CO2激光与药物联合治疗瘢痕疙瘩--附30例疗效及随访观察

目的观察CO     

30例瘢痕疙瘩综合治疗分析

瘢痕疙瘩是以持续增生并渐向周围皮肤侵蚀，切除后易复发为特征的皮肤纤维化疾病，目前尚无特效治疗方法。我们对30例瘢痕疙瘩患者在手术切除后分别采用康宁克通局部注射，弹力绷带持续加压包扎综合治疗，取得较为满意的效果，现总结如下。     

瘢痕疙瘩的综合治疗研究进展

瘢痕疙瘩是一种难治性皮肤疾病,其发病机制尚不明确,治疗方法有手术、局部注射、放射线照射、CO2激光、加压等,但单一方法治疗复发率高.本文对国内外多种方法联合应用治疗瘢痕疙瘩进行了综述,以期为临床治疗瘢痕疙瘩提供思路.     

曲安奈得注射治疗瘢痕疙瘩的临床疗效观察

目的探讨曲安奈得注射治疗瘢痕疙瘩的疗效。方法采用曲安奈得局部注射治疗瘢痕疙瘩并观察疗效。结果74例患者中治愈60例占81．02％,显效12例占16．22％,无效2例（占2．70％）。结论曲安奈得局部注射治疗瘢痕疙瘩是简单有效的方法。     

57例瘢痕疙瘩手术结合放射治疗临床分析

瘢痕是各种创伤愈合的必须结果，但如果生长过度，尤其在面颈和四肢关节部位，可破坏外貌或发生功能障碍。解除生长过度的瘢痕疙瘩是整形外科治疗中的一个重要课题。笔者回顾性分析本院瘢痕疙瘩切除后再应用深部X线机行放射治疗的患者57例，均取得了满意的疗效，现报道如下。     

耳部瘢痕疙瘩的综合治疗

目的 探讨耳部瘢痕疙瘩手术切除方式和术后放疗等综合治疗的疗效.方法 2000年1月-2005年12月收治42例(71侧)耳部瘢痕疙瘩患者.男8例,女34例;年龄16～50岁,平均26.2岁.病程6个月～4年.穿耳孔32例,创伤7例,耳部病变手术3例.瘢痕疙瘩范围0.3 cm×0.3 cm×0.2 cm～6.0 cm×4.0 cm×1.0 cm,形状呈球形、哑铃形、结节形.根据瘢痕疙瘩不同大小和范围,选择不同术式,切除瘢痕并行缺损修复.术后24 h内,高能电子束照射10次,每次2 Gy,总剂量20 Gy,对有复发倾向者,及时行"得宝松"1 mg及2%利多卡因按1:3混合液局部瘢痕内注射3次,每3周1次.结果 术后患者切口均Ⅰ期愈合,皮瓣均成活.37例(64侧)获随访1年,获临床治愈;5例(7侧)于术后3～6个月有复发倾向,及时局部注射"得宝松"后未见复发.根据刘文阁等疗效标准判定治愈37例,显效5例.结论 耳部瘢痕疙瘩尽早采用个体化手术方式,结合早期放疗,可取得满意效果,是治疗的选择方案之一.     

90Sr在瘢痕疙瘩复发治疗中的应用

目的 探讨90Sr同位素敷贴在瘢痕疙瘩复发治疗中的方案和疗效.方法 选取瘢痕疙瘩复发患者50例,共计62处瘢痕疙瘩,患处均有瘙痒、疼痛等不适.25例患者共25处复发瘢痕疙瘩采用手术切除+术后90Sr同位素敷贴治疗(A组);26例患者共37处复发瘢痕疙瘩仅行90Sr同位素敷贴治疗(B组);其中1例患者的2处复发瘢痕疙瘩分别采用了两种治疗方案之一.随访一年,观察疗效、温哥华瘢痕量表(vancouver scar scale,VSS)评分、对患者进行问卷调查.结果 治疗剂量A组低于B组,痊愈率A组高于B组,VSS评分改善及美容效果A组优于B组(P＜0.05),症状改善二组无差异(P＞0.05).结论 90Sr同位素敷贴在瘢痕疙瘩复发治疗中具有简便、经济、有效而易于被患者接受的优点.手术+90Sr同位素敷贴治疗应当作为优先选择的方案,对VSS评分较低、非体表暴露部位或者不适合手术治疗的瘢痕疙瘩可以选择单行90Sr同位素敷贴治疗.     

