综合治疗瘢痕疙瘩疗效分析

目的　探讨手术切除、术后β射线放疗和局部贴敷硅凝胶膜综合治疗瘢痕疙瘩的疗效。　方法　1996年～ 2 0 0 2年对 5 98例瘢痕疙瘩采用了综合治疗。其中男 2 4 3例 ,女 35 5例。年龄 15～ 5 5岁 ,平均 2 8.6岁。病程 6个月～ 6年。瘢痕疙瘩范围 1.0 cm× 1.5 cm～ 8.0 cm× 15 cm。手术切除瘢痕疙瘩后采用直接缝合或植皮术 ,分为直接缝合组 (5 79例 )和植皮组 (19例 )。直接缝合组于术后 2 4～ 4 8小时行β射线切口部位照射 ,其中 5次放疗组 (196例 )总剂量为12～ 15 Gy(5次 /1周 ) ;10次放疗组 (383例 )总剂量为 15～ 2 4 Gy(10次 /2周 )。植皮组在拆线后接受放疗 ,并采用 10次放疗组的方法。其中 32 5例患者局部加用硅凝胶膜 3～ 6个月。　结果　对 5 98例患者均行随访 ,时间 12～ 18个月。 15次放疗组总有效率为 91.3% ,10次放疗组总有效率为 95 .8% ,两组总有效率比较差异有统计学意义 (P<0 .0 1) ;2植皮组 19例中有 6例无效 ;3局部加用硅凝胶膜有效者 185例 ,对总有效率无明显影响 ,但能改善局部瘢痕的质地和色泽。　结论　综合治疗瘢痕疙瘩术中若能直接缝合创面 ,则不采用植皮术 ;10次放疗优于 5次放疗 ;若经济条件允许 ,应尽量局部加用硅凝胶膜。

ANALYSIS OF CURATIVE RESULT FOR KELOID WITH INTEGRATED METHODS

OBJECTIVE: To study the curative effects of keloid by operation combined with postoperative beta radiation and silicone gel sheeting. METHODS: From 1996 to 2002, 598 patients with keloid (243 males, 355 females, aging 15-55 years with an average of 28.6 years) were treated by integrated therapy. Their disease courses were from 6 months to 6 years. The keloid area ranged from 1.0 cm x 1.5 cm-8.0 cm x 15 cm. First, keloid was removed by operation, and then the wounds were sutured directly (group suture) or covered with skin graft (group graft). In group suture, the operational sites were managed by beta ray radiotherapy 24-48 hours after operation. The total doses of radiation were 12-15 Gy, 5 times 1 week (group suture A) and 10 times 2 weeks (group suture B). Radiotherapy was not taken until stitches were taken out in group graft, and then the same methods were adopted as group suture B. After radiotherapy, silicone gel sheeting was used in 325 cases for 3-6 months. RESULTS: All patients were followed up for 12-18 months. (1) The overall efficacy was 91.3% in group suture A (n = 196), and 95.8% in group suture B (n = 383), respectively. There was significant difference between the two groups (P < 0.01). (2) Radiotherapy was of no effect in 6 cases of group graft (n = 19). (3) Silicone gel sheeting had effectiveness in 185 cases. Silicone gel sheeting had no obvious effect on the overall efficacy, but it could improve the quality of texture and color of skin. CONCLUSION: By use of integrated methods to treat keloid, if the wound can be sutured directly, skin grafting should not be adopted. The results in group suture B are better than those in group suture A; silicone gel sheeting should be used as possible.