瘢痕核心摘除术联合局部注射醋酸曲安奈德和90锶-90钇敷贴治疗病理性瘢痕的疗效观察

目的 探讨瘢痕核心摘除术联合局部注射醋酸曲安奈德和90锶-90钇敷贴治疗病理性瘢痕的临床疗效及安全性.方法 将瘢痕核心部位结缔组织切除后的94例患者随机分为2组,试验组(A组)48例患者,切口缝合后,即行局部醋酸曲安奈德注射,术后3d内行90锶-90钇敷贴治疗,治疗剂量6Gy/次,每周1次,连续5次为1个疗程,总吸收剂量每疗程30Gy/野;对照组(B组)46例患者,切口缝合后,即行局部醋酸曲安奈德注射.结果 A组第1疗程治愈率87.5%,有效率为97.9%,B组治愈率69.6%,有效率为86.9%,两组治愈率及有效率差异有统计学意义(P <0.05),对所有患者随访12～24个月,无放射治疗相关性肿瘤等并发症发生.结论 手术摘除瘢痕内纤维核心后局部注射醋酸曲安奈德,术后早期应用90锶-90钇敷贴治疗病理性瘢痕疗效满意,不良反应少,是较好的治疗方法.     

90锶-90钇敷贴联合得宝松注射治疗头面部瘢痕疙瘩的疗效观察

目的 观察90Sr-90Y敷贴联合得宝松注射,治疗头面部瘢痕疙瘩的临床疗效.方法 2008年1月至2013年5月,32例头面部瘢痕疙瘩患者首先于皮损内注射得宝松,每4周1次,共3～4次;待瘢痕疙瘩体积缩小、变平后,使用90Sr-90Y敷贴治疗,每次吸收剂量为400～600 cGy,每周2次,4次为一疗程,通常每个部位治疗2～3疗程,总吸收剂量小于80 Gy.结果 32例患者中治愈26例,显效4例,治愈率为81.25％,总有效率为93.75％.结论 90Sr-90Y敷贴联合得宝松注射,治疗头面部瘢痕疙瘩,方法简便、安全,疗效好,值得临床推广应用.     

单一曲安奈德皮损内注射与联合放疗治疗瘢痕疙瘩的疗效对比研究

目的:比较曲安奈德皮损内注射联合放疗与单纯曲安奈德皮损内注射两种治疗瘢痕疙瘩的方法的临床疗效.方法:将瘢痕疙瘩患者分为A、B两组.A组行曲安奈德皮损内注射联合放疗:曲安奈德注射液40～80 mg,每4周注射1次,至瘢痕疙瘩变软变平,在最后一次注射后1周之内行,局部6MeV电子线外照射1600～2000cGy/4～9次/4～19天;B组行单纯曲安奈德皮损内注射,方法同A组,瘢痕疙瘩变平变软后加强1次,总共注射2～8次.结果:A、B两组总有效率分别为87.23%,79.59%;治愈率为55.32%,34.69%.经x2检验两组治愈率有统计学差异(P＜0.05).结论:曲安奈德皮损内注射联合放疗疗效确切,联合治疗优于单纯曲安奈德皮损内注射.     

得宝松联合~（90）Sr-~（90）Y敷贴治疗瘢痕疙瘩疗效观察

2007年10月～2010年10月,笔者和同位素室合作采用得宝松局部注射加90Sr-90Y敷贴联合治疗瘢痕疙瘩76例,并与单用得宝松局部注射组76病例进行疗效对比观察,现将结果报道如下。     

手术去核、得宝松局部注射联合90Sr-90Y敷贴三联治疗耳部瘢痕疙瘩的疗效观察

目的探讨手术去核,得宝松局部注射联合90Sr-90Y敷贴三联治疗耳部瘢痕疙瘩的临床效果。方法随机将间46例耳部瘢痕疙瘩患者分为2组,每组23例。三联组采用手术去核,得宝松局部皮下注射和90Sr-90Y敷贴三联治疗。二联组实施手术去核和得宝松局部皮下注射二联治疗。观察2组治疗效果。结果三联组治愈18例(78.3%),有效率95.7%。二联组治愈9例(39.1%),有效率56.5%。三联组疗效优于二联组,差异有统计学意义(P0.01)。结论手术去核,得宝松局部注射联合90Sr-90Y敷贴三联治疗耳部瘢痕疙瘩,方法简单、效果可靠、不易复发。     

