瘢痕表皮回植加曲安缩松治疗瘢痕疙瘩的临床研究

目的：探讨一种不必产生新供区且更有效地综合综合治疗瘢痕疙瘩的临床途径。方法：将整块切除的瘢痕疙瘩削薄仅保留表皮层，然后将其回植于创面并即刻给予基底及周边曲安缩松注射。伤口愈合后再重复注射2-4次。共治疗22例。结果：19例（86.4%）愈合良好，随访6个月-2年未见复发。2例（9.1%）因并发感染中止注射曲安松导致瘢痕疙瘩复发。1例（4.5%）因月经紊乱拒绝继续使用曲安缩松而致部分复发。结论：该方法简单、经济、疗程短，不产生新供皮区，避免了单一手术切除带来的高复发率及长期单纯类固醇激素注射所产生的副作用。     

曲安缩松剂量与瘢痕萎缩量的定量研究

目的 探讨瘢痕治疗中曲安缩松用量与瘢痕萎缩量的关系。方法 结合临床病例作定量研究。结果 对８２例增生性瘢痕作了定量研究。,定量观察了曲安缩松用量和增生性瘢痕的萎缩量。结论 瘢痕形成的时间越长治疗所需的曲安缩松剂量就越大;曲安缩松的总剂量随着瘢痕体积的增加而成比例也增加。     

抗组织胺制剂治疗瘢痕疙瘩的疗效观察

为探索治疗瘢痕疙瘩的新途径，采用作者研制的高液压瘢痕注射器向瘢痕内注射抗组织胺制剂，并和注射曲安缩松混悬液对比。结果表明，抗组织胺制剂能有效抑制瘢痕的增生，使瘢痕变软，且副作用明显低于后者。此结论从临床上支持了瘢痕疙瘩发病机制中的免疫改变机理     

曲安奈德局部注射治疗儿童病理性瘢痕的单组率Meta分析

目的：通过分析曲安奈德局部注射治疗儿童病理性瘢痕的有效率、显效率和不良反应发生率来评价该治疗方法的临床疗效和安全性。方法：检索CNKI、万方、PubMed、Embase、CochraneLibrary数据库，搜集关于曲安奈德局部注射治疗儿童病理性瘢痕的随机对照试验、非随机对照试验、队列研究及病例报告论文，提取资料后，采用Stata软件进行Meta分析。结果：共将5篇文献650例患儿纳入Meta分析，曲安奈德局部注射治疗儿童病理性瘢痕的有效率是88%(95%CI:0.82,0.94)，治疗儿童病理性瘢痕的显效率是48%(95%CI:0.25,0.71)，局部注射曲安奈德的不良反应发生率是7%(95%CI:0.05,0.08)。结论：曲安奈德局部注射治疗儿童病理性瘢痕的疗效确切，使用低浓度（10 mg/ml）药物注射具有较高的安全性。     

维拉帕米对兔耳增生性瘢痕作用的实验研究

目的　探讨钙通道阻滞剂维拉帕米对兔耳增生性瘢痕的作用。方法　建立兔耳外伤性皮肤早期瘢痕增生模型 ,将 2 4只兔随机平均分为 3组 ,每组 8只 ,各组瘢痕内分别注射维拉帕米 2 5 μl(0 .0 6 2 5mg) 瘢痕、曲安缩松 2 5 μl(1mg 瘢痕 )、生理盐水 2 5 μl(0 .2 2 5mg 瘢痕 ) ,1次 10d ,共 2次。观察瘢痕外形变化。治疗后 2 0d在瘢痕处取材 ,切片行HE及Masson染色。光镜下观察 ,计算瘢痕增生指数、切片内成纤维细胞数密度 ,计算机辅助图象分析测算切片内胶原纤维面密度。结果　与生理盐水组相比 ,维拉帕米组和曲安缩松组瘢痕均变软、变平 ,色泽变浅 ,瘢痕增生指数及胶原纤维面密度均降低 ,3组间成纤维细胞数密度无显著变化 ;维拉帕米组瘢痕增生指数高于曲安缩松组 ,胶原纤维面密度两组间无显著性差异。结论　外伤性兔耳早期增生性瘢痕局部注射维拉帕米可降低瘢痕内胶原含量 ,引起瘢痕萎缩。本实验条件下维拉帕米的促瘢痕萎缩作用弱于曲安缩松。     

