202例烧伤后瘢痕治疗的临床体会

目的探讨烧伤后瘢痕的治疗、术后恢复情况及烧伤后瘢痕的防治策略，为今后的瘢痕治疗提供更好的依据。 方法回顾性分析新疆维吾尔自治区人民医院烧伤、创面修复外科2007年1月至2017年2月间收治的202例烧伤后瘢痕手术患者的病例资料，根据患者瘢痕的不同部位、不同性质选择相应的手术方法。术后瘢痕组织送病理检查，统计上述患者住院时间、手术费用、术后病理结果、治疗效果及术后随访情况。 结果本组患者住院期间无死亡，无严重并发症出现，平均住院时间(14.50±6.04) d，平均手术费用(1.59±0.37)万元，术后瘢痕部位均得到适当松解，创面均愈合良好出院。术后病理提示发生恶变22例(10.89%)，其中高分化鳞癌15例(7.43%)，恶性黑色素瘤2例(0.99%)，基底细胞癌1例(0.50%)，梭形细胞癌1例(0.50%)，低分化鳞癌1例(0.50%)，局部恶变重度异性增生2例(0.99%)。术后随访时间中位数10个月，随访过程中复发3例。 结论目前手术仍是治疗烧伤后瘢痕挛缩的较为有效的方法之一，其防治较为复杂，建议严格把握手术时机及手术适应证，使用个体化治疗方案。

Clinical experience of treatment of 202 cases with scar after burn

ObjectiveTo investigate the treatment and postoperative recovery of post-burn scar and control strategy, and provide better basis for future scar treatment. MethodsRetrospective analysis of 202 cases of post-burn scar surgery patients treated by the Department of Burns, Wound Repair Surgery, People′s Hospital of Xinjiang Uygur Autonomous Region from January 2007 to February 2017 was done. The operative methods were selected according to the nature of scar in different parts of the patient. And the scar tissue was examined by pathological examination. Statistics of the patients with the hospitalization time, operation cost, postoperative pathological results, therapeutic effect and the follow-up status. ResultsThere was no perioperative deaths and serious complications during hospitalization. The average hospitalization time of patients was (14.50±6.04) days, and the average operation cost of patients was (15.9±3.7) thousand yuan. The scar was properly loosened and the wounds healed well after discharge. Postoperative pathology showed malignant transformation in 22 cases(10.89%). Among them, there were 15 cases (7.43%) of high-grade differentiated squamous cell carcinoma, 2 cases(0.99%) of malignant melanoma, 1 case (0.50%) of basal cell carcinoma, 1 case(0.50%) of spindle cell carcinoma, 1 case(0.50%) of low differentiated squamous cell carcinoma, 2 cases (0.99%) of local malignant change, and severe hyperplasia of opposite sex. The median follow-up time was 10 months, and 3 cases recurred during the follow-up period. ConclusionsAt present, operation is still one of the effective methods for the treatment of post-burn scar. The prevention and treatment of this disease is complicated. It is suggested that the operation time and indication should be strictly controlled and individualized treatment should be adopted.