年龄因素对90锶-90钇敷贴器治疗皮肤血管瘤疗效的影响

目的 探讨年龄因素对90锶-90钇(90Sr-90Y)敷贴器治疗皮肤血管瘤疗效的影响.方法 对224例不同年龄段婴幼儿和儿童皮肤血管瘤患者进行90Sr-90Y敷贴器治疗,回顾性分析了其疗效与患者年龄的关系.结果 (1)在1个月至＜1岁组和1至＜5岁组之间,1个月至＜1岁组和5～10岁组之间,1至＜5岁组和5～10岁组之间,其疗效差异均有统计学意义(P＜0.05);随着患者年龄的增长,其痊愈率逐渐降低,而其显效率、好转率和无效率却逐渐升高.(2)90Sr-90Y敷贴器治疗后痊愈或显效的199例患者中,在1个月至＜1岁组和1至＜5岁组之间,1个月至＜1岁组和5～10岁组之间,其疗程分布差异均有统计学意义(P＜0.05);在1至＜5岁组和5～10岁组之间,其疗程分布差异无统计学意义(P＞0.05).随着患者年龄的增长,其所需疗程数呈增加的趋势.结论 患者的年龄是影响90Sr-90Y敷贴器治疗皮肤血管瘤疗效的因素,患者年龄越小则疗效越好、疗程越短、射线的不良反应越轻.     

低浓度5-FU与糖皮质激素联合治疗胸骨前瘢痕疙瘩的疗效分析

目的 探讨低浓度(0.25%)5-氟尿嘧啶(5-FU)与糖皮质激素混合注射治疗胸骨前瘢痕疙瘩的效果.方法 将本组的98例患者(共有167个胸骨前瘢痕疙瘩,病史1～42年)分成A、B、C三组,均行瘢痕疙瘩全层注射.对A组的22例患者行单纯5-FU(2.5% 5-FU 0.6 ml 2%利多卡因5.4 ml)注射,对B组的22例患者行单纯5-FU和糖皮质激素(1%曲安奈德5 ml 2%利多卡因1 ml)交替注射,对C组的54例患者行5-FU与糖皮质激素的混合液注射(2.5% 5-FU 0.6 ml 1%曲安奈德5 ml 2%利多卡因0.4 ml).在瘢痕疙瘩完全萎缩后,逐渐降低药物浓度,并延长注射间隔期.治疗次数为6～22次,治疗3～36个月,随访6～26个月.结果 局部注射低浓度5-FU,能够减轻瘢痕的充血程度和痛痒症状(有效率均为95.5%),但只有在与糖皮质激素交替或联合使用后,才能促使瘢痕明显萎缩(P＜0.05),而联合使用比交替使用更为有效(P＜0.05).结论 低浓度5-FU与糖皮质激素联合治疗胸骨前瘢痕疙瘩,具有较良好的疗效.     

三种方式治疗增生性瘢痕的疗效分析

目的:探讨比较三种治疗方式(醋酸曲安奈德针、美皮护贴及32P敷贴)治疗增生性瘢痕的临床疗效及安全性,探寻一种更安全有效的临床治疗方式。方法:选择我院2013年01月-2016年01月在门诊治疗增生性瘢痕患者384例,根据治疗方式不同分为三组,A组126例,采用局部注射曲安奈德针;B组128例,采用美皮护贴敷治疗;C组130例,采用~(32)P敷贴治疗。均随访1年,记录患者接受三种治疗方式的疗效数据。通过对比三组实验数据的χ~2值来检验治愈率的差异。结果:经过数据分析,A组治疗病例126例,治愈率52.38%;B组治疗病例128例,治愈率57.81%;C组治疗病例130例,治愈率92.31%。对随访1年后的数据记录及临床实验结果统计分析,三组治疗后对治愈率进行两两统计比较:A组和B组治愈率差异不具有统计学意义(P0.05),A组和C组治愈率差异有统计学意义(P0.05),B组和C组治愈率差异有统计学意义(P0.05)。结论:三种方法(醋酸曲安奈德针、美皮护贴及~(32)P敷贴)治疗中,~(32)P敷贴治疗法是治疗增生性瘢痕的较为有效的方式。     

硬膜外腔药物注射对大鼠股骨头的形态学影响

目的 了解硬膜外腔药物注射对SD大鼠股骨头的形态学影响.方法 雄性SD大鼠72只,随机分为6组,每组12只.组1注射利多卡因、维生素B1、维生素B12、生理盐水;组2注射醋酸曲安奈德、利多卡因、维生素B1、维生素B12、生理盐水;组3注射醋酸曲安奈德、利多卡因、维生素B1、生理盐水;组4注射醋酸曲安奈德、利多卡因、维生...     