耳廓瘢痕疙瘩综合治疗的临床观察

目的评价手术联合曲安奈德局部注射治疗耳廓瘢痕疙瘩的临床效果。方法对12例(20侧)患者采用部分或全部切除耳廓瘢痕,皮瓣恢复耳廓正常外形。术后10 d切口及残余瘢痕内注射曲安奈德注射液,曲安奈德10~20 mg以2%利多卡因稀释1倍后注射,每2周1次,视瘢痕消退情况逐渐撤药。结果随访6~36个月,治愈8例,显效4例,有效率100%,疗效满意。结论手术联合曲安奈德局部注射是治疗耳廓瘢痕疙瘩的有效方法。     

曲安缩松治疗增生性瘢痕

我科自1993年1月至1999年5月,采用曲安缩松注射液瘢痕内注射治疗增生性瘢痕85例,随访3月～6年,疗效满意,现报告如下。1　临床资料85例患者,年龄:6岁～50岁;瘢痕部位:颌面部42例;腹部10例,四肢20例,前胸部11例,会阴部2例。病损面积0.5cm2～18cm2。2　治疗方法常规碘酒、酒精消毒瘢痕表面。曲安缩松注射液1ml加2%利多卡因1ml,用412针头在瘢痕上分别多点进针,注射药液于瘢痕组织内,直至发白。20天注射一次,连续注射4次。对有复发倾向者,3个月后注射一次,6个月再注射一次。3　结果85例中,大多数病人瘢痕部位变得平坦,柔软,色泽减退,部分病人瘢痕…     

曲安奈德局部注射联合外用5%咪喹莫特治疗瘢痕疙瘩疗效观察

目的：观察曲安奈德局部注射联合外用5%咪喹莫特乳膏治疗瘢痕疙瘩的临床疗效。方法：将患者随机分为两组,治疗组给予曲安奈德局部注射治疗,每10～15天注射1次,2～3次为1个疗程,最多不超过3个疗程。同时外用5%咪喹莫特每周3次,连续外用3个月;对照组单纯给予曲安奈德注射液局部注射治疗。治疗结束后随访1年,判断疗效并观察复发情况。结果：治疗组有效率96.4%,明显优于对照组（P〈0.05）,差异有显著性意义。治疗组复发率低于对照组。结论：曲安奈德局部注射联合外用5%咪喹莫特乳膏治疗瘢痕疙瘩治愈率高,疗效确切。     

三种不同方法治疗瘢痕疙瘩的疗效比较

目的：比较单纯放射治疗,曲安奈德注射＋放射治疗与手术＋放射治疗瘢痕疙瘩的疗效。方法：回顾分析91例瘢痕疙瘩患者采用三种治疗方法的疗效,其中单纯放射治疗28例,曲安奈德注射＋放射治疗31例,手术＋放射治疗32例。结果：单纯放射治疗组治愈率为35.8%,有效率为67.9%;曲安奈德注射＋放射治疗组治愈率为64.5%,有效率为90.3%;手术＋放射治疗组治愈率为71.9%,有效率为93.8%。单纯放射治疗组的治愈率和有效率与曲安奈德注射＋放射治疗组以及手术＋放射治疗组比较差异均有统计学意义（P〈0.05）,曲安奈德注射＋放射治疗组与手术＋放射治疗组的治愈率和有效率比较差异均无统计学意义（P〉0.05）。结论：曲安奈德注射＋放射治疗与手术＋放射治疗对瘢痕疙瘩的疗效均优于单纯放射治疗,前两者疗效相当。     

瘢痕皮瓣修复上睑皮肤瘢痕性缺损

目的：探讨局部瘢痕皮瓣修复上睑皮肤瘢痕性缺损的效果。方法：烧伤、感染后的瘢痕疙瘩所致上睑皮肤瘢痕性缺损10例;采用保留瘢痕皮肤的瘢痕内剥除塑形手术方法,同时松解复位外翻的眼睑,术后曲安奈德瘢痕内注射2～5次。结果：除1例皮瓣坏死改善不明显外,其余病例瘢痕疙瘩和睑外翻完全矫正。随访3～12月,无复发,重睑形态良好。结论：瘢痕皮瓣是修复上睑皮肤瘢痕性缺损的良好办法。     

Intra-lesional injections of collagenase are ineffective in the treatment of keloid and hypertrophic scars.

