病理性瘢痕的非手术治疗新进展

病理性瘢痕是创伤后真皮成纤维细胞过度增殖而形成的良性病变，常见致病因素包括外伤、手术、烧伤、痤疮及皮肤感染等，目前其发病机制以成纤维细胞过度增殖、胶原过度沉积且排列紊乱为主。病理性瘢痕的治疗主要分为手术和非手术治疗，其中非手术治疗以其操作简单，创伤较小等优势被长期广泛应用于临床。除了压迫疗法、硅酮凝胶外用、药物和放射治疗等方法外，干细胞与自体脂肪移植、A型肉毒毒素注射、细胞因子治疗、激光及射频等新型疗法目前也已被广泛应用于瘢痕的非手术治疗和研究中。本文拟就目前瘢痕非手术治疗的国内外进展进行综述，并探讨新型治疗方法的优势及应用前景。     

增生性瘢痕及瘢痕疙瘩的非手术治疗

瘢痕是人体组织创伤修复的自然产物,是损伤愈合部位的纤维组织增生的结果.瘢痕治疗棘手,所以瘢痕的预防重于治疗,多种瘢痕的非手术治疗方式同时也是预防手段.根据其组织学和形态学的区别可分为浅表性瘢痕、增生性瘢痕、萎缩性瘢痕和瘢痕疙瘩.其中,瘢痕疙瘩常超出原损伤的边缘,通常不会自行消退,切除后往往会复发,与增生性瘢痕统称为病理性瘢痕.对于瘢痕疙瘩和非功能部位大片增生性瘢痕主要采取非手术治疗的方法.这些方法种类繁多,报道疗效不一,可以说没有任何一种治疗方法对所有患者都是最有效的,为了追求最佳效果往往需要多种治疗方式的联合实施.现将增生性瘢痕和瘢痕疙瘩的非手术治疗综述如下.     

病理性瘢痕的注射治疗进展

皮肤伤口的愈合是一个相对复杂的生物学过程,此过程涉及成纤维细胞与巨噬细胞等多种细胞在不同愈合阶段的共同协调,包括细胞迁移和增殖、血管再生、细胞外基质沉积和重塑。修复过程中任何阶段的异常愈合都可能导致病理性瘢痕的发生,临床上根据病理性瘢痕的持续时间、瘢痕组织内胶原蛋白的排列以及是否侵犯周围正常皮肤,可将其分为增生性瘢痕与瘢痕疙瘩。目前的治疗手段包括病灶内注射疗法、手术切除以及放射治疗。注射疗法因其廉价与易操作性作为临床上主要的治疗手段,且随着药理学及细胞因子的深入研究,以及多种辅助注射手段与工具的开发,注射疗法的优势与可行性进一步得到了提高。本文围绕伤口愈合过程中病理性瘢痕最新的注射治疗相关进展等进行综述。     

瘢痕疙瘩发病机制的相关信号转导通路的研究进展

瘢痕疙瘩作为病理性瘢痕的一种,其生长通常超过原损伤界限,无自限性,大多伴有痛、痒等症状,给患者生理、外观、心理、生活和工作带来极大障碍.瘢痕疙瘩的诱因较多,手术切口、外伤、烫伤、过敏、痤疮、蚊虫叮咬、水痘和文身等均可引发瘢痕疙瘩.目前,瘢痕疙瘩的治疗方法有手术治疗、放疗、压力疗法、冷冻疗法、激光、光动力、药物局部注射、...     

硅凝胶在瘢痕防治中的应用

病理性瘢痕包括增生性瘢痕及瘢痕疙瘩,其确切的发病机制并不十分清楚。主要症状为疼痛、瘙痒及活动障碍,并且外观上的不美观对患者的自信心产生负面影响[1]。局部硅凝胶疗法是一种便捷、无创的预防和治疗瘢痕增生的方法,     

γ干扰素治疗病理性瘢痕研究进展

病理性瘢痕继发于组织创伤,是组织修复愈合的产物,其临床治疗措施有药物治疗、手术治疗、压力疗法、局部激素注射等.干扰素(IFN)是近年来应用逐渐增多的细胞因子类药物,包括α、β和γ3种类型,本文主要对IFN-γ治疗病理性瘢痕的研究进行综述.     

成纤维细胞与创面微环境信号交流失调导致病理性瘢痕形成的机制

病理性瘢痕是因伤口愈合过程发生各种信号交流失调而形成的病理性产物,主要包括增生性瘢痕和瘢痕疙瘩,是整形外科的重难点疾病,严重影响患者的生理和心理健康.近年来研究的病理性瘢痕的病因主要包括遗传基因、细胞因子、炎症递质、免疫应答、环境因素等,各种因素均在病理性瘢痕的发生发展中起一定的作用,但细胞作为生物体的基本单位,必然承...     

