曲安奈德抑制兔耳瘢痕增生与氧自由基作用的初步研究

目的 了解曲安奈德局部注射对兔耳增生性瘢痕组织中丙二醛含量的影响,并探讨曲安奈德抑制兔耳增生性瘢痕的作用与氧自由基的关系. 方法 新西兰兔共18只,随机选取其中的14只制作兔耳增生性瘢痕模型,4只作为正常兔耳皮肤组织标本,共8例;兔耳增生性瘢痕组织标本28例,随机分为曲安奈德组(10例)、生理盐水组(10例)、空白对照组(8例).制模术后6周予曲安奈德原液(1 ml:40 mg)分点注射于瘢痕样组织内,每处2～3点,总量0.3～0.4 ml,每周1次,3次为一疗程.制模术后9周取材,显微镜下记数成纤维细胞,并用测微尺测量瘢痕的相对增生厚度,以计算瘢痕增生指数,采用分光光度法测定丙二醛含量变化. 结果 ①大体形态学变化:曲安奈德局部治疗3周后,瘢痕颜色接近兔耳的正常肤色,略高出皮面,表面平整,触之质软.②组织学变化:与空白对照组、生理盐水组比较,曲安奈德组胶原纤维多为平行排列,数量减少.③成纤维细胞密度与瘢痕增生指数变化:与正常皮肤组比较,空白对照组以及生理盐水组成纤维细胞密度增高(P＜0.05),而曲安奈德组则无显著性差异(P＞0.05);生理盐水组与空白对照组间成纤维细胞密度及瘢痕增生指数比较差异无统计学意义(P＞0.05),与此两组比较,曲安奈德组则显著降低(P＜0.05).④丙二醛含量变化:与空白对照组、生理盐水组、正常皮肤组比较,曲安奈德组丙二醛含量明显增高(P＜0.05);生理盐水组与空白对照组间比较差异无统计学意义(P＞0.05);与正常皮肤组比较,空白对照组和生理盐水组丙二醛含量增高(P＜0.05). 结论 曲安奈德局部注射引起兔耳增生性瘢痕组织中氧自由基水平进一步升高.     

手术切除联合电子线照射治疗瘢痕疙瘩的疗效分析

目的 探讨手术切除联合电子线照射治疗瘢痕疙瘩的效果.方法 2016年6月至2020年1月就诊的瘢痕疙瘩患者53例,均接受手术切除联合术后电子线照射治疗(4 Gy/次,1次/d,连续治疗5 d),术后定期随访,观察并分析本组患者的治疗效果及不良反应发生情况.结果 53例患者中,治愈46例,显效5例,治疗有效率96.23％...     

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。     

曲安奈德局部注射联合冷冻治疗瘢痕疙瘩

瘢痕疙瘩是临床上较为棘手的疾病之一，具有明显的个体差异，可由轻微外伤所引发。目前的治疗有药物、放射、手术等多种方法，但疗效报道不一。笔者采用醋酸曲安奈德注射液局部注射联合冷冻治疗瘢痕疙瘩，取得较为满意的效果，现报道如下。     

曲安奈德局部注射治疗瘢痕疙瘩的疗效观察

瘢痕疙瘩是临床上常见的创伤和炎症反应后伤口过度愈合所致的一种增生性疾病,严重影响患者的生理和心理健康。自2013年1—12月,我们对28例瘢痕疙瘩患者,采用手术治疗及术后放疗联合曲安奈德局部注射的方法,效果良好。现总结如下。     

手术切除联合注射曲安奈德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曲安奈德加术后早期放射治疗瘢痕疙瘩的疗效。方法：110例患者随机分为对照组和治疗组,对149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曲安奈德,术后24h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,治疗组治愈率为83．6％,与对照组58．2％相比较,P〈0．05。结论：手术切除瘢痕疙瘩,术中注射曲安奈德加早期术后放疗能够有效提高瘢痕疙瘩的治愈率。     

手术切除联合曲安奈德局部注射治疗耳部瘢痕疙瘩

目的:探讨耳廓瘢痕疙瘩的分型、手术方案及联合曲安奈德局部注射治疗的临床疗效.方法:根据瘢痕疙瘩与耳洞的关系将其分为单侧型和双侧型,根据分型及瘢痕大小设计切口线及局部皮瓣,尽量切除瘢痕疙瘩,并摘除内核,必要时保留部分瘢痕边缘,修薄后以6-0线全层无张力缝合,拆线后先以拉力胶固定切口1个月,之后行曲安奈德局部皮下注射,浓度...     

