难治性瘢痕疙瘩术后电子线照射客观临床结果及患者满意度研究

Objective clinical outcome and patient satisfaction in self-assessment of postoperative electronic radiation for refractory keloids

目的分析放疗在难治性瘢痕疙瘩中的作用,评估患者对疗效的满意度,并与客观结果进行比较。方法2013—2018年间北京协和医院收治的144例难治性瘢痕疙瘩患者,290处瘢痕疙瘩,15~81岁(中位数28岁)。全部瘢痕疙瘩均在术后24h接受电子线照射。放疗采用5~7MeV电子线源皮距照射技术。照射剂量16~18 Gy分2次,1次/周。随访35~91个月(中位数48个月)。参考患者与观察者瘢痕疙瘩评估量表评估满意度。Cox模型多因素分析。结果290处瘢痕疙瘩中52处(17.9%)治疗后复发。复发距放疗结束时间3~42个月(中位数12个月)。主要不良反应为色素沉着、切口扩展。单因素分析提示局部切口颜色深于皮肤色、瘙痒、疼痛、年轻与复发相关,多因素分析提示局部切口颜色深于皮肤色及疼痛程度为瘢痕疙瘩复发的独立预后因素。复发、照射区色素沉着、切口扩展是患者不满意的主要原因。结论电子线治疗难治性瘢痕疙瘩可取得满意疗效,局部切口颜色深于皮肤色及疼痛程度为瘢痕疙瘩复发独立预后因素。患者主观评估并不总是符合患者的临床检查和复发状况。

Objective Objective To investigate the role of radiotherapy in the treatment of refractory keloids,evaluate the self-assessment degree of satisfaction of patients and compare with the objective outcomes.Methods A total of 144 patients(290 lesions)with refractory keloids admitted to Peking Union Medical College Hospital from 2013 to 2018 were included in this study.The median age was 28 years old(range:15-81 years old).All lesions were subjected to electronic radiation at postoperative 24h.The regime of 5 to 7MeV electron beam radiation therapy was adopted.The total dose was ranged from 16 to 18 Gy/2f(at 1-week interval).The median follow-up time was 48 months(range:35-91 months).Patient and Observer Scar Assessment Scale(POSAS)was used to evaluate the degree of satisfaction.Multivariate analysis was performed by Cox proportional hazards model.Results Among 290 keloids,52 keloids(17.9%)relapsed in 3 to 42 months from the end of radiotherapy(median 12 months).The main side effects were hyperpigmentation and local incisional extension.Univariate analysis showed that local incisional color darker than skin,pruritus,pain and young age were associated with recurrence.Multivariate analysis indicated that local incisional color darker than skin and pain were the independent prognostic factors for scar recurrence.Recurrence,hyperpigmentation and local incisional extension were the main reasons for patients′dissatisfaction.Conclusions Postoperative electronic radiation can achieve satisfactory efficacy in the treatment of refractory keloids.Local incisional color darker than skin and pain are the independent prognostic factors of keloid recurrence.Patient self-assessment results are not fully consistent with the objective clinical outcomes and recurrence status.