多种方法综合治疗皮肤病理性瘢痕的临床观察

目的：观察手术切除、放射治疗、硅凝胶膜贴敷综合治疗皮肤病理性瘢痕的临床效果，探讨理想的治疗方法。方法：对357例皮肤增生性瘢痕和瘢痕疙瘩患者进行手术切除瘢痕，术后1—7d即进行放射治疗（直线加速器电子射线的剂量为3Gy／次，5次；或2Gy／次，8—10次，总剂量15～20Gy；γ射线的剂量为5—6Gy／次，2～3次，总剂量15—20Gy），放射治疗结束、切口拆线后1周内开始运用硅凝胶膜贴敷，每日至少贴敷12h以上，连续1—3个月。术后随访6个月～2年。结果：357例皮肤增生性瘢痕和瘢痕疙瘩经综合治疗后痊愈241例（192／49），占67．5％；显效74例（48／26），占20．7％；有效23例（14／9），占6．5％；无效19例（11／8），占5．3％；综合治疗总有效率为94．7％。7例（2．0％）出现放射性损伤，创面发生溃疡，治疗1个月后溃疡愈合，瘢痕未复发；315例（88．2％）患者治疗部位出现色素沉着，3～6个月自然消失。结论：手术切除、放射治疗、硅凝胶膜贴敷综合治疗皮肤病理性瘢痕效果良好，是一种可行的治疗方法。

Clinical observation on treating pathological scar with combination of operation, radiation and application of mepiform

Objective： To observe the clinical effects of the combination treatment consisting of operation, radiation and application of mepiform to treat pathological scar and investigate the ideal treated approaches. Methods ： Three hundred and fifty seven patients with hyperplastic scar and keloma were treated with combination of operation, radiation and application of mepiform. They accepted radiation and application of mepiform therapies 1 to 7 days and 10 days after operation, respectively. Results： The scar appearances of 241 patients （67.5 % of total cases） became planus, without apparente hyperplasia. The scar appearances of 74 patients （20. 7 % of total cases） turned weak red, without apparente hyperplasia. The scar appearances of 23 patients （6. 5 % of total cases） became eobblyand locally highlight to skin surface, with apparente hyperplasia. The scars of 19 patients （5.3 % of total cases） recurredand obviously highlighted to skin surface 2 months after treating. Collectively, the total efficency is 94. 7 %. Seven patients were injured after radiation with the scar ulcers showing up. , However, the ulcers healed after 1 month＇s treating, with no recrudescence. Conclusion： The combination treatment consisting of operation, radiation and application of mepiform was effective to restrain hyperlasia of pathological scars and thus proved to be feasible to treat pathological scars.