基于减张缝合为主的综合疗法治疗胸部瘢痕疙瘩的近远期预后

Short-term and long-term prognosis of combined therapy based on tension-reduced suture for chest keloids

目的探讨基于减张缝合为主的综合疗法治疗胸部瘢痕疙瘩的近远期预后。方法采用前瞻性、随机对照研究方法,选择在2012年2月至2017年6月期间就诊的90例胸部瘢痕疙瘩患者当做研究对象,所有患者以随机数字表法为根据均分为观察组与对照组。以减张缝合方式治疗观察组患者,放疗结束后外用硅酮凝胶类药物8个月;对照组给予传统缝合治疗,术后仅给予放疗。结果所有患者都切口愈合良好,切口甲级愈合,无严重并发症发生。观察组治疗后1个月的总有效率为97.8%,对照组为86.7%,观察组比对照组明显要高(P<0.05)。观察组治疗后8个月的疤痕硬度为(0.62±0.22)N/mm^3,对照组为(0.70±0.14)N/mm^3,观察组比对照组明显要低(P<0.05),都低于治疗前的(0.77±0.22)N/mm^3和(0.78±0.21)N/mm^3(P<0.05)。观察组与对照组治疗后8个月的患者和观察者瘢痕评估量表评分(POSAS)都比治疗前明显要低(P<0.05),且观察组治疗后的评分比对照组明显要低(P<0.05)。结论基于减张缝合为主的综合疗法治疗胸部瘢痕疙瘩安全性佳,能提高近期治疗效果,在远期疗效中能降低瘢痕硬度,改善瘢痕状况。

Objective To investigate the short- and long-term prognosis of combined therapy based on tension-reduced suture for chest keloids. Methods A total of 90 patients with chest keloids who were treated from February 2012 to June 2017 were selected and divided into study group and control group randomly （45 cases each）. The study group patients were treated with tension-reduced suture and silicone gel for external use for 8 months after the radiation therapy. The control group was treated with traditional suture and postoperative radiotherapy. Results All the patients healed well and the incisions healed at first grade without serious complication. The total effective rate in study group was significant higher than that in control group at 1 month after the operation （97.8% vs 86. 7% ,P 〈0. 05）. The keloid hardness in study group was lower than that in control group at 8 months after the treatment [ （0. 62 ±0. 22） N/mm3 vs （0. 70 ±0. 14） N/ramz , P 〈 0. 05 ], and both of them was lower than that before the treatment [ （0. 62 ± 0. 22） N/ram3 vs （0. 77 ± 0. 22） N/ram3 , （0. 70 ± 0. 14） N/mm3 vs （0. 78 ± 0. 21 ） N/ram3 , all P 〈 0. 05 ]. Patient and observer scar assessment scoring （POSAS） in both group was decreased after the treatment, and the POSAS in study group was lower than that in control group after the treatment （ all P 〈 0. 05 ）. Conclusion short- and long-term prognosis of combined therapy based on tension-reduced suture is safe and effective in the treatment of chest keloid. It can improve the therapeutic effect in the near future, and it also can reduce the hardness of scar and improve the condition of scar in the long term.