瘢痕内切除后即时放疗治疗瘢痕疙瘩临床研究.doc

瘢痕内切除后即时放疗治疗瘢痕疙瘩临床研究[摘要]目的：探讨瘢痕内切除后即时放疗治疗瘢痕疙瘩的临床疗效。 方法：自2002年2月～2007年6月对我科收治的18例瘢痕疙瘩患者行瘢痕内切除术，术后24h内辅以6MeV高能电子束（β射线）放射治疗，连续照射每天一次连续照射4～6次，照射总剂量15～20Gy。术后平均随访36月。 结果：优良10例（55.6%），显效5例（27.8%），无效3例（16.7%），总有效率83.3%。3例伤口延迟愈合（16.7%），术后出现色素沉着3例（16.7%），毛细血管轻度扩张2例（11.1%），随访期内未发生如皮肤恶性肿瘤等并发症。结论：瘢痕内切除后即时放射治疗，术后复发率低，是治疗瘢痕疙瘩较好的治疗手段。 [关键词]瘢痕疙瘩；放射治疗；瘢痕内切除 [中图分类号]R622 [文献标识码]A [文章编号]1008-6455（2009）01-0005-03 Clinical analysis of keloids with intralesional excision and immediate postoperative adjuvant radiotherapy SHEN Hua,SHEN Zun-li,WANG Yong-chun,HUANG Yi-xiong,ZHANG Zhao-feng,JIA Wan-xin （Department of Plastic Surgery, the First Affiliated Hospital of Shanghai Jiaotong University,Shanghai 200080,China） Abstract:ObjectiveTo evaluate the treatment results of keloids with intralesional excision and immediate postoperative adjuvant radiotherapy in the management of keloids.MethodsEighteen patients with a combined total of 21 keloids were treated with 6 MeV electron beam radiotherapy after surgical intralesional excision of the keloids. All patients received a total dose of 15～20Gy on 4～6 consecutive days beginning the day of surgery. Mean daily fractions of 300～400cGy were administered .The time interval between keloid excision and delivery of first fraction of radiotherapy was less than 24h in all case. The median follow-up was 36months.Results10 cases were noted to have excellent result and 5 cases were good,total effective rate was 83.3% and 3 patients of recurrence was observed during this period, only a few adverse effects such as delayed wound-healing in 3 patients, hypopigmentation was observed in 3 patients (16.7%), and telangiectasias in 2 patients (11.1%). No severe complications or secondary m alignancies were observed.ConclusionsIntralesional excision of keloid and postoperative electron radiotherapy and is well tolerated and very effective in preventing keloid recurrence. Key words：keloid;radiotherapy;intralesional excision 瘢痕疙瘩是由于皮肤对创伤后炎症过度反应所致的