古芝燕 陈晓娟 李俊茹

[摘要]目的：探究不同濃度曲安奈德局部注射联合手术切除治疗面部瘢痕疙瘩的临床效果。方法：选择2017年3月-2018年4月在笔者医院就诊的90例面部瘢痕疙瘩患者，经过随机数表法分为对照组（n=45）和观察组（n=45）。对照组采用低浓度曲安奈德（40mg/3ml）局部注射联合手术切除治疗，观察组采用高浓度曲安奈德（40mg/1.5ml）局部注射联合手术切除治疗。对两组治疗效果、抑郁自评量表（Self-rating depression scale， SDS）评分、焦虑自评量表（Self-rating anxiety scale， SAS）评分、温哥华瘢痕量表（Vancouver scar scale ，VSS）评分、不良反应情况及治疗满意度进行比较。结果：观察组治疗有效率（95.56%）明显高于对照组（66.67%），差异有统计学意义（P<0.05）。治疗后，两组SDS、SAS及VVS评分明显降低，且观察组明显低于对照组，差异有统计学意义（P<0.05）。治疗后，对照组不良反应发生率为2.22%，观察组不良反应发生率为4.44%，两组比较差异无统计学意义（χ2=4.939，P>0.05）。观察组治疗满意度（95.56%）明显高于对照组（80.00%），差异有统计学意义（P<0.05）。结论：高浓度曲安奈德局部注射联合手术切除具有较好的治疗效果，可以显著降低患者瘢痕评分，降低不良反应发生率，治疗满意度高。

[关键词]瘢痕疙瘩;面部;曲安奈德注射液：手术切除;温哥华瘢痕量表;抑郁自评量表;焦虑自评量表;不良反应

[中图分类号]R619+.6    [文献标志码]A    [文章编号]1008-6455（2019）07-0079-03

Local Injection of Triamcinolone Acetonide with Different Concentrations Combined with Surgical Resection for Facial Keloid

GU Zhi-yan1，CHEN Xiao-juan1，LI Jun-ru2

（1.Department of Aesthetic and Plastic Burn Surgery，West China Hospital，Sichuan University，Chengdu 610041，Sichuan，China;

2.Outpatient Department of West China Hospital，Sichuan University，Chengdu 610041，Sichuan，China）

Abstract： Objective  To investigate the clinical effects of different concentrations of triamcinolone acetonide combined with local surgical resection for facial keloid. Methods  90 patients with facial scars were enrolled in our hospital from March 2017 to April 2018， and they were randomly divided into the control group （n=45） and the observation group （n=45）. The control group was treated with low-concentration triamcinolone acetonide （40mg/3ml） combined with local excision and resection. The observation group was treated with high concentration of triamcinolone acetonide （40mg/1.5ml） combined with local resection. The treatment outcomes， self-rating depression scale （SDS） score， self-rating anxiety scale （SAS） score， Vancouver scar scale （VSS） score， adverse reactions， and treatment satisfaction were compared. Results  The effective rate of the observation group （95.56%） was significantly higher than that of the control group （66.67%）， the difference was statistically significant（P<0.05）. After treatment， the scores of SDS， SAS and VVS in the two groups were significantly decreased， and the scores in the observation group were significantly lower than those in the control group（P<0.05）. After treatment， the incidence of adverse reactions was 2.22% in the control group and 4.44% in the observation group， but there was no significant difference between the two groups （χ2=4.939，P>0.05）. The treatment satisfaction of the observation group （95.56%） was significantly higher than that of the control group （80.00%，P<0.05）. Conclusion  High-concentration triamcinolone acetonide combined with surgical resection has a good therapeutic effect， which can significantly reduce the scar score of patients， reduce the occurrence of adverse reactions， and have a good therapeutic satisfaction.

Key words： keloid; face; triamcinolone acetonide injection： surgical excision; vancouver scar scale; self-rating depression scale; self-rating anxiety scale; adverse reactions

瘢痕疙瘩主要是由于手术、外伤或感染等引起的一种常见皮肤层纤维组织增生性疾病，其病变位于真皮层，一般不超过真皮深层，形成机制暂未明确[1]。瘢痕疙瘩尤其是面部瘢痕疙瘩严重影响患者美观，对患者心理造成极大影响[2-3]。……