瘢痕核心摘除术联合局部注射醋酸曲安奈德和90^锶-90^钇敷贴治疗病理性瘢痕的疗效观察

Clinical observation of pathological scars treated with keloid core enucleation combined with triamcin- olone injection and 90^Sr-90^Y applicator brachytherapy

目的探讨瘢痕核心摘除术联合局部注射醋酸曲安奈德和99^锶-90^钇敷贴治疗病理性瘢痕的临床疗效及安全性。方法将瘢痕核心部位结缔组织切除后的94例患者随机分为2组，试验组（A组）48例患者，切口缝合后，即行局部醋酸曲安奈德注射，术后3d内行。99^锶-90^钇敷贴治疗，治疗剂量6Gy／次，每周1次，连续5次为1个疗程，总吸收剂量每疗程30Gy／野；对照组（B组）46例患者，切口缝合后，即行局部醋酸曲安奈德注射。结果A组第1疗程治愈率87．5％，有效率为97．9％，B组治愈率69．6％，有效率为86．9％，两组治愈率及有效率差异有统计学意义（P〈0．05），对所有患者随访12～24个月，无放射治疗相关性肿瘤等并发症发生。结论手术摘除瘢痕内纤维核心后局部注射醋酸曲安奈德，术后早期应用99^锶-90^钇敷贴治疗病理性瘢痕疗效满意，不良反应少，是较好的治疗方法。

Objective To explore the clinical effect of treated with keloid core enucleation combined with triamcinolone injection and 90^Sr-90^Yapplicator brachytherapy. Methods 94 patients with keloid core enucleation were randomly divided into group A and group B. 48 patients（ group A） were immediately intralesional injection of triameinolone when the incision was sutured, and they were treated by 90^Sr-90^Y applicator brachytherapy within postoperative 3 days, dose 6 Gy/time, once a week for five consecutive times as a course, and all patients received a total dose of 30 Gy/field. 46 patients （group B） were immediately intralesional injection of triamcinolone acetonide only. Results The cure rates of A group and B group were 87.5% and 69.6% respectively. The effective rates of A group and B group were 97.9% and 86.9% respectively, therefore the difference between the two groups was significant. All patients were followed-up for 12 -24 months, there was no radiation treatment-related complication such as tumor. Conclusion Keloid core extirpation and immediate- ly intralesional injection of steroid combined with 90^Sr-90^Y applicator brachytherapy is well tolerated and very ef- fective in preventing hypertrophic sears and keloids recurrence.