^90Sr-^90Y敷贴治疗瘢痕疙瘩的疗效观察

瘢痕疙瘩是皮肤在创伤后,由于大量结缔组织增殖和透明变性而形成的瘢痕过度增长,超出原有皮损范围的一种皮肤良性肿瘤。患者多有瘢痕体质,甚至微小创伤如蚊叮即可引起瘢痕,瘢痕形成后常有瘙痒或疼痛。     

醋酸曲安奈德局部注射联合手术切除治疗耳部瘢痕疙瘩

目的总结注射醋酸曲安奈德控制瘢痕疙瘩生长后联合手术切除耳垂瘢痕疙瘩的临床经验。方法采用耳垂瘢痕疙瘩局部注射醋酸曲安奈德治疗3~4次后,手术切除耳垂瘢痕疙瘩,术中保留部分瘢痕疙瘩边缘皮肤并行无张力缝合,术后观察6~24个月。结果本组31只耳手术切口全部一期愈合,随访6~24个月,26只耳治愈,4只耳有效,1只耳无效,有效治愈率约96.8%。结论醋酸曲安奈德局部注射后手术切除能有效治疗耳部瘢痕疙瘩。     

槲皮素联合放射线抑制瘢痕疙瘩成纤维细胞胶原合成

目的比较槲皮素、放射线以及二者同时干预对瘢痕疙瘩成纤维细胞胶原合成的影响。方法体外培养瘢痕疙瘩及正常皮肤成纤维细胞,MTT法测定瘢痕疙瘩成纤维细胞干预前后的生长曲线;比色法检测细胞上清液中羟脯氨酸含量;免疫细胞化学检测细胞内Ⅰ、Ⅲ型胶原;RT-PCR及Real-time PCR检测Ⅰ、Ⅲ型胶原及TGFβ-1基因表达。结果①槲皮素可抑制体外培养瘢痕疙瘩成纤维细胞生长及胶原合成,该作用呈剂量依赖效应;②槲皮素可降低Ⅰ、Ⅲ型胶原和TGFβ-1基因mRNA水平;③放射线联合槲皮素作用后抑制作用更明显。结论槲皮素可增强放射线对瘢痕疙瘩成纤维细胞胶原合成的抑制效应,其作用机制之一是抑制了TGFβ-1基因的转录。     

Promoted activation of matrix metalloproteinase (MMP)-2 in keloid fibroblasts and increased expression of MMP-2 in collagen bundle regions: implications for mechanisms of keloid progression

Aims:  Keloid is characterized by excessive deposition of collagen, resulting from aberrant extracellular matrix (ECM) production and degradation. The aim was to investigate the role of matrix metalloproteinases (MMPs) and tissue inhibitor of metalloproteinases (TIMPs) in pathological wound healing in keloids.
Methods and results:  Semiquantitative analysis of 60 keloid tissue samples and 25 mature scar tissue samples demonstrated significantly increased expression of MMP-2, TIMP-2 and TIMP-3 in keloids compared with mature scars. Within keloid regions, MMP-2 expression was significantly higher in collagen bundle regions than in non-collagen bundle regions. Double immunofluorescence revealed that keloid fibroblasts between collagen bundles exhibited MMP-2, TIMP-2 and membrane-type 1 MMP (MT1-MMP) co-expression, whereas only MMP-2 expression was evident on the edge of collagen bundles. Western blot analysis and gelatin zymography of 13 keloid-derived fibroblasts (KFbs) and six normal skin dermal-derived fibroblasts (NFbs) demonstrated that unstimulated KFbs exhibited significantly increased MMP-2 activity and expression compared with NFbs under the same conditions.
Conclusions:  These results together indicate that MMP-2 activity can be promoted in keloid fibroblasts between collagen bundles in cooperation with TIMP-2 and MT1-MMP. This could contribute to remodelling of collagen bundle regions and invasion of fibroblasts into peripheral normal regions through promoted degradation of ECM.     

KTP激光与药物治疗泪道疾病的临床分析

目的分析研究KTP激光联合药物治疗慢性泪道病的方法和疗效。方法采用KTP激光疏通鼻泪管后,再注入四环素可的松眼膏,定期冲洗泪道,必要时扩张治疗。结果本组泪道阻塞97例(108只眼),治愈率98眼,占90.74%;好转:3只眼,占2.77%;无效:7只眼,占6.48%;总有效率:93.51%。并发症:术后并发症是假道形成和再次粘连,不通。本组无并发症发生。结论激光泪道成形术联合抗生素眼膏灌注具有以下优点:(1)KTP激光疏通泪道创伤较小,面部不留瘢痕。(2)泪道灌注四环素可的松眼膏具有抗菌消炎,支撑泪道,预防粘连,减少并发症。是一种安全有效,值得推广的方法。     