核摘除术结合90Sr-90Y敷贴器放射治疗耳部瘢痕疙瘩

目的 探讨瘢痕核摘除术结合90Sr-90Y敷贴器放射治疗耳部瘢痕疙瘩的方法和疗效.方法 回顾性分析自2007年1月至2010年2月收治的59例耳部瘢痕疙瘩患者,采用保留瘢痕皮肤的核摘除,并于术后结合90Sr-90Y敷贴器放射治疗1～2个疗程(1个疗程吸收剂量20～30Gy),观察并分析术后疗效.结果 本组59例患者(64处瘢痕疙瘩),经1～3年随访,治愈者53例(89.8%),显效者6例(10.2%).结论 核摘除术结合90Sr-90Y敷贴器放射治疗耳部瘢痕疙瘩安全,高效,值得临床推广.     

The facial keloid: a comparison of treatment outcome between intralesional steroid injection and excision combined with radiotherapy

Background

Various conflicting claims of superiority of particular treatment modalities or regimens abound in the literature for the treatment of keloid. This study was designed to determine the more reliable method to flatten keloid between intralesional triamcinolone injection and excision combined with radiotherapy.

Methods

One hundred and seven consecutive patients presenting with facial keloids were alternately allocated into two groups. Group A was managed by intralesional injection of 10 mg per linear centimetre of keloid scar, fortnightly for a maximum of 6 months, while group B underwent excision combined with 16 Gray of radiation administered in four fractions, in as many consecutive days, commencing immediately preoperatively.

Results

Flattening of lesion was achieved in 81 % of scars managed with triamcinolone, while 58 % of those treated by excision combined with radiotherapy remained flat during the course of study. The difference between the two results was statistically significant (P?<?0.01).

Conclusions

Intralesional injection of triamcinolone is significantly more efficacious than excision combined with radiotherapy in the management of facial keloids. Level of Evidence: Level II, therapeutic study.     

Surgical Excision Versus Aspiration Combined with Intralesional Triamcinolone Acetonide Injection Plus Wrist Immobilization Therapy in the Treatment of Dorsal Wrist Ganglion; A Randomized Controlled Trial

Ganglion is the most common benign soft tissue tumour of hand and represents about 60–70% of all such soft tissue tumours. Treatment options include observation, aspiration, intralesional steroids and surgical and arthroscopic excision. Aspiration with intralesional steroid, with its many advantages, may be an alternative choice for its treatment but the operative treatment is the best method when considering the recurrence rate. Objective: To compare the result of surgical excision versus aspiration combined with intralesional triamcinolone acetonide injection plus wrist immobilization therapy in the treatment of dorsal wrist ganglion. Study period: November 2007 to October 2009. Participants: 36 patients above 15 years of age, having the disease for first time, having no history of wrist injury and with no history of use of steroid or any allergy to it, were selected for the study. Setting: The study was undertaken at SKIMS Medical College Hospital, Bemina Srinagar Kashmir. Patients were randomly allocated to undergo either surgical excision (group A, n = 18) or aspiration combined with intralesional triamcinolone acetonide injection plus wrist immobilization (group B, n = 18) using table of random numbers. All the patients were operated under local anaesthesia. Fisher-exact-test, Chi-square test were used for statistics. The success rate of surgery was 94.4% and that of aspiration with triamcinolone acetonide injection plus wrist immobilization was 61.1%. The difference in success rate was statistically significant(p = 0.041). Surgery is the most successful form of treatment when considering the cure rate of dorsal wrist ganglion.     

