两种方法治疗瘢痕疙瘩的前瞻性研究

A randomized prospective study on the clinical effect of two treatments on keloids

目的比较二氧化碳点阵激光联合^32P敷贴和二氧化碳点阵激光联合复方倍他米松注射治疗瘢痕疙瘩的临床效果。方法选取70例瘢痕疙瘩患者,采用随机、开放的前瞻性研究方法,将其分为二氧化碳点阵激光联合^32P敷贴组（A组,36例）和二氧化碳点阵激光联合复方倍他米松注射组（B组,34例）。2组均先采用二氧化碳点阵激光治疗,后采用重组人表皮生长因子凝胶进行换药。创面愈合24 h内,A组给予^32P敷贴0.4-0.8 MBQ/cm^2治疗,B组行局部复方倍他米松注射治疗,每月1次,连用3次。比较2组患者的临床疗效、症状改善情况、患者满意度和不良反应的发生率。结果 A组的治愈率和满意度高于B组的治愈率和满意度（χ^2=5.884,t=2.193,P〈0.05）;A、B两组患者治疗后温哥华瘢痕量表评分、疼痛评分、瘙痒评分均较治疗前有所降低（t=30.070、14.797、11.889,t=18.049、10.016、8.290,P〈0.01）,治疗后A组上述评分均低于B组（t=5.861、5.480、3.069,P〈0.01）。结论二氧化碳点阵激光联合^32P敷贴治疗,能明显提高临床疗效,改善症状,但技术有待改进。

Objective To evaluate the effect of two treatment approaches on keloids： fractional CO2 laser combined with^32P applicator,and fractional CO2 laser combined with intralesional injection of compound betamethasone.Methods A total of 70 patients were divided into two groups： group A（ n = 36） treated with fractional CO2 laser combined with^32P applicator,and group B（ n = 34） treated with fractional CO2 laser combined with intralesional injection of compound betamethasone. All patients received fractional CO2 laser therapy first and then recombinant human epidermal growth factor gel. After the wound healed,patients in group A received^32P applicator therapy,0. 4-0. 8 MBQ /cm^2 for 96 hours; patients in group B received compound betamethasone injection therapy,once every month for 3 times.The clinical effect,symptoms,satisfaction and ratio of side effects between the two groups were compared. Results The cure rate and satisfaction in group A were significantly higher than those in group B（ χ^2= 5. 884,t = 2. 193,P〈0. 05）. The Vancouver Scar Scale（ VSS） scores,pain scores,and itch scores were significantly improved in both groups after treatment（ t = 30. 070,14. 797,11. 889; t = 18. 049,10. 016,8. 290,P〈0. 01）; the above items in group A were significantly lower than those in group B after comprehensive intervention（ t = 5. 861,5. 480,3. 069,P〈0. 01）. Conclusion Fractional CO2 laser combined with^32P applicator is highly effective on keloids with satisfactory clinical results. However,the technique still needs improvement.