孟卫荣 李娜 杨丽 程静 韩军涛

[摘要]目的：探讨耳廓瘢痕疙瘩的分型、手术方案及联合曲安奈德局部注射治疗的临床疗效。方法：根据瘢痕疙瘩与耳洞的关系将其分为单侧型和双侧型，根据分型及瘢痕大小设计切口线及局部皮瓣，尽量切除瘢痕疙瘩，并摘除内核，必要时保留部分瘢痕边缘，修薄后以6-0线全层无张力缝合，拆线后先以拉力胶固定切口1个月，之后行曲安奈德局部皮下注射，浓度为20mg/ml，每2周1次，持续3～5次。结果：本组53例患者共65只患耳，术后伤口均一期愈合，外形良好，术后均按要求行局部曲安奈德注射，随访6～26个月，8例出现不同程度复发，其中2例行再次治疗后未见复发。结论：手术切除联合曲安奈德局部注射治疗耳廓瘢痕疙瘩，临床效果确切，简单易行，值得推广应用。

[关键词]瘢痕疙瘩;耳廓;手术切除;曲安奈德;局部注射

[中图分类号]R619+.6    [文献标志码]A    [文章编号]1008-6455（2021）01-0012-03

Effect of Surgical Resection Combined with Topical Injection of Triamcinolone on Auricular Keloid

MENG Wei-rong，LI Na，YANG Li，CHENG Jing，HAN Jun-tao

（Burns Centre of PLA，Department of Burns and Cutaneous Surgery，Xijing Hospital，Air Force Medical University，Xian 710032，Shaanxi，China）

Abstract： Objective  To investigate the clinical classification， surgical protocol and clinical efficacy of surgical resection combined with topical injection of triamcinolone on auricular keloid. Methods  According to the relationship between keloid and ear cavity， auricular keloid is divided into unilateral type and bilateral type. The incision line and local flap were designed according to the classification and keloid size. When the keloid and core were removed， the part of the keloid edge could be retained to keep the incision sutured without any tension. After removing the stitches， the incision was fixed with tensile adhesive for 1 month. Then， triamcinolone acetonide was topical injected subcutaneously， the concentration was 20mg/ml， once every two weeks， lasting for 3-5 times. Results  A total of 65 ear in 53 patients were involved in this group. After surgery， local triamcinolone injection was performed as required. Follow-up was conducted for 6 to 26 months， and 8 cases had different degrees of recurrence， 2 cases of which had no recurrence after retreatment. Conclusion  Surgical resection combined with topical injection of triamcinolone in the treatment of auricle keloid has a definite clinical effect and is simple and feasible.

Key words： keloid; auricle; surgical resection; triamcinolone; topical injection

愛美是人的天性，戴耳环是人类最早的美容手段之一。多数情况下，穿耳洞后形成的创面通过两侧上皮的向内爬行而愈合，形成耳洞。但有少数人因感染或其他原因，在穿孔处形成瘢痕，轻者形成芝麻大小的增生性瘢痕，重者形成形态大小不一的瘢痕疙瘩，不仅严重影响耳部的外观，而且时常伴有孔隙感染等炎症反应。若在耳轮处，则会波及耳软骨，形成耳软骨炎，进而造成耳廓畸形。自2015年至今，笔者科室门诊共接诊此类患者180人次，多数患者经局部注射曲安奈德及激光治疗而治愈，其中53例因局部瘢痕疙瘩较大而行手术治疗，术后结合曲安奈德局部注射，现将治疗方案报道如下。……