A型肉毒毒素预防与治疗早期增生性瘢痕的临床初探

Prevention and treatment of early hypertrophic sears with botulinum toxin type A

目的探索A型肉毒毒素（botulinurn toxin type A，BTXA）对早期增生性瘢痕（hypertrophic scar，HTS）的临床预防及治疗效果。方法早期HTS周围及组织内注射BTXA，观察瘢痕注射药物后形态学变化、组织学变化及临床症状表现；手术切口缝合后即刻向周围肌肉浅层注射BTXA，观察远期瘢痕愈合情况。结果局部注射BTXA可以明显减轻早期FITS疼痛和瘙痒症状，促使瘢痕组织萎缩、软化；组织切片HE染色显示HTS组织内结构有所变化。同时，手术切口周围肌肉浅层注射BTXA可以降低术后切口HTS的发生、发展概率。结论BTXA对早期HTS具有一定程度的治疗和预防作用，其疗效可能是通过降低瘢痕两侧张力及活动，干扰瘢痕内小神经传导，以及影响成纤维细胞增殖分化，促进凋亡进而减少胶原合成而起作用。

Objective To explore the effect of botulinum toxin type A （BTXA） in the treatment of early hypertrophic scars （HTS）. Methods BTXA was injected into and around the early HTS, and then the modal and histological changes of the scars as well as the clinical reaction were observed in the patient. BTXA was also injected into muscle around the incision and effect on the cicatrization observed. Results Injection of BTXA could obviously alleviate ache and pruritus of early HTS and could impel the atrophy and inteneration of early HTS. Changes were found in paraffin-embedded tissue section by the hemetoxylin and eosin （HE） staining. Injection of BTXA into muscle around the cut could can reduce occurrence of FITS. Conclusion BTXA can help prevent the early HTS to a certain extent. The mechanism underlying this effect may be related to the reducing the tension around scars and proliferative activity, interfering with the signal transduction of small nerves, affecting the proliferation and apoptosis of fibroblasts and subsequently decreasing the collagen synthesis.