^(32)P敷贴+曲安奈德序贯治疗皮肤瘢痕疙瘩近期疗效及其VTIQ评估的临床研究

A calinical study on the short⁃term efficacy of^(32)P brachytherapy combined with triamcinolone acetonide sequential therapy for skin keloids and VTIQ evaluation application

目的:探讨^(32)P敷贴近距离放疗+瘤体内注射曲安奈德混合液序贯综合治疗皮肤瘢痕疙瘩的近期疗效及声触诊组织成像定量技术(VTIQ)对其疗效评估的初步临床应用。方法:收集2022年6月至2023年1月对在本院核医学门诊就诊的23例皮肤瘢痕疙瘩患者(观察组),采用^(32)P敷贴近距离放疗+瘤体内注射曲安奈德混合液序贯综合方法进行治疗,治疗前、后行改良法温哥华瘢痕量表(VSS)评分,同时对病灶进行声触诊组织成像定量技术(VTIQ)测定剪切波速度(SWV,m/s),用以评估其近期疗效;收集本院核医学门诊2020年6月至2023年1月仅行^(32)P敷贴近距离放疗的共29例皮肤瘢痕疙瘩患者作为对照组,比较两组疗效。结果:(1)对23例观察组患者的34个病灶共完成了102次注射和68次^(32)P敷贴近距离放疗,总有效率(治愈+显效)为79.41%(27/34),对照组29例患者的42个病灶共进行了173次^(32)P敷贴近距离放疗,总有效率为80.95%(34/42),两组总有效率差异无统计学意义(χ^(2)=0.028,P=0.867);观察组的每病灶^(32)P治疗次数(次数/病灶)和总疗程(d)较对照组显著减少[2.00(2.00,2.00)比4.00(3.25,5.00);66.00(63.25,72.00)比169.0(132.2,194.0),P<0.01)]。(2)观察组治疗后SWVmax(m/s)和SWVmean(m/s)皆较治疗前显著下降(5.79±3.05比6.75±3.80,4.68±1.92比5.35±2.38,P<0.05),治疗后改良法VSS评分(分)较治疗前减少(9.04±1.85比11.03±2.33,P<0.05),治疗前SWVmean与改良法VSS评分呈一定程度的相关性(r=0.44,P<0.05)。结论:^(32)P敷贴近距离放疗+瘤体内注射曲安奈德混合液序贯治疗皮肤瘢痕疙瘩的近期疗效满意,与单独^(32)P敷贴相比,在不降低疗效的同时显著减少了^(32)P敷贴治疗次数和缩短了总疗程;声触诊组织成像定量技术(VTIQ)可望为早期疗效评估提供敏感、客观的定量指标。

Objective:To assess the short term efficacy of^(32)P brachytherapy combined with intralesional triamcinolone acetonide mixture injection in the treatment of skin keloids and the preliminary application value of virtual touch tissue imaging quantification(VTIQ).Methods:A total of 34 lesions in 23 patients with skin keloids who attended our Nuclear Medicine Clinic from June 2022 to 2023 January were treated with^(32)P brachytherapy+intralesional triamcinolone acetonide mixture injection as observation group,while 42 lesions in 29 patients of control group treated with only^(32)P brachytherapy from June 2020 to 2023 January.The modified Vancouver Score Scale(VSS)was performed before and after treatment.The shear wave velocity(SWV,m/s)was measured by the VTIQ to assess the shortterm efficacy.Results:(1)102 times of intralesional triamcinolone acetonide mixture injections and 68 times of^(32)P application brachytherapy were completed in experimental group,and 173 times of^(32)P application in control group.The total shortterm effective rates(effective and cured)were 79.41%and 80.95%(χ^(2)=0.028,P=0.867)in observation group and control group respectively.The times and duration of treatment in the experimental group were significantly less than those of the control group[2.00(2.00,2.00)vs 4.00(3.25,5.00),66.00(63.25,72.00)vs 169.0(132.2,194.0),P<0.01).(2)In observation group,the SWVmax(m/s)and SWVmean(m/s)after treatment were significantly lower than those of before treatment(5.79±3.05 vs 6.75±3.80,4.68±1.92 vs 5.35±2.38,P<0.05),the modified VSS score after treatment was lower than before(9.04±1.85 vs 11.03±2.33,P<0.01),there was a certain correlation between SWVmean and the modified VSS score before treatment(r=0.44,P<0.05).Conclusion:The shortterm effect of sequential treatment in skin keloids with^(32)P brachytherapy combined with intralesional injection of triamcinolone acetonide mixture is satisfactory.Compared with^(32)P application alone,it significantly reduced the times of treatments and shortened duration without reducing the efficacy.VTIQ may be a sensitive and objective method to evaluate the therapeutic effect.