耳部瘢痕疙瘩的序列综合治疗

Synthetic serial treatment of ear cheloid

目的：探讨耳部瘢痕疙瘩按照外科手术、术后放疗、药物注射的序列进行综合治疗的疗效。方法：对39例（50侧）耳部瘢痕疙瘩病例,根据瘢痕疙瘩的大小、位置、浸润范围,对直径小于1.0cm的采用梭形切除后直接拉拢缝合;对直径为1.0~3.0cm的在切除后采用局部推进皮瓣进行修复;对直径大于3.0cm的巨大瘢痕疙瘩,采用瘢痕内核切除保留瘢痕表皮形成瘢痕皮瓣进行修复。然后所有病例在手术后24h内进行第一次放射治疗,每次剂量3Gy,每天1次,连续5~7d,总剂量15~21Gy,1周后拆线,每月电话随访一次。对随访中发现的有复发倾向者行激素类药物瘢痕内注射治疗,每周1次,总计4次。最后根据刘文阁等疗效标准判定疗效。结果：术后所有患者切口均Ⅰ期愈合,局部皮瓣全部成活。34例（44侧）随访1年,达到临床治愈,临床治愈率为87.18%;5例（6侧）术后有复发倾向者,切口局部注射＂曲安奈德注射液＂后未见复发。结论：耳部瘢痕疙瘩采用手术切除加术后早期放疗,再结合药物注射的序列综合治疗,可明显降低复发率,取得满意效果。

Objective To discuss the curative effect of comprehensive treatment with the sequence of surgery, postoperative radiotherapy and drug injection on treating ear keloid.Methods According to the size, location, inifltration range of the ear keloid of 39 cases （50 sides）, fusiform excision and suture were conducted on ear keloids with the diameter smaller than 1.0 cm; for ear keloids with the diameter of 1.0-3.0cm, they were repaired by local advancement skin lfap grafting after excision; for great ear keloids with the diameter larger than 3.0cm, they were repaired by removing the keloid core, reserving the keloid epidermis and forming scar lfap. All patients were treated with radiotherapy in 24h after the operation, with each dose 3Gy, one time each day, lasting for 5-7d and with the total dose of 15-21Gy. Stitches were taken out in one week and patients were followed up by calling phones. During the follow-up visits, if there were patients with the recurrent possibility, they were injected with hormone drugs, one time each week, totally four times. Finally, curative standards including Liu Wenge were used to evaluate the curative effect. Results Incisions of all patients after operation were all one-stage healing and the local lfap all survived. Thirty four cases （44 sides） were followed up for one year and they all reached clinical cure, with the clinical cure rate 87.18%; for 5 cases （6 sides） with the recurrence possiblity, no recurrence occurred after the incision was injected with ＂triamcinolone acetonide acetate＂. Conclusion The comprehensive treatment with the sequence of excision, early postoperative radiotherapy and drug injection on treating ear keloid can evidently reduce the recurrence rate and obtain satisfying results.