本文來源：《中華整形外科雜志》2021年1月 第37卷 第1期

DOI:10.3760/cma.j.cn114453-20200624-00384

作者單位：1南方醫科大學皮膚病醫院整形美容外科，廣州510091；2南方醫科大學皮膚病醫院檢驗科，廣州510091；3南方醫科大學皮膚病醫院放射科，廣州510091

通信作者：王春梅，Email：chunmei22@hotmail.com

【摘要】 

目的 探討曲安奈德聯合玻璃酸酶注射輔助淺層X線放療，在治療多發性瘢痕疙瘩中的臨床應用價值。

方法 回顧性分析南方醫科大學皮膚病醫院門診2018年3月至2019年10月治療的144例多發性瘢痕疙瘩患者資料，男性89例，女性55例，年齡16～68歲，平均28歲；病程1～20年，平均6年。根據治療方法分為A組65例，采用曲安奈德聯合玻璃酸酶局部注射輔助淺層X線放療；B組79例，采用曲安奈德聯合玻璃酸酶局部注射治療。治療后隨訪6～18個月，對2組患者進行溫哥華瘢痕量表（VSS）評估和有效性評價。采用兩獨立樣本t檢驗及卡方檢驗進行統計分析。

結果 Ａ組治療前VSS評分為（11.9±0.9）分，治療后為（6.5±1.1）分，５１例好轉、１４例顯效，顯效率為21.54%（14/65），不良反應主要表現為一過性色素沉著。Ｂ組治療前VSS評分為（12.1±1.0）分，治療后為（8.3±1.0）分，７４例好轉、２例顯效、３例無效，顯效率為2.63%(2/76)，不良反應主要包括毛細血管擴張、皮膚萎縮等，有部分女性患者出現月經周期異常（3例），毛發增多（2例）。2組患者治療前VSS評分比較差異無統計學意義（t=-1.114，P=0.267），治療后VSS評分比較差異有統計學意義（t=-10.208，P<0.001）。2組顯效率比較差異有統計學意義（χ2=12.450，P<0.001）。

結論 曲安奈德聯合玻璃酸酶注射輔助淺層X線治療多發性瘢痕疙瘩效果理想，不良反應發生率低，是具有臨床應用前景的干預方法。

基金項目：廣東省自然科學基金（2016A030313207）

A study on the efficacy of triamcinolone acetonide combined with hyaluronidase injection and superficial X-ray in the treatment of multiple keloids

Wu Lizhen1, Hou Chenrong1, Xie Zhenmou2, Wang Weijia3, Wang Chunmei1

1Department of Plastic & Cosmetic Surgery, Southern Medical University Dermatology Hospital, Guangzhou 510091, China; 2Department of Clinical Laboratory, Southern Medical University Dermatology Hospital, Guangzhou 510091, China;3Department of Radiology, Southern Medical University Dermatology Hospital, Guangzhou 510091, China

Corresponding author: Wang Chunmei, Email:chunmei22@hotmail.com

【Abstract】

Objective To investigate the clinical application value of triamcinolone acetonide combined with hyaluronidase injection and shallow X-ray in the treatment of multiple keloids. 

Methods From March 2018 to October 2019, 144 cases of multiple keloids in outpatient department were analyzed retrospectively. There were 89 males and 55 females, aged from 16 to 68, with an average age of 28 years. The average duration was 6 years(ranged from 1 to 20 years). Among them, 65 cases were treated with superficial X-ray radiotherapy combined with local injection (group A) and 79 cases were treated only with local injection (group B). The Vancouver Scar Scale (VSS), t\|test and chi-square test were used to evaluate the validity of the two groups. 

 The patients were followed up for 6-18 months. 

ResultsIn group A, the VSS was changed from 11.9±0.9 to 6.5±1.1. 51 cases were improved and 14 cases showed obviously effective. The significant effect rate was 21.54%（14/65）. The main side effect of group A was transient pigmentation. In group B, the VSS was changed varied from 12.1±1.0 to 8.3±1.0. 74 cases were improved, 2 cases were markedly effective, but 3 cases were ineffective. The significant effective rate was 2.63%(2/76). The side effects include telangiectasia, skin atrophy, even arousing abnormal menstrual cycles and hair growth in several females. The comparability between the two groups was confirmed by the VSS scores before treatment(t=-1.114,P=0.267). Then, the difference of VSS scores became significant after treatment(t=-10.208, P<0.001), the same to apparent efficiency (χ2=12.450, P<0.001). 

Conclusions Triamcinolone acetonide combined with hyaluronidase injection and shallow X-ray radiation therapy for multiple keloids has ideal curative effect and low incidence of adverse reactions, which is a prospected clinical method.

【Key words】Triamcinolone acetonide; Hyaluronoglucosaminidase; Keloids; Superficial X\|ray

Fund program: National Natural Science Foundation of Guangdong Province（2016A030313207）

Disclosure of Conflicts of Interest: The authors have no financial interest to declare in relation to the content of this article.

Ethical Approval: This study was conducted in accordance with the Helsinki Declaration.