CO2激光TMR与机械TMR管道内应用VEGF后的形态学对照观察

目的:对照观察ＣＯ２激光ＴＭＲ与机械ＴＭＲ管道内应用ＶＥＧＦ后心肌管道的热损伤、血管生成及纤维化等形态学变化,探讨ＴＭＲ结合ＶＥＧＦ应用的方法。方法:采用成年家兔４０只,均分Ａ、Ｂ两组。分别行ＣＯ２激光ＴＭＲ和机械ＴＭＲ,同时在两组的管道内注射血管内皮细胞生长因子(ＶＥＧＦ)。术后不同时间对照观察心肌管道的形态学变化。结果:激光ＴＭＲ管道内存在着严重的热损伤,而机械ＴＭＲ管道内无任何热损伤迹象;术后２周血管生成达高峰期,激光组新生血管密度/数量为(１７．８４±０．２５)条/１０×４倍,机械组为(２４．２０±０．９８)条/１０×４倍,Ｐ＜０．０１;术后６~８周新生血管密度/数量激光组为(８．９３±０．２４)条/１０×４倍,机械组为(１１．０８±０．９６)条/１０×４倍,Ｐ＜０．０１;管道残迹纤维化的直径,激光组为(１．６６±０．０４)ｍｍ,机械组为(０．６６±０．０４)ｍｍ,Ｐ＜０．００１。结论:从ＴＭＲ管道内新生血管密度/数量及管道残迹纤维化程度来看,机械ＴＭＲ结合ＶＥＧＦ的应用方法明显优于ＣＯ２激光ＴＭＲ结合ＶＥＧＦ。     

Endobronchial laser therapy — Differential therapeutic use and clinical value

Summary Endobronchial laser irradiation was performed on 27 patients with inoperable malignant (n=23) and benign (n=4) disease of the bronchial system for the treatment of recurrent pulmonary bleeding and recanalization of centrally obstructed or stenosed airways. The essentially palliative measure led in more than half the patients with hemoptysis to immediate and lasting hemostasis, in all patients with stenosis to complete or partial restoration of airway patency, and in 7 of 11 patients with total obstruction to a radiologically verifiable re-expansion of atelectasis. In the total of 58 laser treatments performed, complications occurred in three cases and were managed by conventional clinical measures. Successful recanalization in patients with pre-existing bronchial obstruction presupposes a short-segment, polypous tumor growth, intact bronchial wall structures, and short occlusion time. In addition to the treatment and prophylaxis of recurrent pulmonary bleeding, the principal use of endobronchial laser treatment in the future will probably concentrate on the palliative therapy of preocclusive stenoses of the trachea and main bronchi.     

Two peculiar conditions following a coma: a clinical case of heterotopic ossification concomitant with keloid formation

The etiology and formation pattern of heterotopic ossifications (HO) are still unknown. They occur in soft tissues in which bone does not normally form, near one or more proximal joints. In this article, the authors report a peculiar case of a 31-year-old patient affected by scapulo-humeral ankylosis that occurred about 6 months after a coma, in which two unusual concomitant conditions were observed: HO formation in the scapulo-humeral region and the development of keloids during wound repair. The scapulo-humeral ankylosis was resolved surgically with the removal of the HO, which was then studied morphologically to understand its formation pattern. By light microscopy and transmission electron microscopy, it was observed that heterotopic bone displays the normal microscopic structure of primary bone, in which two types of bone tissue were recognized, i.e., woven-fibered bone, deeply located and produced first, and lamellar bone. This suggests that the pattern of HO formation retraces the ontogenetic steps that normally occur during intramembranous ossification. The authors also discuss the peculiar concomitance of HO formation and keloid development, speculating that, although they are different conditions localized in dissimilar regions, they might be hypothetically triggered by a common event, such as the release of factors likely issued during the coma status.     

准分子激光原位角膜磨镶术后干眼症的临床观察

目的 了解近视眼患者行准分子激光原位角膜磨镶术准分子激光原位角膜磨镶术术后千眼症状及相关指标的变化。方法 48例（96眼）近视眼患者行准分子激光原位角膜磨镶术手术，分别观察术前、术后1周、1个月、2个月、3个月的干眼症状，包括千涩感、异物感等，并行角膜荧光素染色检查、泪膜破裂时间测定及泪液分泌试验。结果 术后1周至2个月干眼症状较术前明显加重；术后1周角膜荧光素染色着色眼数较术前明显增加；术后1周、1个月、2个月泪膜破裂时间均较术前缩短；术后1周、1个月、2个月泪液分泌量较术前明显减少。结论 干眼症是准分子激光原位角膜磨镶术术后的常见并发症，临床应积极采取预防措施，以使准分子激光原位角膜磨镶术术后干眼症的发生率和严重程度降到最低。