578例瘢痕疙瘩放疗疗效观察

Electron-beam irradiation therapy for keloids： retrospective study of 578 cases

目的 评价高能电子线放疗瘢痕疙瘩的疗效及影响因素.方法 1998-2012年间收治可随访到的瘢痕患者578例共846处瘢痕,年龄5～80岁（中位数29岁）.术后放疗841处,需植皮瘢痕39处,术后1d内开始放疗的656处,瘢痕最大径＞5 cm的349处.放疗采用6、7 MeV电子线源皮距照射技术,照射野为瘢痕切口（包括缝线针眼）外扩1 cm.照射剂量16～18 Gy分2次,术后第1、8天各照射1次,植皮患者需要在皮瓣成活后开始放疗（约为术后10 ～15 d）.随访时间8～185个月（中位数36个月）.结果 846处瘢痕疙瘩治疗后有效为736处（87.0％）,另有89处（10.5％）瘢痕疙瘩在4～33个月出现复发,21处（2.5％）治疗无效.单因素分析显示瘢痕长度、瘢痕部位、植皮与否、术后照射开始时间为影响疗效因素（P =0.007、0.000、0.000、0.001）,多因素分析显示瘢痕部位、植皮与否为影响疗效因素（P =001、0.001）.结论 采用高能电子线治疗瘢痕疙瘩可取得满意疗效,治疗面平坦是保证电子线治疗瘢痕效果的重要因素.

Objective To analyze the outcomes of radiotherapy for keloids by high energy electron beams and the factors influencing the treatment outcome.Methods From Jan 1998 to Jun 2012,846lesions in 578 patients received radiotherapy.The median age is 29 years old （range 5-80 years old）.There are 841 lesions with postoperative radiotherapy and 39 lesions with skin-grafting.656 lesions treated within 1 day after operations.The max diameter of 348 keloids are 〉 5 cm.We used 6 MeV and 7 MeV electron-beam radiation therapy.The total dose ranging from 16-18 Gy/2f （interval 1 week）.Treatment fields including entire keloid scars,and any suture/puncture holes with a 1 cm-margin around the lesion were used.The skin grafting patients need radiotherapy after the flap survived （about 10-15 days after the operation）.The median follow-up period was 36 months （range 8-185 months）.Results There are 736 （87.0%） of 846 lesions with radiotherapy effective.Other 89 （10.5%） lesions relapse in 4-33 months （median 12 months）.21 lesions were of no avail.The univarate analysis shows that keloids length,keloids location,skin-grafting,interval between operations and irradiations are the influencing factors of outcomes （P =0.007,0.000,0.000,0.001）.The multivariate analysis shows that keloids location and skin-grafting remained statistically significant differences （P =0.001,0.001）.Most of the recurrence cases are large and bent scars.Conclusions High-energy electron-beam radiotherapy for keloids can receive good outcomes.Treatment fields flat is very important for electron-beam radiotherapy.