耳郭部位的瘢痕疙瘩治疗

Treatment of Auricle Keloid

目的探讨治疗耳郭部位瘢痕疙并维持耳郭形态的方案。方法回顾性分析2018年1月至2019年6月收治的耳郭部位瘢痕疙瘩患者28例。根据瘢痕疙瘩大小和累及部位,在能够维持耳郭形态的前提下,采用"完全切除"或"核心切除"的手术方式;18岁以下患者于术后即刻、2周、4周、6周、8周注射曲安奈德,其余患者分别于术后0(术后当日)、2、4、6 d行放射治疗;术后7~10 d拆线,拆线1周后外用硅酮凝胶或贴片。结果全部患者术后随访5~14个月,平均随访8个月。4例(14.3%)出现复发倾向,早期给予局部曲安奈德注射处理后均得到良好控制;患者对耳郭形态满意,无再次手术、放疗的病例。结论根据患者个体化差异决定手术方案,同时配合积极复诊及辅助治疗,可获得耳郭形态的重塑并维持远期效果。

Objective To explore the surgical method of auricle keloid treatment and auricle shape maintainance.Methods From January 2018 to June 2019,28 patients with auricle keloid were included.According to the size of keloid and the site involved,"complete resection"or"core resection"was adopted on the premise of maintaining auricle morphology.After operation,patients under the age of 18 years were accepted intralesional injection with triamcinolone acetonide 0,2,4,6,8 weeks after surgery,while other patients received radiation therapy 0,2,4,6 days after surgery.The sutures were removed 7-10 days after surgery,and the silicone gel or patch would be used 1 week after suture removing.Results The patients were followed up for 5-14 months,8 months on average,4 patients(14.3%)showed a tendency of recurrence.Their recurrence were well controlled by early triamcinolone acetonide injection.The patients were satisfied with the auricle morphology,and there were no cases of reoperation or re-radiotherapy.Conclusion According to the individual difference of patients,the operation plan can be determined,and at the same time,the shape of auricle can be reconstructed and the long-term effect can be maintained with the active reexamination and auxiliary treatment.