耳部瘢痕疙瘩个体化的综合治疗

目的 探讨耳部瘢痕疙瘩手术切除方式和术后放疗等综合治疗的疗效. 方法 2000年1月-2005年12月收治42例(71侧) 耳部瘢痕疙瘩患者.男8例,女34例;年龄16～50岁,平均26.2岁.病程6个月～4年.穿耳孔32例,创伤7例,耳部病变手术3例.瘢痕疙瘩范围 0.3 cm × 0.3 cm×0.2 cm～6.0 cm×4.0 cm×1.0 cm,形状呈球形、哑铃形、结节形.根据瘢痕疙瘩不同大小和范围,选择不同术式,切除瘢痕并行缺损修复.术后24 h内,高能电子束照射 10 次,每次2 Gy,总剂量20 Gy,对有复发倾向者,及时行"得宝松"1 mg 及 2%利多卡因按1∶3 混合液局部瘢痕内注射3次,每3周1次. 结果 术后患者切口均Ⅰ期愈合,皮瓣均成活.37例(64侧)获随访 1 年,获临床治愈;5 例(7侧)于术后3～6个月有复发倾向,及时局部注射"得宝松"后未见复发.根据刘文阁等疗效标准判定治愈37例,显效5例. 结论 耳部瘢痕疙瘩尽早采用个体化手术方式,结合早期放疗,可取得满意效果,是治疗的选择方案之一.

SYNTHETIC THERAPY FOR KELOID IN AURAL REGION

OBJECTIVE: To summarize the effectiveness of surgical removal combined with adjuvant therapy on the aural region keloid. METHODS: From January 2000 to December 2005, 42 patients (71 side ears) with keloid at the aural region were treated. There were 8 males and 34 females, aged 16 to 50 years (mean 26.2 years). The course of disease ranged from 6 months to 4 years. The causes of disease included earhole piercing (n=32), ear trauma (n=7), and postoperative hyperplasia (n=3); the sizes of keloids ranged from 0.3 cm x 0.3 cm x 0.2 cm to 6.0 cm x 4.0 cm x 1.0 cm withglobular, dumb-bell, nodular shapes. According to the different sizes and the range of keloids, different operations to remove the keloids and repair the defect tissue were chosen. Wounds were exposed to the electron beam at first 24 hours after operation, once a day at 2 Gy eachtime for 10 days. An immediate local injection for the keloid withhormones anti-scar drugs, whichwas a mixture of Beta-methasone (Diprospan) and 2% Lidocaine with a proportion of 1 : 3, was given to the patients who had recurrence trend 3 times, every 3 weeks. RESULTS: After operation, all the wounds healed by first intention. And 37 cases (64 lateral ears) were followed up for 1 year, and all achieved clinical cure. Five cases (7 lateral ears) had the trend of recurrence 3-6 months after operation and were cured after the immediate local injection for the keloid with hormones anti-scar drugs. According to LIU Wenge's curative criterion, 37cases were cured and 5 cases responded to treatment. CONCLUSION: Surgical removal combined withlocal radiation and hormones infiltrated individually as early as possible can effectively treat aural region keloids. And it is an optimal method.