The treatment of keloid and hypertrophic scars remains difficult. Enzymatic digestion of keloid scars has been previously proposed as an effective treatment strategy for reducing the volume of keloid scars. To test this, we administered intra-lesional injections of pure collagenase (between 600 and 4500 units for each scar) into the keloid and hypertrophic scars of seven human volunteers (five keloid and two hypertrophic scars). Five patients (three keloid and two hypertrophic) received more than one injection of collagenase. The treatment resulted in a temporary reduction in scar volume for three of the patients with keloid scars. However, scar volumes for these three patients returned to the same (or greater) levels after 6 months of follow-up. Treatment with collagenase produced no change in scar volume for the two patients with hypertrophic scar. Side effects were numerous and severe including; pain, swelling, blistering, ulceration and ecchymosis at the site of injection. One patient required admission to hospital for 48 h after the first injection. Maximum length of follow-up was 6 months. None of the seven patients completed the study and returned for final follow-up at 2 years. This pilot study suggests that treatment of keloid and hypertrophic scars with intra-lesional injections of collagenase is ineffective.     

瘢痕疙瘩中Smads表达的研究

目的 探讨不同类型Smads在瘢痕疙瘩、正常瘢痕和正常皮肤中的差异表达及其意义.方法 采用RT-PCR和Western Blot法分别对10例瘢痕疙瘩、10例正常瘢痕及10例正常皮肤组织,以及体外培养瘢痕疙瘩、正常瘢痕及正常皮肤成纤维细胞中的Smads mRNA及蛋白的表达水平进行检测.用t检验比较其表达差异,P<0.05为差异具有统计学意义.结果 在瘢痕疙瘩组织及瘢痕疙瘩成纤维细胞中,Smad7的mRNA及蛋白水平表达明显低于正常瘢痕(P<0.05)和正常皮肤(P<0.05),而Smad2、3的mRNA及蛋白水平表达以及磷酸化的Smad2、3的蛋白水平表达并无明显改变(P>0.05).结论 在瘢痕疙瘩中,存在有Smad7的表达缺陷,这可能是增高的转化生长因子-β1(TGF-β1)/Smads信号传导不能被自身负反馈循环终止的重要原因.     

瘢痕疙瘩成纤维细胞p53基因突变的研究

目的　探讨瘢痕疙瘩成纤维细胞中 p5 3基因第 4～ 8外显子的突变规律及其意义。　方法　取瘢痕患者手术切除的瘢痕疙瘩和增生性瘢痕标本各 12例 ,并设患者自身正常皮肤标本及血标本为对照。体外分离、培养上述组织标本的成纤维细胞。采用聚合酶链式反应 单链构象多态性(PCR SSCP)分析方法和基因测序法 ,检测各种组织成纤维细胞中p5 3基因的突变情况。　 结果　 12例瘢痕疙瘩标本中有 9例p5 3基因外显子 4、5、6、7出现点突变和移码突变 ,增生性瘢痕标本、正常皮肤标本及血标本中均未检出突变。　结论　p5 3基因突变是瘢痕疙瘩形成和发展的重要因素之一。     

综合疗法对头面部瘢痕的治疗分析

目的:探究综合疗法对头面部瘢痕的治疗效果。方法:选取在我院进行治疗的头面部瘢痕的患者48例,采取手术切除、术中切缘注射糖皮质激素、术后加压、局灶放疗等综合治疗,经过术后随访,观者患者的恢复情况。结果:经过术后的随访,患者术后效果比较好,治愈35例,占72.92%,显效11例,占22.92%,总有效率为95.83%,仅有2例无效,占4.17%,无患者治疗后随访中复发,患者对于治疗比较满意。结论:对于头面部瘢痕的患者来说,采取手术切除、术中切缘注射糖皮质激素、术后加压、局灶放疗等综合治疗,能够取得良好的临床效果,而且患者术后复发率比较低,情况比较满意,值得在临床推广。     