手术联合放射性核素90Sr-90Y或曲安奈德治疗兔耳增生性瘢痕的疗效

目的探讨手术联合90Sr90Y（以下简称90Sr）照射或曲安奈德注射治疗增生性瘢痕的最佳方案及安全性。方法将兔耳增生性瘢痕随机分为8组：A组直接行放射性核素90sr照射,B组手术修薄后2d行90sr照射,c组手术修薄后1周行90sr照射,D组直接注射曲安奈德,E组手术修薄后1周注射曲安奈德,F组直接注射生理盐水,G组手术修薄后1周注射生理盐水,H组为空白对照。观察各组的组织学变化。结果（1）90sr照射组（A、B、C组）与曲安奈德注射组（D、E组）成纤维细胞数、胶原纤维面密度值、微血管数、a平滑肌肌动蛋白（a—SMA）阳性颗粒吸光度值均明显低于生理盐水组（F、G组）和空白对照组（H组）;其中B组最明显;A、C、D、E各组差异无统计学意义。（2）90sr照射各组黑色素颗粒面密度值明显低于其他各组,差异有统计学意义（P〈O．05）。（3）90Sr照射各组未发现异型细胞。结论（1）90Sr及曲安奈德可以抑制兔耳增生性瘢痕的增生,二者疗效差异无统计学意义。（2）对增生性瘢痕早期进行90sr干预可取得较好效果。（3）经90sr照射易引起色素脱失,但一般不会引起癌变。     

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。     

局部注射曲安奈德治疗甲状腺术后增生性瘢痕

目的观察曲安奈德局部注射治疗甲状腺术后增生性瘢痕的疗效及安全性。方法对35例甲状腺术后增生性瘢痕进行局部注射曲安奈德治疗。结果局部刺痛、搔痒感缓解率为100%,局部平整率为91.4%,色素消退率82.9%,随访两年无复发。结论曲安奈德局部注射治疗甲状腺术后增生性瘢痕疗效显著,常规剂量无明显毒副作用。     

皮肤滚针导人曲安奈德治疗增生性瘢痕效果观察

目的 评价皮肤滚针瘢痕内导入曲安奈德治疗增生性瘢痕的临床效果.方法 利用皮肤滚针在32例烧伤或烫伤后增生性瘢痕上往复滚动,同时将曲安奈德注射液滴注到创面上,通过微针及其针孔使曲安奈德注射液进入瘢痕组织内发挥疗效.疗效评价采用临床治愈、有效和无效三级标准,以及温哥华烧伤瘢痕评估标准和痛痒视觉模拟评分法,评估患者治疗前后以及治疗后自身对照区痛痒程度、皮肤色泽、硬度和厚度等改变.结果 32例患者经1～3次治疗,临床治愈28例,显效4例,无效0例,总有效率为100％.患者痛痒程度、皮肤色泽、硬度和厚度在治疗前、后及治疗后自身对照差异均有统计学意义(P＜0.05).结论 皮肤滚针瘢痕内导入曲安奈德注射液对治疗增生性瘢痕有较好疗效,为药物治疗大面积增生性瘢痕提供了新方法.     

他克莫司抑制兔耳瘢痕增生的作用及其机制研究

目的：他克莫司是临床广泛应用的一种药物,其对增生性瘢痕是否产生作用并无相关报道,为此提出并证实了他克莫司可以抑制兔耳瘢痕增生。方法：建立兔耳增生性瘢痕模型,选10只新西兰大耳白兔双耳腹侧用打孔器制作直径1cm圆形创面,伤后14天创面上皮化后给药,每只兔左耳为空白对照组涂等剂量凡士林软膏,右耳为他克莫司治疗组。分别在伤后14天、21天2、8天3、5天和49天采集标本,行HE染色,观察形态学差异;Real-t i me PCR检测纤维化相关因子TGF-β1、TGF-β2、Col l agen-α1等的表达。结果：HE染色可见他克莫司组成纤维细胞数量及胶原纤维较对照组明显减少,PCR结果可见TGF-β1、TGF-β2及Col l agen-α1表达较对照组在各时间点均减少。结论：实验组较对照组瘢痕明显减轻,证明他克莫司显著抑制兔耳瘢痕增生,可作为临床上治疗及预防瘢痕增生的全新疗法。     

Cushing's syndrome after intralesional triamcinolone acetonide: A systematic review of the literature and multinational survey

Background

Intralesional triamcinolone acetonide (TAC) is a well-established treatment for keloids and hypertrophic scars. The present text provides a systematic review of all previously reported cases of Cushing's syndrome resulting from intralesional TAC in an effort to discover whether an association exists between dosage or frequency of injection and the subsequent development of Cushing's syndrome. Data collected from a multinational survey of plastic surgeons is presented and discussed to understand current trends in the use of TAC. Recommendations for early recognition of Cushing's syndrome, TAC dosages in children, and follow up guidelines are presented.

