复方倍他米松局部注射联合光动力疗法治疗小型瘢痕疙瘩的临床疗效观察

Clinical effect observation of compound betamethasone local injection combined with photodynamic therapy for small keloids

目的观察复方倍他米松注射液局部注射联合光动力疗法治疗小型瘢痕疙瘩的临床效果。方法选取2021年2月至2023年2月,解放军第943医院烧伤整形科治疗的小型瘢痕疙瘩患者63例,随机分为3组(倍他米松组、光动力组和联合治疗组),每组21例。倍他米松组使用复方倍他米松注射液局部注射,光动力组使用光动力疗法治疗,联合治疗组使用倍他米松局部注射后加用光动力疗法进行联合治疗。3组持续治疗6个月后,比较瘢痕疙瘩形态、瘙痒和疼痛症状、临床效果、不良反应及复发率。结果治疗前,3组患者瘢痕疙瘩形态温哥华量表(VSS)、疼痛和瘙痒视觉模拟评分(VAS)差异均无统计学意义(P>0.05)。治疗后6个月,联合治疗组VSS评分(2.95±0.50)分,低于倍他米松组(6.57±0.75)分和光动力组(6.52±0.75)分;联合治疗组瘙痒VAS评分(2.10±0.99)分、疼痛VAS(1.19±0.81)分,低于倍他米松组瘙痒VAS(4.14±0.79)分、疼痛VAS(3.10±0.63)分和光动力组瘙痒VAS(4.38±0.92)分、疼痛VAS(3.14±0.66)分,上述比较差异具有统计学意义(P<0.05)。治疗后6个月,联合治疗组总有效率95.24%,明显高于倍他米松组61.90%和光动力组57.14%,差异具有统计学意义(χ^(2)=8.867,P=0.012);不良反应率联合治疗组4.76%,低于倍他米松组42.86%和光动力组33.33%,差异具有统计学意义(χ^(2)=8.379,P=0.015);复发率联合治疗组4.76%,低于倍他米松组42.86%和光动力组38.10%,差异具有统计学意义(χ^(2)=8.867,P=0.012)。结论复方倍他米松局部注射联合光动力疗法治疗小型瘢痕疙瘩较单一方法效果明显,可显著改善瘢痕疙瘩形态,减轻疼痛和瘙痒,降低复发率,且安全性较高。

Objective To observe the clinical effect of compound betamethasone injection combined with photodynamic therapy forsmall keloid treatment.Methods 63 patients in the Department of Burns and Surgery of the PLA 943rd Hospital with small keloid treated from February 2021 to February 2023 were randomly divided into three groups(betamethasone group,photodynamic group and combined treatment group),with 21 patients in each group.The betamethasone group received compound betamethasone injection for local injection,the photodynamic group wastreated with photodynamic therapy,and the combined treatment group received betamethasone for local injection followed by combined photodynamic therapy.After 6 months of continuous treatment,the 3 groups will compare the scar morphology,pruritus and pain symptoms,clinical effects,adverse effects and recurrence rate.Results Before treatment,the Vancouver scar scale(VSS)and visual analog scale(VAS)were not statistically different(P>0.05).6 months after treatment,The VSS of the combined treatment group was(2.95±0.50),which was lower than of betamethasone group(6.57±0.75)and photodynamic group(6.52±0.75).Combination treatment group VAS in pruritus(2.10±0.99),pain(1.19±0.81),lower than betamethasone group in pruritus(4.14±0.79),pain(3.10±0.63)and photodynamic group in pruritus(4.38±0.92),pain(3.14±0.66).The above differences were statistically significant(P<0.05).At 6 months after treatment,the overall response rate in the combined treatment group was 95.24%,which was significantly higher than that in the betamethasone group,61.90% and 57.14% in the photodynamic group,Statistically significant difference(χ^(2)=8.867,P=0.012).The adverse reaction rate was 4.76%,which was lower than that in the betamethasone group 42.86% and 33.33% in the photodynamic group(χ^(2)=8.379,P=0.015)The recurrence rate was 4.76%in the combined treatment group,which was lower than that in the betamethasone group 42.86%,and 38.10% in the photodynamic group(χ^(2)=8.867,P=0.012).Conclusion Compound betamethasone local injection combined with photodynamic therapy treats small keloid more effectively than the single method,which can significantly improve keloid morphology,reduce pain and itching,reduce recurrence rate,and have high safety.