贴麻后火针剥除术治疗寻常疣:多中心随机对照研究

Fire needling stripping after local anesthesia for verruca vulgaris: a multi-center randomized controlled trial

目的:比较贴麻后火针剥除术、单纯火针与液氮冷冻治疗寻常疣的临床疗效。方法:将900例寻常疣患者随机分为火针剥除术组(300例,脱落2例)、火针组(300例,脱落4例)和液氮冷冻组(300例,脱落5例)。火针剥除术组采用复方利多卡因乳膏贴麻处理后行火针治疗,并剥除疣体坏死组织;火针组仅行火针治疗,不行贴麻及剥除术;液氮冷冻组采用液氮冷冻法治疗,3组均每周治疗1次,共治疗3周。观察3组患者治疗前后皮损(数目、大小、厚度、颜色、瘙痒、同形反应)评分及外周血T淋巴细胞(+3CD、+4CD、+8CD、+4CD/+8CD)水平,记录3组试验过程中的不良反应,并于治疗后5周随访时评定临床疗效。结果:与治疗前比较,3组患者治疗后各项皮损评分均降低(P<0.05),外周血T淋巴细胞水平均上升(P<0.05)。治疗后火针剥除术组各项皮损评分均低于火针组及液氮冷冻组(P<0.05),T淋巴细胞水平均高于火针组及液氮冷冻组(P<0.05);液氮冷冻组各项皮损评分均低于火针组(P<0.05)。随访时火针剥除术组总有效率为88.6%(264/298),高于火针组的81.4%(241/296)及液氮冷冻组的81.4%(240/295,P<0.05)。液氮冷冻组感染、灼痛及瘢痕不良反应发生例数高于火针剥除术组及火针组(P<0.05)。结论:贴麻后火针剥除术可有效治疗寻常疣,改善患者皮损情况及免疫功能,其疗效优于单纯火针及液氮冷冻。

Objective To compare the clinical therapeutic effect of fire needling stripping after local anesthesia, simple fire needling and liquid nitrogen cryotherapy on verruca vulgaris. Methods A total of 900 patients with verruca vulgaris were randomized into a fire needling stripping group(300 cases, 2 cases dropped off), a fire needling group(300 cases, 4 cases dropped off) and a liquid nitrogen cryotherapy group(300 cases, 5 cases dropped off). After local anesthesia of compound lidocaine cream, fire needling therapy was adopted, and the necrotic tissue of verruca was stripped in the fire needling stripping group. Simple fire needling therapy was adopted in the fire needling group, without local anesthesia and stripping. Liquid nitrogen cryotherapy was adopted in the liquid nitrogen cryotherapy group. The treatment was given once a week, and totally 3 weeks were required in the 3 groups. The skin lesion scores of number, area, thickness, color, pruritus, isomorphism and the level of T lymphocyte(+3 CD 、+4 CD 、+8 CD 、+4 CD/+8 CD) in peripheral blood were observed before and after treatment, and the adverse reaction was recorded in the 3 groups. Five weeks after treatment, the therapeutic effect was evaluated. Results Compared before treatment, the skin lesion scores were decreased(P<0.05), the levels of T lymphocyte in peripheral blood were increased in the 3 groups(P<0.05). After treatment, all the items of the skin lesion score in the fire needling stripping group were lower than those in the fire needling group and the liquid nitrogen cryotherapy group(P<0.05), the levels of T lymphocyte in peripheral blood were higher than those in the fire needling group and the liquid nitrogen cryotherapy group(P<0.05);all the items of the skin lesion score in the liquid nitrogen cryotherapy group were lower than those in the fire needling group(P<0.05). At the follow-up, the total effective rate was 88.6%(264/298) in the fire needling stripping group, which was superior to 81.4%(241/296) in the fire needling group and 81.4%(240/295) in the liquid nitrogen cryotherapy group(P<0.05). The cases of infection, causalgia and cicatrix in the liquid nitrogen cryotherapy group were more than those in the fire needling stripping group and the fire needling group(P<0.05). Conclusion Fire needling stripping after local anesthesia can effectively treat the verruca vulgaris, improve the skin lesion and immunity, its therapeutic effect is superior to simple fire needling and liquid nitrogen cryotherapy.