Clinical status of hospitalized keloid cases from 2013 to 2018

ObjectsKeloids are intractable scar diseases and sometimes undergo hospitalization. This study aims to represent current status of keloid management in a national sample of hospitalized scar cases.MethodsData of scar-diagnosed cases admitted in 1064 China’s tertiary hospitals between 2013 and 2018, were obtained from the Hospital Quality Monitoring System (HQMS) database. Variables analyzed include sex, age, nationality, occupation, hospital department, accompanied symptoms at admission, surgical treatment, length of stay (LOS), and hospitalization cost. The potential risk factors of keloid diagnosis among scar cases were preliminarily identified through the Cochran-Mantel-Haenszel tests and univariate regression analyses.ResultsThis study identified 177,586 scar cases including 21,777 keloid cases and 155,809 non-keloid scar cases. The prevalence of scars in the HQMS database was gradually decreased from 0.123% in 2013 to 0.075% in 2018. We found a preponderances of males (54.32%), adults (61.52%), Han nationality (93.38%), and students (17.35%) in scar cases, among whom keloid cases accounted for growing proportions increasing from 9.2% in 2013 to 15.1% in 2018. Comparing non-keloid scar cases, keloid cases consisted of more women (59.1% VS 43.8%), office staffs (13.08% VS 6.75%) and retirees (5.16% VS 2.65%), and less Zhuang (0.79% VS 1.40%) and Hui nationalities (0.76% VS 1.00%), and showed lower incidence of accompanied symptoms (4.51% VS 47.96%) and higher rate of receiving operations (57.96% VS 50.28%, P < 0.001). Both the LOS and cost per hospitalization were lower in keloid cases. Furthermore, the adult and older women, Han and Uyghur nationalities, office staffs and retirees, and admitted in otolaryngology and dermatology departments, were potential predictors of keloid diagnosis among hospitalized scar cases.ConclusionWhen viewed at the national level, keloid occupies an important part in scar management in Chinese tertiary hospitals. Demographic and clinical differences between keloids and other scars facilitate understanding and promoting of individualized anti-scar therapeutic strategies.     

In-situ irradiation of keloid scars with Nd:YAG laser

In-situ coagulation of keloid with Nd:YAG laser irradiation was carried out in in a cohort study of 17 patients, each with one keloid scar situated on either the sternum (six), abdomen (seven), shoulder (two), hip (one), or ear lobe (one). The duration of scarring was three to 17 years and size varied from 3-8 cm long. One to two doses of laser irradiation was required for complete coagulation. At three months, 10 (58.8%) keloids had completely healed; but in seven (41.1%), 25-50% of residual keloid persisted. Intralesional triamcinolone injection, once in four patients and twice in three patients, produced complete resolution in all seven patients. At 18 months to five years follow-up, 14 patients remain keloid-free but in three keloid recurred and was re-treated with laser coagulation with complete resolution. The treatment was carried out as an outpatient procedure under local anaesthesia. There were no complications. The results of this initial study suggest that Nd:YAG laser irradiation coagulation is effective treatment for keloid scarring.     

Treatment outcomes for keloid scar management in the pediatric burn population

Introduction

Keloids scars are challenging problems facing many reconstructive surgeons and have proven to be resistant to many treatments. This is evident by the broad range of treatments available and implemented with inconsistent results. We reviewed our experience to better define the disorder and to evaluate the impact of specific treatment options as related to our patient population.

Methods

After obtaining Institutional Review Board approval, we examined the medical records of pediatric patients who were evaluated at our pediatric burn center between 2000 to 2008. All study subjects were identified as having keloid scars confirmed by clinical evaluation (raised scar extending beyond the margins of the original wound 0005 and 0010). Treatments included excision and grafting [split thickness autograft (STAG) or full thickness autograft (FTAG)], excision and grafting with steroid injection, excision and primary closure, or excision and primary closure with steroid injection. Patients were included only if there was follow-up of 12 months or greater.

