核切除局部皮瓣成形术联合浅层X线照射治疗耳廓瘢痕疙瘩

Treatment of auricular keloid with local excision of local flap and shallow X-ray irradiation

目的探讨核切除局部皮瓣成形术联合浅层X线照射治疗耳廓瘢痕疙瘩的疗效。方法耳廓瘢痕疙瘩患者36例(瘢痕42处)采取核切除局部皮瓣成形术联合浅层X线照射治疗(术后24小时开始照射,每天一次,每次5gy,连续三次为一疗程,必要时追加一个疗程),随访患者12月～36月疗效,探讨复发相关因素。结果患者术后皮瓣均成活,切口愈合良好,耳廓外形恢复正常,随访治疗有效率,1年有效率92.56%,2年87.56%,3年76.34%。结论核切除局部皮瓣成形术联合浅层X线照射治疗耳廓瘢痕疙瘩近期中期疗效明显,随着随访时间延长,瘢痕复发率逐年提高,复发因素与局部皮瓣张力较高、伤口感染、再次损伤等不良刺激有关。

Objective To investigate the effect of nuclear excision and local skin flap plasty combined with shallow X-ray irradiation in the treatment of auricular keloid.Method Thirty-six patients with auricular keloid(42 scars)were treated with nuclear excision and local skin flap plasty combined with shallow X-ray irradiation(radiation started 24 hours after operation,5 Gy per day for three consecutive courses of treatment,if necessary,adding a course of treatment).The patients were followed up for 12 to 36 months to explore the related factors of recurrence.Result All the flaps survived,the wound healed well,the shape of auricle returned to normal.The effective rate of follow-up treatment was 92.56%in one year,87.56%in two years and 76.34%in three years.Conclusion The short-term and medium-term curative effect of nuclear excision and local skin flap plasty combined with shallow X-ray irradiation in the treatment of auricular keloid is obvious.With the prolongation of follow-up time,the recurrence rate of scar increases year by year.The recurrence factors are related to the high tension of local skin flap,wound infection,re-injury and other adverse stimuli.