手术切除联合浅层X线放疗在瘢痕疙瘩治疗中的应用

目的 观察手术联合浅层X线放疗在瘢痕疙瘩中的治疗效果。方法 共200例瘢痕疙瘩患者,其中瘢痕疙瘩直径10 cm以下166例(83%),直径10 cm以上34例(17%);病程5年68例(29%)。采取手术切除后立即照射121例(60.5%),拆线后照射58例(29%),切口痊愈后照射21例(10.5%)。所有患者放疗后均随访2年,观察瘢痕大小、病程长短、术后不同时间点进行放疗对疗效的影响。结果 本组患者2年内复发31例(15.5%),总有效率80%以上。术后立即照射及拆线后照射的有效率分别为97%及90%,切口痊愈后照射的治疗有效率为58%。直径10cm以下瘢痕疙瘩复发率6.63%,直径10cm以上的瘢痕疙瘩复发率23.5%。病程5年的复发率为11.7%。本组中仅有1例发生放射性溃疡(0.5%),未见放射性皮炎等其他严重并发症。结论 瘢痕疙瘩手术切除联合浅层X线放疗是一种安全的治疗方式,疗效明显。术后即刻或拆线后立即开始放疗可有效降低复发率,小面积或短病程的患者疗效更为明显。

The Application of Surgical Excision Combining Shallow X-ray Radiation in the Treatment of Keloids

Objective To observe the clinical effects of surgical excision combining shallow X-ray radiation in the treatment of keloids. Methods Two hundreds cases with keloids were enrolled, including 166 cases with the diameter less than 10 cm（83%） and 34 cases with the diameter more than 10 cm（17%）. In 132 cases, the duration was less than 5 years（66%）, while in 68 cases, the duration was more than 5 years（34%）. 121 cases received X-ray radiation immediately after surgery（60.5%）, 58 cases after clearing（29%） and 21 cases after incision healed（10.5%）. All the patients were followed up for 2 years after radiotherapy, and the clinical effects were observed. Results The keloids recurred in 31 cases within 2years（15.5%）, the effective rate was more than 80%. The effective rate of radiotherapy immediately after surgery, after clearing and after incision healed were 97%, 90% and 58% respectively. The recurrence rate was 6.63% in the keloids with the diameter less than 10 cm, and 23.5% in the keloids with the diameter more than 10 cm. The recurrence rate was 8.3% in the patients with the duration less than 5 years, and 11.7% in the patients with the duration more than 5 years. Radiationinduced ulceration was observed only in one case, and no other severe complication was observed. Conclusion Surgical excision combining shallow X-ray radiation is a safe and effective method for the treatment of keloids. Early postoperative radiotherapy can reduce the recurrence rate. The effect in the patients with less diameter and shorter duration is more obvious.