Methods

A systematic review of the literature from 1950 to 2012 was performed to evaluate outcomes following intralesional TAC used for the treatment of scars. A confidential survey was sent to 4125 plastic surgeons, 102 responses from 9 countries were received.

Results

A total of 18 cases of Cushing's syndrome after intralesional TAC have been reported in the English world literature. Survey data reveals that at least 30% (25/84) of plastic surgeons exceed the recommended dosage of TAC and 47% (46/97) are not aware of Cushing's syndrome as a possible complication of intralesional TAC.

Conclusions

Cushing's syndrome resulting from intralesional TAC has been reported multiple times in the literature. Published literature suggests that TAC administered within the most recent recommendations does not appear to place adult patients at increased risk for developing Cushing's syndrome. Children appear to be most at risk for developing Cushing's syndrome and yet insufficient recommendations currently exist with regard to their safe dosage. Intralesional dosage should not exceed 30 mg per month in children while noting that at least one reported case of Cushing's syndrome resulted from a smaller dose. Diligent follow up and patient education is advised for any patient treated with TAC so that complications can be recognized and addressed promptly.     

Aspiration and triamcinolone acetonide injection of wrist synovial cysts in children

Purpose

The aim of this case series report is to assess the effectiveness of aspiration and injection of triamcinolone acetonide for treatment of wrist synovial cysts in children.

Methods

Twenty-one records of pediatric patients with synovial cyst on the wrist treated with aspiration and triamcinolone acetonide injection were selected for analysis of their outcomes. All cases were aspirated and injected at the operating room under mask induction anesthesia. Three categories were used to classify the patients' outcomes: (1) successful treatment with no recurrence, (2) successful treatment with residual sclerotic lump, and (3) recurrence of cyst.

Results

Fourteen females and 7 males with an average age of 7.2 years had a mean time with the cyst of 1 year. All children were asymptomatic. After aspiration, 13 (62%) of 21 patients experienced successful treatment of the synovial cyst with no recurrence after a single intervention. Five patients had a residual lump at the site of the cyst (24%), which disappeared after an average of 6 months. Three patients experienced true recurrence of the synovial cyst (14%). Average follow-up was 2.5 years.

Conclusions

Aspiration and injection of triamcinolone accounted for a considerable reduction in recurrence. Aspiration and triamcinolone acetonide injection of wrist synovial cysts is an effective and safe treatment that may be considered as first-line treatment in the pediatric population if there is no resolution after 1 year of observation.     

去炎舒松用于预防隆乳术后包膜挛缩的实验研究

目的 探讨去炎舒松用于抑制假体隆乳后包膜挛缩的方法.方法 20只新西兰大白兔,平均分为2组,每组将10ml硅凝胶假体1个随机置入兔背部肌肉下,将有许多侧孔远端为盲端的扩张器导管跨越假体顶部,与导管相连的注射壶置于皮下.分别在假体置入1、2、3个月时,向对照组经注射壶注入3 ml生理盐水,向实验组注入去炎舒松10 mg/3 ml.在6个月时观察测量记录包膜挛缩情况,Baker评分,压缩实验,包膜切开后裂开最大宽度的测定,包膜厚度的比较,取包膜样本切片进行HE染色和天狼猩红染色,镜下观察比较包膜特点.结果 生理盐水组Baker评分、包膜裂开最大宽度、包膜厚度明显高于去炎舒松组（P＜0.01）.生理盐水组假体压缩率明显低于去炎舒松组（P＜0.01）.去炎舒松组包膜较生理盐水组薄,胶原排列规则、疏松.结论 去炎舒松通过特制的导管给药能有效地降低隆乳术后包膜挛缩.     

