瘢痕注射联合手术切除激光治疗面部增生性瘢痕疗效及对VSS评分和瘙痒评分的影响

Efficacy of Intralesional Injection Combined with Surgical Excision and Laser Therapy in the Treatment of Facial Hyperplastic Scarring and the Influence on VSS Score and Pruritus Score

目的:研究瘢痕注射联合手术切除、激光治疗面部增生性瘢痕对VSS评分和瘙痒评分的影响。方法:选取2019年1月至2021年1月于西京医院整形科就诊的面部增生性瘢痕患者153例,使用随机数字表经简单随机分为A、B、C三组,每组51例;A组采用手术切除的治疗方法,B组采用瘢痕注射联合手术切除的治疗方法,C组采用瘢痕注射联合手术切除、激光的治疗方法;分别于患者治疗前和最后一次治疗后3个月复诊时比较临床疗效、温哥华瘢痕量表评分(VSS)评分、瘙痒和疼痛评分,不良反应。结果:三组疗效等级、总有效率比较差异有统计学意义(H=22.236、P≤0.001,χ^(2)=9.590、P=0.008),C组临床痊愈比例、总有效率均显著高于A组、B组(P<0.05),但A组、B组临床痊愈比例及总有效率比较差异无统计学意义(P>0.05);治疗前三组VSS量表瘢痕的厚度、瘢痕的色泽、瘢痕的血管分布、瘢痕的柔韧度评分及总分比较无差异(P>0.05),三组治疗后瘢痕的厚度色泽、血管分布、柔韧度的评分较治疗前均显著下降,其中C组治疗后瘢痕的厚度、瘢痕的色泽、瘢痕的血管分布、瘢痕的柔韧度的评分及总分显著低于A组、B组(P<0.05);C组T1、T2时间VSS量表瘢痕的厚度、瘢痕的色泽、瘢痕的血管分布、瘢痕的柔韧度评分及总分差值显著高于A组、B组(P<0.05);三组治疗前NRS评分和VAS评分比较无差异(P>0.05)三组治疗后NRS评分和VAS评分较治疗前均显著下降,且C组治疗后上述评分显著低于A组、B组(P<0.05);C组T1、T2时间NRS评分和VAS评分差值显著高于A组、B组(P<0.05);三组患者治疗期间均有不同程度的色素沉着、皮肤萎缩、水疱、皮肤肿胀等不良反应,但均可耐受,其中C组不良反应总发生率显著低于A组、B组(P<0.05)。结论:瘢痕注射联合手术切除、激光治疗能有效治疗面部增生性瘢痕,显著降低VSS评分和瘙痒评分。

Objective:To study the effect of intralesional injection combined with surgical excision and laser therapy for treating facial hyperplastic scarring on the Vancouver Scar Scale(VSS)score and pruritus score.Methods:From January 2019 to January 2021,153 patients with facial hyperplastic scar were treated in the Department of Plastic Surgery,Xijing Hospital.The patients were randomly divided into groups A,B,and C by random number table method,with 51 cases in each group,treated with surgical excision,intralesional injection combined with surgical excision,and intralesional injection combined with surgical excision and laser therapy,respectively.Clinical effects,VSS scores,pruritus and pain scores,and adverse reactions were compared among the groups.Results:There were statistically significant differences in total effective rate among the 3 groups(H=22.236,P≤0.001,χ^(2)=9.590,P=0.008).The clinical recovery rate and total effective rate in group C were significantly higher than those in group A and group B(P<0.05),but there was no statistically significant difference between group A and group B(P>0.05).The scores for scar thickness,color,blood vessel distribution,and flexibility,and the total scores in the 3 groups were similar before treatment(P>0.05).After treatment,the above scores in the 3 groups decreased,and group C had significantly lower scores than group A and group B(P<0.05).The difference values of these scores at T1 and T2 were significantly higher in group C than in group A and group B(P<0.05).The 3 groups had similar NRS scores and VAS scores before treatment(P>0.05).After treatment,the NRS scores and VAS scores in the 3 groups decreased significantly,and group C had significantly lower scores than group A and group B(P<0.05).The difference values of NRS scores and VAS scores at T1 and T2 were significantly higher in group C than in group A and group B(P<0.05).Adverse reactions were observed in all groups but were tolerable.The total incidence of adverse reactions in group C was significantly lower than that in group A or group B(P<0.05).Conclusion:Intralesional injection combined with surgical excision and laser therapy is effective in the treatment of facial hyperplastic scars,and can significantly reduce the VSS score and pruritus score.