瘢痕切除即刻局部注射曲安奈德联合放疗治疗耳廓瘢痕疙瘩疗效观察

目的:探讨手术切除,术中曲安奈德局部注射,术后放疗联合治疗耳廓瘢痕疙瘩的效果。方法:将病例分为三组:第一组:12例,24个瘢痕疙瘩(手术+曲安奈德注射+放疗),手术切除瘢痕疙瘩,术中注射醋酸曲安奈德,注射剂量依切缘大小而异,每次注射量不大于40mg,术后每周1次,连续4～8次,术后24h内行局部浅层放疗3天;第二组:11例,22个瘢痕疙瘩(手术+放疗),手术切除瘢痕疙瘩,术后24h内行放疗3天;第三组:17例,23个瘢痕疙瘩(手术+曲安奈德注射),手术切除瘢痕疙瘩,术中即刻注射曲安奈德,术后每周1次,连续4～8次。结果:第一组、第二组、第三组有效率分别为95.83%、77.27%、52.17%。第一组与第二组、第三组比较有显著差异(P<0.05)。结论:手术切除,术中曲安奈德局部注射联合术后放疗治疗耳廓瘢痕疙瘩副作用小、复发率低,值得临床应用。     

手术联合5-氟尿嘧啶与糖皮质激素治疗儿童腹股沟瘢痕疙瘩

目的探讨手术联合5-氟尿嘧啶（5-Fluorouracll，5-FU）与糖皮质激素注射治疗儿童腹股沟瘢痕疙瘩的效果。方法18例患者．共19个腹股沟瘢痕疙瘩，平均病史2、7年。手术切除瘢痕疙瘩，术后2～3周将0.05ml 5-FU注射液与1ml复方倍他米松注射液和1ml 2％利多卡因混合后适量注射入伤口内，以后逐渐降低5-FU和复方倍他米松注射液浓度并延长注射间歇期。平均治疗时间为8个月。结果手术联合5-FU与糖皮质激素混合注射治疗儿童腹股沟瘢痕疙瘩有效率为100％，其中完全治愈者72.2％，效果良好者27．8％。结论手术联合5-FU与糖皮质激素注射是治疗儿童腹股沟瘢痕疙瘩安全有效的方法。     

瘢痕内切除后即时放疗治疗瘢痕疙瘩临床分析

目的：探讨瘢痕内切除后即时放疗治疗瘢痕疙瘩的临床疗效。方法：自2002年2月～2007年6月对我科收治的18例瘢痕疙瘩患者行瘢痕内切除术,术后24h内辅以6MeV高能电子束（13射线）放射治疗,连续照射每天一次连续照射4～6次,照射总剂量15～20Gy。术后平均随访36月。结果：优良10例（55．6％）,显效5例（27．8％）,无效3例（16．7％）,总有效率83．3％。3例伤口延迟愈合（16．7％）,术后出现色素沉着3例（16．7％）,毛细血管轻度扩张2例（11.1％）,随访期内未发生如皮肤恶性肿瘤等并发症。结论：瘢痕内切除后即时放射治疗,术后复发率低,是治疗瘢痕疙瘩较好的治疗手段。     

手术联合平阳霉素和曲安奈德治疗胸部瘢痕疙瘩

目的:探讨能否通过手术切除联合使用平阳霉素和曲安奈德局部注射的方法达到增加手术治疗胸部瘢痕疙瘩的有效率以及显著降低胸部瘢痕疙瘩手术后复发率的目的。方法:37例患者,共计52个胸部瘢痕疙瘩,其中35个瘢痕疙瘩位于胸骨柄处,17个瘢痕疙瘩位于胸骨柄上下方及左右。病史0.5～10年。34例患者有明确胸部抓挠史。术前先于手术切口注射0.25mg/ml的平阳霉素与20mg曲安奈德混合液,然后手术切除胸部瘢痕疙瘩,恢复胸部皮肤平整的外观。手术后3～4周开始于手术切口愈合处再次注射0.25mg/ml的平阳霉素与20mg曲安奈德混合液,每4周复查及必要时注射一次,如果瘢痕稳定无复发,可以每2月复查及必要时注射一次。如果不需药物治疗半年以上无复发视为治愈,如果上次注射半年内需要再次注射者为有效。结果:2009年5月～2012年5月,采用上述手术方法共治疗胸部瘢痕疙瘩患者37例,手术后注射治疗时间为2～5个月(平均3个月),不需药物治疗随访期3～24个月(平均10个月)。治愈32例(86.5%),有效5例(13.5%),总有效率100%。结论:手术切除联合局部注射平阳霉素和曲安奈德混合液是治疗胸部瘢痕疙瘩的有效方法。     