Results

One hundred and ten subjects with a diagnosis of a keloid scar were identified. Twenty-six were treated with excision and skin grafting and 8 were treated with a steroid and surgery regimen. Of the patients treated with surgery and steroids, the treatment varied from an intra-operative injection to post-operative injections at 6-week intervals. The number of injections was determined by the administering surgeon and varied from one to three. Clinical end points were determined by the administering surgeon and included: (1) no further improvement in scar maturation or (2) absence of improvement. Recurrence was defined as return of a raised scar consistent with a keloid scar. The recurrence rate was 87.5% for patients treated with surgery and steroids and 80.0% for surgery only. This difference was not statistically significant.

Conclusions

Our data demonstrate that steroids do not significantly decrease recurrence in pediatric burn related keloids as compared to previously published series involving non-burn related keloids 0015 and 0025. This further emphasizes that burn related keloids respond differently to conventional treatments that have proven successful in keloid scars from other mechanisms of injury. A consistent and effective treatment algorithm should be implemented in treating keloid scars from burn wounds.     

增生性瘢痕和瘢痕疙瘩P53基因多态性的分析

目的 探讨p53基因codon-72部位的多态性分布是否与增生性瘢痕及瘢痕疙瘩的易发性有关。方法 以日本医科大学整形外科行手术治疗患者的切除瘢痕标本为材料，利用限制性片段长度多态性分析法(RFLP)及DNA序列分析法(DNA-sequence)，对54例瘢痕疙瘩标本和30例增生性瘢痕标本的p53基因codon-72部位编码精氨酸(Arg)和脯氨酸(Pro)的等位基因CGC(Arg)和CCC(Pro)进行了分析。结果 与正常日本人群外周血p53基因codon-72部位的多态性频度分布相比，瘢痕疙瘩差异无显著性，而增生性瘢痕则差异有显著性。此外，由穿耳孔所致的耳部瘢痕疙瘩CGC(Arg)基因型显著增高。结论 推测p53codon 72部位具有CGC／CGC(Arg／Arg)纯合型者耳部瘢痕疙瘩的发生率明显增高，具有CCC／CCC(pro／pro)纯合型者增生性瘢痕发生率增高。     

蛋白糖基化抑制剂对病理性瘢痕成纤维细胞Fas蛋白的表达与功能的影响

目的 研究N-糖链合成抑制剂衣霉素对病理性瘢痕成纤维细胞Fas蛋白的表达与诱导凋亡功能的影响.方法 瘢痕疙瘩及增生性瘢痕各5例,以健康皮肤为对照,免疫组织化学法检测组织中成纤维细胞Fas蛋白表达;组织块贴壁法培养成纤维细胞;Western Blot法及流式细胞术检测衣霉素处理及未处理各组成纤维细胞Fas蛋白水平的表达及凋亡率的变化.结果 病理性瘢痕及健康皮肤成纤维细胞胞质及胞膜中均可见Fas蛋白表达;增生性瘢痕、瘢痕疙瘩及健康皮肤成纤维细胞Fas蛋白糖基化水平依次降低,3组成纤维细胞在Fas单克隆抗体(Fas monoelonal antibody,FasMcAb)作用后凋亡率与Fas蛋白糖基化成正相关,衣霉素可明显降低病理性瘢痕成纤维细胞Fas蛋白糖基化水平,但对健康皮肤成纤维细胞Fas蛋白糖基化水平抑制作用不明显.结论 FasMcAb诱导病理性瘢痕成纤维细胞凋亡与成纤维细胞Fas蛋白糖基化水平成正相关,而衣霉素可显著降低成纤维细胞Fas蛋白糖基化水平.     

相对静息期的增生性瘢痕和瘢痕疙瘩中Ⅳ型胶原的分布及表达

目的：了解Ⅳ型胶原在相对静息期增生性瘢痕、瘢痕疙瘩中的表达与作用。方法：利用免疫组化的方法检测Ⅳ型胶原在瘢痕中的分布及表达。结果：在所有的病理性瘢痕标本中均有Ⅳ型胶原的表达，在增生性瘢痕中的表达强于而且多于瘢痕疙瘩中的表达。表达区域在瘢痕表皮的基底膜层、血管和皮肤附件的周围。与凋亡相关基因的表达几乎一致。结论：提示我们Ⅳ型胶原与相对静息期增生性瘢痕和瘢痕疙瘩的转归有着重要的关系。