曲安奈德联合玻璃酸酶注射辅助浅层X线放射治疗多发性瘢痕疙瘩的有效性研究

目的探讨曲安奈德联合玻璃酸酶注射辅助浅层X线放疗,在治疗多发性瘢痕疙瘩中的临床应用价值。方法回顾性分析南方医科大学皮肤病医院门诊2018年3月至2019年10月治疗的144例多发性瘢痕疙瘩患者资料,男性89例,女性55例,年龄16~68岁,平均28岁;病程1~20年,平均6年。根据治疗方法分为A组65例,采用曲安奈德联合玻璃酸酶局部注射辅助浅层X线放疗;B组79例,采用曲安奈德联合玻璃酸酶局部注射治疗。治疗后随访6~18个月,对2组患者进行温哥华瘢痕量表(VSS)评估和有效性评价。采用两独立样本t检验及卡方检验进行统计分析。结果 A组治疗前VSS评分为(11.9±0.9)分,治疗后为(6.5±1.1)分,51例好转、14例显效,显效率为21.54%(14/65),不良反应主要表现为一过性色素沉着。B组治疗前VSS评分为(12.1±1.0)分,治疗后为(8.3±1.0)分,74例好转、2例显效、3例无效,显效率为2.63%(2/76),不良反应主要包括毛细血管扩张、皮肤萎缩等,有部分女性患者出现月经周期异常(3例),毛发增多(2例)。2组患者治疗前VSS评分比较差异无统计学意义(t=-1.114,P=0.267),治疗后VSS评分比较差异有统计学意义(t=-10.208,P<0.001)。2组显效率比较差异有统计学意义(χ2=12.450,P<0.001)。结论曲安奈德联合玻璃酸酶注射辅助浅层X线治疗多发性瘢痕疙瘩效果理想,不良反应发生率低,是具有临床应用前景的干预方法。     

血卟啉单甲醚声动力疗法对兔耳增生性瘢痕的疗效

目的观察血卟啉单甲醚声动力疗法对兔耳增生性瘢痕（hyperplastic scar,HS）的疗效。方法成年大耳白兔60只,随机分成5组。在声动力治疗第2、4、6、8周分别切取两组瘢痕组织,进行指标检测。结果治疗组可降低成纤维细胞密度、瘢痕增生指数,与模型对照组比较差异有统计学意义（P〈O．05）,可降低胶原纤维的面密度,从上皮化后第4周开始与模型组比较差异有统计学意义（P〈O．01）。结论声动力效应能够显著降低兔耳HS,可望为HS治疗提供新的手段。     

曲安奈德后Tenon囊下注射治疗糖尿病黄斑水肿的临床研究

目的总结后Tenon囊下注射曲安奈德治疗糖尿病性黄斑水肿(DME)的短期疗效。方法收集门诊确诊DME病人25例,同时接受后Tenon囊下注射曲安奈德(20 mg/0.5 mL),治疗前和注射后4周定期进行门诊回访观察,包括:国际标准对数视力表检查最佳矫正视力(BCVA)、光学相干断层成像(OCT)计算中心视网膜平均厚度、眼压检查。结果术后第1周最佳矫正视力提高2行以上有9只眼(30%,P<0.05),第4周有11只眼(36.7%,P<0.05)。平均最佳矫正视力统计学有提高;平均中心视网膜厚度(CRT)治疗前为(411±170)μm:治疗后1周(349±102)μm(P<0.05),治疗后4周(360±159)μm(P<0.05)。治疗前眼压平均值为(15.6±3.2)mm Hg,治疗后第1周为(16.3±5.6)mm Hg(P>0.05),治疗后4周为(15.5±2.8)mm Hg(P>0.05),观察期间没有发现与注射药物相关的眼科并发症。结论对DME进行后Tenon囊下注射曲安奈德后,短期观察最佳矫正视力和中心视网膜厚度均有变化。     

Inhibition of hypertrophic scar formation with oral asiaticoside treatment in a rabbit ear scar model

Hypertrophic scar (HS) is a fibrotic skin disease characterised by over‐productive collagen and excessive inflammatory reaction, which can be functionally and cosmetically problematic. A scar‐prone constitute will accelerate HS formation and functional disorder, which deserves systemic therapy with oral medicine. To examine the oral therapeutic effectiveness on HS with convincing evidence of gross view and histological improvement, a rabbit ear HS model was employed with oral administration of asiaticoside (AS) at the doses of 12 and 24 mg kg⁻¹ d⁻¹ daily for 60 consecutive days. Gross observation and histological findings showed that oral AS treatment could significantly inhibit HS formation in a dose dependent manner. Semi‐quantification of scar elevation index at days 7, 15, 30, and 60, and quantitative polymerase chain reaction at days 30 and 60 also provided the evidences of reduced scar thickness and inhibited fibrotic gene expressions of collagens I, III, TGF‐β1, interleukins 1β, 6 and 8, and enhanced gene expression of SMAD 7 and PPAR‐γ with a dose‐dependent manner. These results indicated that AS is likely to serve as a systemic therapeutic agent of HS treatment for those who may have scar‐prone constitute via anti‐inflammation, inhibiting fibrotic process, and enhancing matrix degradation.