Combination therapy using non‐ablative fractional laser and intralesional triamcinolone injection for hypertrophic scars and keloids treatment

Combinations of various treatment modalities were shown to be more effective than monotherapy when treating hypertrophic scars and keloids. This study was conducted to assess the effectiveness of combination therapy with non‐ablative fractional laser and intralesional steroid injection. From May 2015 to June 2017, a total of 38 patients with hypertrophic scars or keloids were evaluated. The control group of 21 patients received steroid injection alone, and 17 patients (the combined group) received 1550‐nm erbium‐glass fractional laser treatment and steroid injection simultaneously. The mean number of treatment sessions was statistically fewer in the combined group than in the control group (6.95 vs 5.47, P = .042). There was a significant difference in the patient's scale in the combined group (14.62 vs 22.82, P = .005); however, the observer's scale was not significantly different (17.92 vs 20.55, P = .549). The recurrence rate was 38.1% (8/21) in the control group and 35.3% (6/17) in the combined groups and showed no significant difference (P = .859). However, the mean remission period was statistically longer in the combined group (3.00 months vs 4.17 months, P = .042). Combination therapy with non‐ablative fractional laser and intralesional steroid injection showed better results for the treatment of hypertrophic scars and keloids with fewer treatment sessions, better patient satisfaction, and longer remission periods.     

Management of chest keloids

Keloid formation is one of the most challenging clinical problems in wound healing. With increasing frequency of open heart surgery, chest keloid formations are not infrequent in the clinical practice. The numerous treatment methods including surgical excision, intralesional steroid injection, radiation therapy, laser therapy, silicone gel sheeting, and pressure therapy underscore how little is understood about keloids. Keloids have a tendency to recur after surgical excision as a single treatment. Stretching tension is clearly associated with keloid generation, as keloids tend to occur on high tension sites such as chest region. The authors treated 58 chest keloid patients with surgical excision followed by intraoperative and postoperative intralesional steroid injection. Even with minor complications and recurrences, our protocol results in excellent outcomes in cases of chest keloids.     

Treatment of Small Keloids Using Intralesional 5-fluorouracil and Triamcinolone Acetonide versus Intralesional Bleomycin and Triamcinolone Acetonide

BACKGROUND: The aberration of wound healing leads to scar formation in the form of hypertrophic scars and keloids. Various modalities with variable results have been used in the treatment of keloids. OBJECTIVE: We sought to evaluate outcomes in the treatment of small keloids with the combination of intralesional 5-fluorouracil (5-FU) and triamcinolone acetonide versus intralesional bleomycin and triamcinolone acetonide. DESIGN: Sixty clinically diagnosed keloid lesions in 40 patients aged 18 to 60 years were divided equally into Groups A (n=30) and B (n=30). The combination of intralesional 5-FU and triamcinolone acetonide (TAC) was given to Group A and the combination of intralesional bleomycin and triamcinolone acetonide was given to Group B. Treatment was repeated in both groups at three-week intervals until keloid flattening was achieved or a maximum of 10 treatments were completed. Before treatment, the lesions were assessed using the Vancouver Scar Scale and their size was measured using vernier calipers. RESULTS: In Group A, 15 (50%) keloids showed an excellent response, 10 (33.33%) keloids showed a good response, three (10%) keloids showed a fair response, and two (6.66%) keloids showed a poor response. In Group B, 23 (76%) keloids showed an excellent response, three (10%) keloids showed a good response, two (6.66%) keloids showed a fair response, and two (6.66%) keloids showed a poor response. CONCLUSION: Patient response regarding treatment duration, flattening of lesions, improvements in the Vancouver Scar Scale score, and recurrence rates were statistically significant in Group B. A greater improvement in the signs and symptoms of keloids (with respect to cosmetic problems, restriction of movement, and tenderness) was observed in the patients treated with a combination of intralesional bleomycin and triamcinolone acetonide compared to those treated with a combination of intralesional 5-FU and triamcinolone acetonide.