高瘢痕疙瘩的显效率。     

皮肤扩张术联合术后早期电子线放疗治疗下颌角痤疮后瘢痕疙瘩

目的探讨皮肤扩张术联合术后早期电子线放疗治疗下颌角痤疮后瘢痕疙瘩的疗效。方法 10例下颌角痤疮后瘢痕疙瘩患者(皮损面积5.0 cm×5.0 cm~15.0 cm×7.0 cm,高度0.5~1.5 cm)接受皮肤扩张术联合术后早期电子线放疗,术后随访12~24个月评价疗效。结果 10例患者均全部完成治疗过程,扩张皮瓣转移后无坏死和切口瘢痕疙瘩复发,结果满意。主要并发症为一期手术后出现血肿1例,注水壶翻转注水困难1例,经过对症处理均治愈。结论皮肤扩张术联合术后早期电子线放疗是治疗下颌角痤疮后瘢痕疙瘩较好的方法。     

Treatment of hypertrophic scars and keloids with a fractional CO2 laser: A personal experience

Abstract

Keloids and hypertrophic scars are both abnormal wound responses in predisposed individuals but they differ in that keloids extend beyond the original wound and almost never regress, while hypertrophic scars remain within the original wound and tend to regress. How keloids grow is not totally clear because there is no animal model; in fact, keloids affect only humans. Different injuries can result in keloids, including burns, surgery, ear piercing, lacerations, abrasions, tattooing, vaccinations, injections, insect bites and any process causing skin inflammation (chicken pox, acne, folliculitis, zoster). Skin or wound tension is considered a critical factor in the formation of keloids and hypertrophic scars. This study is based on eight consecutive patients (four females and four males, F:M = 1:1) with a total of 12 keloids. All of whom were treated monthly with a MiXto SX CO₂ laser, using 13 W of power, 8 SX of index and 40% coverage (density) in combination with Same Plast Gel^® twice a day. Each scar required 12 treatments, and all the patients, followed up for 1 year after the last treatment, had optimum results and no recurrence.     

Postoperative electron beam radiotherapy for keloids: objective findings and patient satisfaction in self-assessment

AIM: To evaluate the role of postoperative radiotherapy in the management of keloids. METHODS: Forty-seven patients with a combined total of 60 keloids were treated with 6-MeV electron beam radiotherapy after surgical excision of the keloids. Mean daily fractions of 4 Gy (range, 3-5 Gy) were administered up to a total dose of 16 Gy (range, 12-18 Gy). The median follow-up was 70 months. Patients were asked to complete a questionnaire addressing their satisfaction with the treatment results. This self-assessment was compared with the clinical outcome. RESULTS: Four keloids (7%) relapsed completely, and five recurrences (8%) were classified as limited relapses. All recurrences were observed at sites of high stretch-tension. Keloid-associated symptoms, e.g. itching and pain, were improved in 81%. Hypopigmentation was observed in 29 patients (62%), a mild redness of the scar in eight patients (17%), and grade 1 telangiectasias in two patients (4%). No severe complications or secondary malignancies were observed. Self-assessments did not fully correspond to the clinical examination and recurrence status. Twelve patients were not satisfied with the treatment result, but only two of these relapsed completely. Three relapsed patients described the result of therapy as excellent or good. CONCLUSION: Postoperative electron radiotherapy is well tolerated and very effective in preventing keloid recurrence. To avoid an overestimation of cosmetic outcome, patients should be informed about achievable results before therapy starts.     

氨基酮戊酸光动力疗法治疗基底细胞癌74例

 目的:探讨不同方式联合氨基酮戊酸光动力疗法（ALA-PDT）治疗基底细胞癌（BCC）的疗效。方法：74例经病理确诊为浅表型或结节型BCC患者,分别采用手术联合ALA-PDT、高频电刀联合ALA-PDT及单纯使用ALA-PDT治疗。治疗后观察创面愈合情况和时间;1年后观察肿瘤复发、疤痕形成、外观效果等情况。 结果：74例患者中,手术联合ALA PDT治疗39例,高频电刀联合ALA PDT治疗31例,单纯ALA PDT治疗4例。所有患者术后创面均未发生感染,平均创面愈合时间为(12.34±1.32) d。3例单纯ALA-PDT治疗患者1年后肿瘤复发;7例出现疤痕增生,1例发生疤痕挛缩;66例（89.19%）对治疗后外观满意,8例基本满意。 结论：BCC可根据皮损发生部位及面积等选择不同方式联合ALA-PDT治疗,临床安全性高且疗效较佳。     

Continuous tension reduction to prevent keloid recurrence after surgical excision: Preliminary experience in Asian patients

Surgical excision combined with postoperative radiotherapy is considered one of the most radical but most effective keloid therapeutic option. However, radiotherapy may not be appropriate for all keloid patients. In this study, we propose an alternate approach to prevent keloid recurrence and provide preliminary assessment in clinical efficacy of this treatment for keloids. Forty consecutive patients with different keloid sites underwent excision without postoperative radiation. After surgery, the tension offloading device was used at least 6 months for the purpose of continuous tension reduction at surgery incision. Scars were assessed independently using scar scale at before and 24‐month follow‐up. Overall, 38 patients completed this research. Clinical results showed that 35 patients achieved healing with an esthetic appearance at 24‐month follow‐up. Three patients showed relapse and the recurrence rate was 7.9%. Both of VSS (Vancouver Scar Scale) and JSW (Japan Scar Workshop Scar Scale) scores decreased significantly at 24‐month follow‐up visit than before. No severe complications were reported. Using the tension offloading device could greatly decrease tension on the surgical incision. The technique of continuous tension reduction could be used as an alternative method to prevent keloid recurrence under the condition of without radiotherapy.     

