难治性瘢痕疙瘩术后电子线放射治疗疗效分析及患者满意度研究

Efficacy analysis and patient satisfaction study of postoperative electron beam radiotherapy for refractory keloid

目的探索难治性瘢痕疙瘩术后电子线放疗的治疗效果、复发的影响因素,评估患者对疗效的满意度。方法共纳入2019~2021年收治的难治性瘢痕疙瘩患者37例(共40处),全部瘢痕疙瘩均在术后接受电子线照射,放疗采用6~9 MeV电子线源皮距照射技术,照射剂量20 Gy/5 Gy/4 F。收集患者一般临床资料,术后定期随访,观察结束向所有患者发放调查问卷,评估患者满意度,分析患者的治疗效果及不良反应情况,使用Logistic回归对影响复发的因素进行分析。结果40处瘢痕中有4处(10%)治疗后复发,有5处(12.5%)治疗后无明显变化,治疗有效率77.5%。主要不良反应为皮肤色素沉着、切口扩展。单因素分析显示:性别、既往史、手术至放疗的时间间隔、是否连续照射、血浆纤维蛋白原含量与复发相关。多因素分析显示:手术至放疗的时间间隔超过24 h是复发的独立危险因素,连续照射是独立保护因素。复发、切口扩展及色素沉着是患者不满意的主要原因。结论手术联合电子线放疗是治疗难治性瘢痕疙瘩的有效手段,手术至放疗时间、能否连续照射是影响瘢痕疙瘩复发的独立预后因素,患者主观评价并不完全符合其临床表现及检查。

Objective To explore the therapeutic effect of postoperative electron beam radiotherapy for intractable keloid and the influencing factors of recurrence,and to evaluate patients’satisfaction with the therapeutic effect.Methods From 2019 to 2021,37 patients with refractory keloids,including 40 keloids,were treated with electron beam irradiation after operation.The radiotherapy was conducted with 6-9 MeV electron beam irradiation from the skin,and the irradiation dose was 20 Gy/5 Gy/4 F.The general clinical data of patients were collected and followed up regularly after operation.After the observation,questionnaires were distributed to all patients to evaluate their satisfaction.The treatment effect and adverse reactions of patients were analyzed,and the factors affecting recurrence were analyzed by Logistic regression.Results Among the 40 scars,4 cases(10%)recurred after treatment,and 5 cases(12.5%)had no obvious change after treatment,and the effective rate was 77.5%.The main adverse reactions were skin pigmentation and incision expansion.Univariate analysis showed that sex,past history,time interval from operation to radiotherapy,continuous irradiation and plasma fibrinogen content were related to recurrence.Multivariate analysis showed that the interval between operation and radiotherapy for more than 24 hours was an independent risk factor for recurrence,and continuous irradiation was an independent protective factor.Recurrence,incision expansion and pigmentation were the main reasons for patients’dissatisfaction.Conclusion Surgery combined with electron beam radiotherapy is an effective method for the treatment of refractory keloid.The time from operation to radiotherapy and continuous irradiation are independent prognostic factors affecting the recurrence of keloid,and the subjective evaluation of patients is not completely consistent with their clinical manifestations and examinations.