Combined surgical excision and radiation therapy for keloid treatment
Combined surgical excision and radiation therapy for keloid treatment
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DOI：
10.1097/scs.0b013e3180de62a1
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发表时间：
2007-09-01
影响因子：
0.9
通讯作者：
Hirano, Akiyoshi
中科院分区：
文献类型：
--
作者：
Akita, Sadanori;Akino, Kozo;Hirano, Akiyoshi
已经尝试了各种方法来治疗和管理瘢痕疙瘩;然而，在长期随访中几乎没有令人满意的临床证据。此外，有一个发生和复发的解剖位置偏好。通常，局部张力高、皮脂腺多的解剖部位易发病。在一个研究所，对38例瘢痕疙瘩进行了手术切除和术后放疗联合治疗，使用电子束，仅在铅屏蔽下打开10 mm的开口，平均随访4.4 +/- 2.5年（范围，1-9年）。颅面部位包括耳朵（n = 6）、颈部（n = 3）和上唇（n = 1）等10个部位。采用温哥华瘢痕量表和硬度计对瘢痕疙瘩和治疗后瘢痕的硬度进行了临床和客观的测试，该硬度计通常用于螺纹球和橡胶的工业测量。在平均4.4 ± 2.5年的随访中，瘢痕的临床特征在治疗后明显更好，为2.6 +/- 0.5 vs 1.0 +/- 0.6，3.7 +/- 0.7 vs 1.7 +/- 0.7，2.9 +/- 0.4 vs 1.3 +/- 0.5，2.7 ± 0.5对1.3 ± 0.5（瘢痕疙瘩与治疗后瘢痕：色素沉着、柔韧性、高度和血管分布，分别为P < 0.01）。治疗后的硬度读数显著降低，15.2 +/- 3.9对7.7 +/- 2.9（瘢痕疙瘩与治疗后瘢痕，P < 0.01）。总复发率为21.2%，颅面部位无复发。因此，手术切除及术后电子线照射的综合治疗，可有效改善疤痕质量及降低长期追踪的复发率。
Various methods have been attempted for the treatment and management of keloids; however, there is little satisfactory clinical evidence in long-term follow ups. Also, there is a preference for occurrence and recurrence in anatomic location. Usually anatomic locations with higher regional tension and more sebaceous glands are inclined toward pathogenesis. Thirty-eight keloids treated with combined surgical excision and postoperative irradiation, using electron beams with only a 10-mm opening by lead shielding, were investigated at a mean follow up of 4.4 +/- 2.5 years (range, 1-9 years) at a single institute. Ten locations such as the ear (n = 6), neck (n = 3), and upper lip (n = 1) were among the craniofacial locations. The hardness of the keloids and posttreatment scars was clinically and objectively tested with the Vancouver scar scale and a durometer, which is often used for the industrial measurement of thread balls and rubber. At a mean of 4.4 2.5 years of follow up, the clinical characteristics of the scars were significantly better posttreatment as 2.6 +/- 0.5 versus 1.0 +/- 0.6, 3.7 +/- 0.7 versus 1.7 +/- 0.7, 2.9 +/- 0.4 versus 1.3 +/- 0.5, and 2.7 +/- 0.5 versus 1.3 0.5 (keloid scars versus posttreatment scars: pigmentation, pliability, height and vascularity, respectively, P < 0.01). The durometer readings were significantly lower posttreatment, 15.2 +/- 3.9 versus 7.7 +/- 2.9 (keloid scars versus posttreatment scars, P < 0.01.). The recurrence rate was 21.2% overall with none in craniofacial locations. Therefore, the combined treatment of surgical excision and postoperative electron beam irradiation is effective for scar quality and reducing the recurrence rate in long-term follow up.