Postoperative radiotherapy of keloids: a twenty-year experience.

In spite of several treatment modalities available, there is no method able to guarantee absolute success in the therapeutic approach to keloids. To evaluate the effectiveness and safety of postoperative radiotherapy we performed a retrospective study on 156 keloids, histologically ascertained, treated by means of orthovoltage radiotherapy in the last twenty years. The total doses administered ranged from 15 to 40 Gy. The radiotherapy started within 7 days from surgery in 127 lesions (81.4%), and within 3 weeks in the remaining 29 (18.6%). Surgical methods to minimize tension at wound sites were adopted. The follow-up ranged from 6 to 216 months. After irradiation a complete remission was obtained in 141 lesions (90.4%) and a partial response in 15 lesions (9.6%). The five-year relapse-free rate was 86.68%. Cosmetic results were evaluated as good or acceptable in 82.73% of the lesions. Afterwards, 17 lesions (10.89%) have relapsed. No stochastic or non stochastic effects have been observed.     

甲硝唑联合克林霉素在细菌性阴道炎患者中的应用效果探讨

目的:探讨甲硝唑联合克林霉素治疗细菌性阴道炎的临床疗效和安全性.方法:选择2010年1月～2011年12月在我院妇产科治疗的108例细菌性阴道炎患者为研究对象,随机将本研究入选患者分为对照组和实验组,对照组仅给予甲硝唑进行抗感染治疗,而实验组则在对照组治疗的基础上加用克林霉素对患者进行治疗,比较对照组和实验组的临床疗效、药物不良反应的发生情况及复发率.结果:实验组患者治疗总有效率(90.74%)明显高于对照组的(70.37%),而实验组患者治疗复发率(7.41%)明显低对照组的(25.93%),实验组和对照组患者间治疗总有效率和治疗复发率差异有显著性(P>0.05),但是实验组和对照组患者间不良反应发生率差异无显著性(P>0.05).结论:甲硝唑联合克林霉素是治疗细菌性阴道炎一种临床疗效确切的治疗方案,该方案具有不良反应少及复发率低等特点.     

Combined surgical excision and electron external beam radiation improves the treatment of keloids: A descriptive study

Keloids are firm, fibrous nodules that form on an individual's skin and are associated with difficult symptoms as well as high recurrence rates. This study aims to improve the surgical techniques that reduce local tension after surgical excision of keloids as well as applying adjuvant radiotherapy to suppress scar formation. A total of 58 patients aged between 21 and 76 years received surgical incision of keloid and immediate postoperation low‐dose radiotherapy. All patient follow‐ups were performed at the out‐patient department. Any sign of a keloid at the incision site was defined as treatment failure or keloid recurrence, regardless of the size. At a median follow‐up of 22 months, the overall recurrence for all lesions was 8.6%, which is improved compared with previous study. In addition, all incisions performed during surgeries were healed and no signs of necrosis or the development of ulcers was observed. Our study suggests that this combined therapy provides excellent local control of keloids and shows promise for future therapy.     

腹腔镜联合药物治疗卵巢子宫内膜异位囊肿的体会

目的:观察腹腔镜联合药物治疗卵巢子宫内膜异位囊肿的临床疗效。方法:选取90例卵巢子宫内膜异位囊肿患者并随机分为两组,45例患者采用单纯腹腔镜手术作为对照组,45例患者采用腹腔镜手术联合药物治疗作为观察组,术后随访患者2年,观察两组患者临床疗效、不孕患者的受孕率,同时对观察组患者用药期间不良反应发生情况进行观察。结果:观察组治疗总有效率为88.88%,对照组为66.66%,观察组显著高于对照组;观察组20例不孕症患者随访2年内14例(70.00%)受孕,对照组19例不孕症患者随访2年内6例(31.58%)受孕,观察组显著高于对照组,差异均有统计学意义(P<0.05)。观察组口服米非司酮的25例患者中,2例表现为肝酶升高,20例口服孕三烯酮的患者,3例发生肝损害,停药或配合护肝治疗后症状消失,其他患者表现为乏力,恶心等轻微不良反应,均在停药后症状消失。结论:腹腔镜联合药物治疗卵巢子宫内膜异位囊肿可提高治疗效果,提高不孕患者受孕率,而且不良反应轻微,可作为患者腹腔镜手术后的辅助治疗。