王春贵 张宝林

[摘要]目的：探讨不同临床分级耳廓瘢痕疙瘩切除术后联合放射治疗与联合博来霉素注射治疗的疗效差异。方法：采用Sawada量表对纳入的156例耳廓瘢痕疙瘩患者进行分级，随机分为单纯手术切除组、手术切除联合放疗组、手术切除联合博来霉素注射组，治疗后随访1年，依据Darzi的瘢痕疙瘩疗效标准判断疗效，并进行统计学分析。结果：对于本研究纳入的所有患者，手术切除联合放疗的有效率为90.4%，手术切除联合博来霉素注射的有效率为83.7%，单纯手术切除的有效率为59.6%；手术组疗效明显低于联合放疗组及联合博来霉素注射组（P<0.01）；而联合放疗组与联合博来霉素注射组相比，疗效比较差异无统计学意义（P>0.05）。对于轻度、重度耳廓瘢痕疙瘩患者，经组间χ2检验，手术组与其他两组疗效比较，差异无统计学意义（P>0.05）；对于中度的耳廓瘢痕疙瘩患者，经组间χ2检验，手术组疗效明显低于其他两组（P<0.01）。结论：在耳廓瘢痕疙瘩治疗中，单纯手术切除疗效较差，对于中度的耳廓瘢痕疙瘩患者，手术切除联合放射治疗与手术切除联合博来霉素注射治療总体满意，可以根据具体情况个性化使用。

[关键词]耳廓；瘢痕疙瘩；Sawada（1990）量表；放射治疗；博来霉素注射治疗

[中图分类号]R619+.6 [文献标志码]A [文章编号]1008-6455（2018）06-0071-04

Abstract： Objecctive To investigate the difference of therapeutic effect between combined radiotherapy and bolamycin injection after different clinical stages of auricle keloid resection. Methods Sawada scale in 156 cases of keloid patients for classification of auricle， were randomly divided into simple surgical excision group， surgical resection combined radiotherapy group， the surgical removal of the joint bleomycin injection group， followed up for 1 year， according to the standard judging curative effect Darzi keloid curative effect， and statistical analysis. Results For all patients included in this study， the effective rate of surgical resection combined with radiotherapy was 90.4%， that of surgical resection combined with bleomycin injection was 83.7%， and that of surgical resection alone was 59.6%.The efficacy of operation group was significantly lower than that of radiotherapy group and borai group （P<0.01）.The difference in curative effect between the radiotherapy group and the borai group was not statistically significant （P>0.05）. For patients with mild and severe auricular keloid， there was no statistically significant difference between the surgical group and the other two groups （P>0.05）.For patients with moderate auricular keloid， the efficacy of the surgical group was significantly lower than that of the other two groups （P>0.01）. Conclusion In keloid treatment of auricle， simple surgical removal of the curative effect is poor， for moderate auricle keloids， surgical removal of combined radiotherapy and surgery with bleomycin injection therapy overall satisfaction， can be used according to the specific situation personalized.

Key words： ear； keloid； sawada（1990） keloid score scale； radiotherapy； intralesional bleomycin injection

耳廓瘢痕疙瘩多由消毒不严格的穿耳洞感染或意外受伤引起，除具有瘢痕疙瘩的特点外，还严重影响患者的面部容貌和心理健康。由于瘢痕疙瘩发病机制尚不清楚，目前尚未建立统一规范的治疗模式，为了进一步提高耳廓瘢痕疙瘩的临床疗效，降低其复发率，2013年1月-2016年12月，笔者科室对156例耳部瘢痕疙瘩患者随机进行单纯手术切除、手术切除联合放疗和手术切除联合博来霉素注射三种不同方法进行治疗并比较疗效，现将结果报道如下。