术后放疗联合局部加压治疗耳部瘢痕疙瘩疗效分析

曹婷 韩文娟 韩莹

[摘要]目的：分析術后放疗联合局部加压治疗耳部瘢痕疙瘩的疗效。方法：选择于笔者医院行手术治疗126例耳部瘢痕疙瘩患者，随机分为加压组、放疗组与放疗+加压组各42例，加压组拆线后以弹力套局部加压，放疗组术后采用浅层X线放疗，放疗+加压组术后先行层X线放疗，拆线后以弹力套局部加压，评价三组患者临床疗效、不良反应情况及治疗满意度。结果：治疗后三组治疗总有效率比较差异无统计学意义（P>0.05）;但放疗组、放疗+加压组治愈率显著高于加压组，差异有统计学意义（P<0.05）;放疗组、放疗+加压组患者治愈率比较差异无统计学意义（P>0.05）。三组患者术后均出现不同程度的瘙痒、疼痛、红肿等不良反应，均未经处理自行消失。放疗组、放疗+加压组患者治疗满意率显著高于加压组（P<0.05），放疗组、放疗+加压组患者治疗满意率比较差异无统计学意义（P>0.05）。结论：术后放疗联合局部加压治疗耳部瘢痕疙瘩安全有效，治愈率及患者治疗满意度均较高，可作为治疗首选。

[关键词]瘢痕疙瘩;手术切除;术后放疗;局部加压治疗;耳部

Abstract： Objective  To analyze the efficacy of postoperative radiotherapy combined with local compression in the treatment of keloids in aural region. Methods  A total of 126 patients with keloids in aural region who underwent surgery in our hospital were enrolled and randomly divided into compression group， radiotherapy group and  radiotherapy + compression group， with 42 cases in each group. Compression group was treated with elastic sleeve partial compression after removing the stitches， and radiotherapy group was given superficial X-ray radiotherapy after surgery， and radiotherapy+compression group was given superficial X-ray radiotherapy and then given elastic sleeve partial compression after removing the stitches. The clinical efficacy， adverse reactions and treatment satisfaction were evaluated in the three groups. Results  After treatment， there was no significant difference in the total effective rate of treatment among the three groups （P>0.05）. But the cure rate in radiotherapy group and radiotherapy+compression group was significantly higher than that in compression group （P<0.05）. There was no significant difference in the cure rate between radiotherapy group and radiotherapy+compression group （P>0.05）. Different degrees of pruritus， pain， redness and other adverse reactions occurred in the three groups after surgery， and all disappeared without treatment. The satisfaction rate of treatment in radiotherapy group and radiotherapy+compression group was significantly higher than that in compression group （P<0.05）， and there was no significant difference in the satisfaction rate of treatment between radiotherapy group and radiotherapy+compression group （P>0.05）. Conclusion  Postoperative radiotherapy combined with local compression is safe and effective in the treatment of keloids in aural region， with the highest cure rate and treatment satisfaction. And it can be used as the first choice for treatment.

Key words： keloid; surgical resection; postoperative radiotherapy; local pressure therapy; ear

瘢痕疙瘩是皮肤创伤愈合过程调节异常的结果，是一种瘢痕组织过度增生形成超过损伤境界的皮肤瘢痕，具有增生能力强、无法自行消退、切除后易复发等特点[1-2]。耳部是瘢痕疙瘩的好发部位之一，多由穿耳洞佩戴饰物刺激或外伤引起，使耳廓变形，还存在瘙痒、疼痛或敏感等症状，可导致功能障碍、影响外貌美观，给患者造成生理与心理的双重痛苦[3]。目前瘢痕疙瘩治疗方法包括手术切除、放疗、局部激素注射、加压治疗等，其中手术可快速清除增生的瘢痕组织，达到美容整复效果，但仍存在极高复发风险，在手术治疗基础上联合应用放疗、局部加压、药物注射等方法以探寻最佳治疗方案是近年研究热点[4-5]。本研……