增生性瘢痕与瘢痕疙瘩的鉴别诊断研究进展

从病理学上，瘢痕（scar）可以分为正常瘢痕（normalscar）和病理性瘢痕（abnormal scar）两大类，而病理性瘢痕主要包括增生性瘢痕（hype rtrophic scar）和瘢痕疙瘩（keloid）。这两种病理性瘢痕除了在形态学、组织病理学上存在差异之外，治疗上的差别也很明显。然而，对于瘢痕疙瘩与增生性瘢痕的鉴别诊断，却没有理想的标准。为了正确区别这两种瘢痕，国内外学者做了大量研究，现将其成果综述如下。     

增生性瘢痕及瘢痕疙瘩的临床治疗进展

尽管众多学者及临床医生对增生性瘢痕及瘢痕疙瘩进行了广泛的临床研究,但至今为止还没有发现一种疗效确切一致的理想的治疗方法[1].笔者回顾了近几年来国内外治疗这两种病理性瘢痕的研究情况,并着重讨论应用手术及非手术治疗病理性瘢痕的进展概况.     

病理性瘢痕的激光治疗进展

病理性瘢痕是人体真皮组织损伤后异常修复的结果,主要包括萎缩性瘢痕、增生性瘢痕和瘢痕疙瘩三大类。近年来,激光治疗病理性瘢痕取得了重要进展,也带来了新的治疗理念。不同激光治疗病理性瘢痕时具有不同的作用效果,应针对性地采取最佳的激光治疗方案。本文对不同激光治疗病理性瘢痕的作用和机制进行综述。     

Up-regulation of α1-adrenoceptors in burn and keloid scars

Stimulation of α₁-adrenoceptors evokes inflammatory cytokine production, boosts neurogenic inflammation and pain, and influences cellular migration and proliferation. Hence, these receptors may play a role both in normal and abnormal wound healing. To investigate this, the distribution of α₁-adrenoceptors in skin biopsies of burn scars (N = 17), keloid scars (N = 12) and unscarred skin (N = 17) was assessed using immunohistochemistry. Staining intensity was greater on vascular smooth muscle in burn scars than in unscarred tissue, consistent with heightened expression of α₁-adrenoceptors. In addition, expression of α₁-adrenoceptors was greater on dermal nerve fibres, blood vessels and fibroblasts in keloid scars than in either burn scars or unscarred skin. These findings suggest that increased vascular expression of α₁-adrenoceptors could alter circulatory dynamics both in burn and keloid scars. In addition, the augmented expression of α₁-adrenoceptors in keloid tissue may contribute to processes that produce or maintain keloid scars, and might be a source of the uncomfortable sensations often associated with these scars.     

Laser in the treatment of hypertrophic burn scars

This prospective study looked at the outcome of laser (light amplification by stimulated emission of radiation) treatment for hypertrophic scarring. Dermatrade mark K laser (a set of combined lasers erbium:yttrium aluminium garnet/carbon dioxide, qualified as a class IV laser) was used. Between 21 June 2000 and 19 November 2002, at the Siemianowice Burn Center, Poland, 592 interventions, using laser, were performed on N= 327 patients (220 women and 107 men, aged between 3 and 80 years). The majority of cases [N= 223 (68.9%)] were patients with post-burn hypertrophic scars, and 104 cases (31.8%) had various types of hypertrophic scars. Evaluation took place using an adapted Vancouver Scar Scale and digital photographs as well as the patient's opinion. It was noted that after laser treatment, satisfactory results were achieved in 72% of cases. The scars had become less red (192/327 scored no redness at the end of the study versus 92/327 upon initial), less raised (272/327 scored a flat scar versus 72/327 upon initial) and demonstrated an improved viscoelasticity (192/327 scored a soft skin versus 62/327 upon initial). Laser treatment did not improve contractures in post-burn hypertrophic scars. Results were not confirmed using objective measurement tools, as these were not available to us.     

The efficacy and safety of fractional CO2 laser therapy in the treatment of burn scars: A meta-analysis

