术前注射和术中瘢痕核心切除术联合术后放疗治疗耳部瘢痕疙瘩20例临床观察

Clinical Observation of Combined Preoperative Injection,Core Excision and Postsurgical Radiotherapy for Earlobe Keloid

目的观察耳部瘢痕疙瘩术前注射和核心切除术联合术后放疗的临床疗效和安全性。方法将入选的40例耳部瘢痕疙瘩患者随机分为两组，各20例。治疗组：术前2个月和术前1个月时分别局部注射曲安奈德及得宝松各1次，以使瘢痕疙瘩呈萎缩趋势。术中行瘢痕疙瘩核心切除术，以保留部分瘢痕皮肤形成组织瓣来修复缺损皮肤，术后18h时予6Mev电子线照射（400cGy／次，1次／d，连续4天，总剂量1600cGy）。对照组：不行术前注射，余同治疗组。两组患者均随访6—30个月。结果治疗组：治愈18例，有效2例；对照组：治愈11例，有效7例，复发2例，两组患者疗效差异有统计学意义（P=0．039〈0．05）。随访期内患者均未见皮肤萎缩或恶性肿瘤等并发症。结论术前注射和术中瘢痕核心切除术联合术后放疗治疗耳部瘢痕疙瘩临床疗效显著，安全可靠，值得临床医生应用。

Objective To investigate clinical efficacy and safety of preoperative injection, core excision and postsurgical radiotherapy for earlobe keloid. Methods Forty patients were randomly divided into two groups, 20 patients per group. The patients in the treatment group were given one intralesional injection of triamcinolone acetonide and betamethasone （diprospan） 2 and 1 months, respectively, prior to operation to induce keloid atrophy. Afterward keloids were removed by core excision. Some keloid skin was used to repair the surgical wound. 18 hours after surgery, lesions were exposed to the electron beam at a dose of 400cGy once daily for 4 days for a total of 1 600cGy. Patients received no preoperative injection served as controls. 40 patients were followed up for 6 - 30 months. Results Eighteen patients were cured and 2 were improved in treatment group. In the control group, 11 patients were cured and 7 were improved. And 1 patient relapsed. The therapeutic efficacy was significantly different between the two groups （Х^2 = 6. 467, P = 0. 039 〈 0. 05 ）. No complications such as skin atrophy or malignant tumor occurred during the follow-up period. Conclusion Combination of preoperative injection, core resection and postsurgical radiotherapy are effective and safe for earlobe keloids.