超脉冲CO_(2)激光联合曲安奈德注射治疗对耳廓瘢痕疙瘩VSS评分及复发情况的影响

The VSS Score of Ultra-pulse CO_(2) Laser Combined with Triamcinolone Acetonide Injection on Patients with Auricular Keloids and the Effect of Recurrence About It

目的:从临床疗效、安全性、复发情况等多方面探讨超脉冲CO_(2)激光联合曲安奈德注射治疗耳廓瘢痕疙瘩的综合效果。方法:选取2016年10月-2019年10月笔者医院128例耳廓瘢痕疙瘩患者,采用Sawada量表进行分级,随机分为联合组(超脉冲CO_(2)激光配合曲安奈德注射治疗,n=43)、激光组(超脉冲CO_(2)激光,n=43)、药物组(曲安奈德注射,n=42)。对比3组临床疗效、温哥华瘢痕量表(VSS)评分、并发症发生率及累计复发率,并对比不同病情程度患者疗效。结果:三组整体疗效与安全性:联合组、激光组总有效率分别为90.70%(39/43)、76.74%(33/43),均高于药物组59.52%(25/42)(P<0.05),3组并发症发生率无明显差异(P>0.05)。不同病情程度临床疗效:轻度、重度患者中,3组临床疗效差异无统计学意义(P>0.05),中度患者中,联合组、激光组总有效率分别为89.47%(17/19)、78.26%(18/23),均高于药物组45.45%(10/22,P<0.05);疗程结束后、治疗后3个月,三组VSS量表各项评分及总分均为联合组<激光组<药物组,差异有统计学意义(P<0.05);随访12个月,联合组累及复发率为7.14%(3/42),低于药物组27.50%(11/40,P<0.05),但与激光组17.07%(7/41)比较无明显差异(P>0.05)。结论:超脉冲CO_(2)激光配合曲安奈德注射治疗耳廓瘢痕疙瘩的临床疗效显著,可有效促进患者瘢痕减退,同时减少复发,是安全可靠的临床治疗方案,尤其对于中、重度患者,联合治疗十分必要。

Objective To explore the comprehensive effects of ultra-pulse CO_(2)laser combined with triamcinolone acetonide injection in the treatment of auricular keloids from various aspects such as clinical efficacy,safety,and recurrence.Methods A total of 128 patients with auricular keloids in our hospital from October 2016 to October 2019 were selected and graded using the Sawada scale.They were randomly divided into combination group(ultra-pulse CO_(2)laser combined with triamcinolone acetonide injection therapy,n=43),laser group(ultra-pulse CO_(2)laser,n=43),drug group(triamcinolone acetonide injection,n=42).The clinical efficacy,Vancouver scar scale(VSS)score,complication rate and cumulative recurrence rate of the three groups were compared,and the efficacy of patients with different degrees of disease was compared.Results the total effective rate of the combined group and the laser group were 90.70%(39/43)and 76.74%(33/43)respectively,which were higher than the drug group 59.52%(25/42,P<0.05),there was no significant difference in the incidence of complications between the 3 groups(P>0.05).In mild and severe patients,the clinical efficacy of the three groups was not statistically different(P>0.05).In moderate patients,the total effective rate of the combination group and the laser group was 89.47%(17/19),78.26%(18/23),all higher than the drug group 45.45%(10/22,P<0.05).After the course of treatment and 3 months after treatment,the scores and total scores of the three groups of VSS scales were all in the combined group0.05).Conclusion Ultra-pulse CO_(2)laser combined with triamcinolone acetonide injection has a significant clinical effect on auricular keloids.It can effectively promote the reduction of scars in patients and reduce recurrence.It is a safe and reliable clinical treatment plan,especially for moderate and severe patients,combined therapy is very necessary.