Although we have numerous publications about the effect of fractional CO₂ laser therapy for burn scars, quantitative data about its efficacy and safety are sparse. The purpose of this meta-analysis was to assess the efficacy and safety of fractional CO₂ laser therapy for the treatment of burn scars. Pertinent studies were identified by a search of PubMed, Embase and Web of Science up to 20 September 2020. Weighted mean difference (WMD) was conducted to combine the results, and a random-effect model was used to pool the results. Publication bias was estimated using Begg and Egger’s regression asymmetry test. Twenty articles were included. Our pooled results suggested that fractional CO₂ laser therapy significantly improved the Vancouver Scar Scale (VSS) score (WMD = −3.24, 95%CI: −4.30, −2.18; P < 0.001). Moreover, the Patient and Observer Scar Assessment Scale (POSAS)-patient (WMD = −14.05, 95%CI: −22.44, −5.65; P = 0.001) and Observer (WMD = −6.31, 95%CI: −8.48, −4.15; P < 0.001) also showed significant improvements with the treatment of fractional CO₂ laser therapy. Fractional CO₂ laser significantly reduced scar thickness measured with ultrasonography (WMD = −0.54, 95%CI: −0.97, −0.10; P < 0.001). For other outcomes, including pigmentation, vascularity, pliability, and height of scar, vascularity and relief, laser therapy was associated with significant improvements. However, only the cutometer measure R2 (scar elasticity) (WMD = −0.06, 95%CI: −0.10, −0.01; P = 0.023) was significantly improved with the laser therapy, but cutometer measures R0 (scar firmness) (WMD = 0.03, 95%CI: −0.04, 0.09; P = 0.482) was not. Side effects and complications induced by fractional CO₂ laser were mild and tolerable. Fractional CO₂ laser therapy significantly improved both the signs and symptoms of burn scars. Considering potential limitations, more large-scale, well-designed RCTs are needed to verify our findings.     

瘢痕硬度测定计的研制及临床应用

为了达到无创伤、客观、定量测定瘢痕硬度的目的,设计制造出瘢痕硬度测定计,并用以测定了50例病人增生性瘢痕治疗前、治疗后1、2、3个月瘢痕的硬度以及相邻正常皮肤的硬度。研究结果表明:本硬度测定计重复性好,精密度达到质控标准;所测定的硬度值在瘢痕和正常皮肤有极显著差异,作为判断瘢痕特征指标有特异性;瘢痕硬度在治疗后3个月<2个月<1个月<治疗前,说明用于监测瘢痕疗效和成熟度具有临床实用价值。     

瘢痕硬度测定计的研制及临床应用

为了达到无创伤、客观、定量测定瘢痕硬度的目的，设计制造出瘢痕硬度测定计，并用以测定了５０例病人增生性瘢痕治疗前、治疗后１、２、３个月瘢痕的硬度以及相邻正常皮肤的硬度。研究结果表明：本硬度测定计重复性好，精密度达到质控标准；所测定的硬度值在瘢痕和正常皮肤有极显著差异，作为判断瘢痕特征指标有特异性；瘢痕硬度在治疗后３个月＜２个月＜１个月＜治疗前，说明用于监测瘢痕疗效和成熟度具有临床实用价值。     

扩张后皮瓣修复面部瘢痕的手术设计

目的　探讨扩张后皮瓣修复面部瘢痕的手术设计。方法　回顾近年来笔者应用扩张后皮瓣修复面部瘢痕的患者。扩张后皮瓣的手术设计常采用直接推进皮瓣、旋转推进皮瓣和异位皮瓣。术中首先确定可供利用的扩张后新获得皮瓣的面积 ,同时测量出病损部位的面积。采用逆行设计 ,先以病损部位所需皮瓣大小及形态拓印一模板 ,在于扩张后新获得的皮瓣上标出拓下皮瓣的大小 ,在保证血供的基础上 ,适当调整 ,直至设计合理后切除病损处瘢痕 ,行皮瓣转移修复。不同的病损部位行不同的皮瓣设计 ,并强调应尽量减少供区的切口线 ,而且使切口在隐蔽处 ,顺皮纹。结果　本组 5 0例患者 ,瘢痕切除后行扩张后皮瓣修复 ,皮瓣成活良好 ,无继发畸形。随访 2 8例患者 ,皮瓣颜色、质地佳 ,切口瘢痕轻度增生。结论　合理设计扩张后皮瓣行转移修复面部瘢痕 ,术后效果良好     

2790 nm钇-钪-镓-石榴石点阵激光治疗凹陷性痤疮瘢痕的疗效

目的 观察评估2790 nm钇-钪-镓石榴石(YSGG)点阵激光治疗面部凹陷性痤疮瘢痕的疗效及安全性.方法 将患者随机分成两组,A组使用2790 nm YSGG点阵激光非剥脱模式治疗1次,再以剥脱模式治疗;B组仅使用2790 nm YSGG点阵激光非剥脱模式进行治疗.每组共治疗4次,每间隔6周治疗1次,治疗前后均以VISIA(R)数字皮肤分析系统对面部瘢痕和肤质进行评分和统计比较,并由患者、医师共同评价满意度.结果 38例患者均完成4次治疗,治疗后所有凹陷性瘢痕均有不同程度的改善,A、B组治愈率分别为56.0％和30.8％,总有效率81.6％,无1例严重不良反应,A组优于B组.结论 2790 nm YSGG点阵激光具有效果明显、精确度高、损伤小、操作方便的优点,且治疗后并发症少、色素沉着程度轻,2790 nm YSGG点阵激光是治疗面部浅表瘢痕安全、有效的方法之一.