A型肉毒毒素注射预防面部创伤或术后增生性瘢痕:有效性及安全性的系统评价

Botulinum toxin A injection in the prevention of facial trauma or postoperative hypertrophic scar: a systemic review of effectiveness and safety

背景:面部瘢痕主要来源于创伤或术后,非常影响容貌,皮肤科及整形科医生尝试了许多方法来改善瘢痕的外观,A型肉毒毒素局部注射在临床上已有较多的应用,但疗效及安全性颇有争议,需要对其有效性及安全性进行评价。目的:采用Meta分析的方法对A型肉毒毒素局部注射预防面部创伤后及手术后增生性瘢痕的有效性及安全性进行评价。方法:计算机检索截至2019年11月的PubMed、EMbase、the Cochrane library、中国知网(CNKI)、中国生物医学文献服务系统、万方数据库、维普中文科技期刊全文数据库中关于A型肉毒素预防面部瘢痕的随机对照试验,手工检索补充不全资料,经2名医生筛选纳入文献并进行文献评价,最后纳入11个随机对照临床试验,试验组注射A型肉毒毒素;对照组注射生理盐水或空白对照。部分资料采用Revman 5.3软件进行Meta分析,不能用软件分析的资料采用描述性分析。结果与结论:①纳入11个随机对照临床试验,共436例患者518个术后切口;结果显示,A型肉毒毒素注射在改善温哥华量表评分、目测类比评分、瘢痕宽度方面优于对照组,差异有显著性(WMD=-1.61,95%CI=-2.06至-0.26,P=0.02;WMD=1.7,95%CI=0.38-3.02,P=0.01;WMD=-0.17,95%CI=-0.22至-0.12,P<0.0001);其暂时的不良事件发生率高于对照组(χ^2=8.335,P=0.004),无严重不良反应发生;②目前证据显示A型肉毒毒素注射与空白对照组相比,能减小术后瘢痕宽度,改善温哥华量表评分、目测类比评分结果,但应在术前术后做充分沟通解释工作,并事先做好应对各种不良反应的措施。

BACKGROUND:Facial scars are mainly caused by trauma or surgery,which greatly affect the appearance.Dermatologists and plastic surgeons have tried many ways to change the appearance of scars.Botulinum toxin A injection is widely used in clinical practice for prevention of scars,but the efficacy and safety are not proved.OBJECTIVE:To evaluate the effectiveness and safety of botulinum toxin A injection in the prevention of facial trauma or postoperative hypertrophic scar.METHODS:PubMed,EMbase,the Cochrane library,CNKI,CBM,WanFang,and VIP were searched for randomized controlled trials regarding botulinum toxin A injection in the prevention of facial scars.Manual retrieval was done for supplement of incomplete data.Two doctors were responsible for literature screen and evaluation.Finally,11 randomized controlled clinical trials were included.The experimental group was injected with botulinum toxin A,and the control group was given saline or nothing.Part of the data was analyzed using Revman 5.3 software for meta-analysis,and the data that could not be analyzed using software were subjected to a descriptive analysis.RESULTS AND CONCLUSION:Eleven randomized controlled trials were included,involving 436 patients with 518 wounds.Meta-analyses showed that Vancouver scar scale score,visual analogue scale score and width of scars in the botulinum toxin A group were significantly better than those in the control group(weighted mean difference(WMD)=-1.61,95%confidence interval(CI)=-2.06 to-0.26,P=0.02;WMD=1.7,95%CI=0.38 to 3.02,P=0.01;WMD=-0.17,95%CI=-0.22 to-0.12,P<0.0001).Incidence of adverse reactions of botulinum toxin A group was higher than that in the control group(χ^2=8.335,P=0.004),but they were all slight and easy to release.There were no serious adverse events in both groups.It seems that botulinum toxin A injection can reduce the width of scars,improve Vancouver scale and visual analogue scale scores.However,it is suggested to make clear communication before and after the operation and take measures to deal with various adverse reactions in advance.