复发性耳部瘢痕疙瘩的形态特征及疗效观察

Surgical Treatment of Recurrent Auricular Keloids Based on Morphological Features

目的探讨复发性耳部瘢痕疙瘩的形态特点及手术方式的选择,并观察其治疗效果。方法回顾性分析2014年1月至2019年1月暨南大学第二临床医学院(深圳市人民医院)耳鼻咽喉头颈外科所有采用手术治疗的复发性耳部瘢痕疙瘩患者的临床资料,根据瘢痕疙瘩的位置、大小、有无窦道以及表面皮肤是否正常等特征选择不同的手术方式,术后半年每3~4周复诊1次,之后每3个月复诊一次,对有复发倾向者及时补充糖皮质激素局部注射治疗,观察治疗后效果。结果21例复发性耳部瘢痕疙瘩患者随访15~62月,单侧19例,双侧2例。有11例患者(11耳)可见窦道,采用联合窦道完全切除瘢痕组织术,术后耳廓外形都基本恢复正常,且均治愈,治愈率达100%;8例患者(10耳)瘢痕疙瘩体积较大、表面皮肤正常,采用瘢痕疙瘩核心切除术,结果治愈4例(5耳),治愈率50%,有效1例(1耳),总有效率60.0%,复发3例(4耳),复发率40.0%;2例患者(2耳)瘢痕疙瘩表面皮肤异常、瘢痕化,采用瘢痕疙瘩切除及耳后游离皮瓣修复术,结果治愈1例,有效1例,总有效率100%。结论根据复发性耳部瘢痕疙瘩的形态特征采用合理的手术方式能有效提高治疗效果和降低复发率。

Objective To report outcomes of surgical treatment of recurrent auricular keloids based on morphological features.Methods In this retrospective cohort study included 21 patients with recurrent auricular keloids(23 ears)treated at the Second Clinical Medical College of Jinan University(Shenzhen People’s Hospital)from January 2014 to January 2019 using three different surgical approaches chosen based on keloids characteristics(e.g.location,size,presence of fistula and skin normality).Postoperatively,patients were asked followed up every 3-4 weeks for 6 months and then every 3 months for 15-62 months.At the first signs of recurrence,intra-lesion injection of corticosteroids was given.Treatment outcomes were evaluated at the last follow-up.Result Recurrent auricular keloids involved on ear in were 19 cases and both ears in 2 cases.11 cases with keloids were treated with Complete scar resection with fistulectomy was performed in 11 ears,resulting in complete lesion resolution and satisfactory restoration of the auricle in all 11 ears(100%).In 8 patients(10 ears)with large keloids but normal top skin,core resection was used,resulting in complete lesion resolution in 4 cases(5 ears,50%)and improvement in 1 case,with recurrence in the remaining 3 cases(4 ears)(recurrence rate=40.0%),yielding a total effectiveness rate of 60.0%.In the 2 cases with abnormal and scarred skin,Keloidectomy and full thickness retroauricular skin grafting was used with complete resolution in 1 case and improvement in the other case(total effectiveness rate=100%).Conclusion Selection of appropriate surgical approaches based on morphological features of recurrent auricular keloids is an effective way to improve treatment outcomes and reduce recurrence.