陈琢琦 亢芷兰 李巍 王涛 陈伟华

[摘要]目的：探讨电子线联合A型肉毒毒素应用于胸壁瘢痕疙瘩切除术后的作用效果。方法：2018年9月-2020年6月，笔者科室收治胸壁瘢痕疙瘩患者106例共106处，采用随机分组法分为观察组和对照组，每组53例，两组均先手术切除瘢痕，观察组术后采取早期电子线放射、A型肉毒毒素联合治疗，对照组术后只接受早期电子线放射治疗，比较两组治疗效果。结果：观察组治愈率和有效率均显著高于对照组，且观察组满意度评分高于对照组，差异具有统计学意义（P<0.05）。结论：在胸壁瘢痕疙瘩治疗上，手术切除结合早期电子线、A型肉毒毒素联合治疗比术后单纯应用早期电子线照射治疗效果更好，患者满意度高，在临床上可用于胸壁瘢痕疙瘩的治疗。

[关键词]病理性瘢痕;瘢痕疙瘩;放射治疗;A型肉毒毒素;手术治疗

[中图分类号]R619+.6    [文献标志码]A    [文章编号]1008-6455（2021）01-0028-04

Application Effect of Electron Beam Irradiation Combined with Botulinum Toxin Type A after Excision of Keloid on Chest Wall

CHEN Zhuo-qi，KANG Zhi-lan，LI Wei，WANG Tao，CHEN Wei-hua

（Department of Plastic Surgery，the Fourth Hospital of Harbin Medical University，Harbin 150000，Heilongjiang，China）

Abstract： Objective  To investigate the effect of electron beam irradiation combined with botulinum toxin type A after excision of keloid on chest wall. Methods  From September 2018 to June 2020， 106 patients with chest wall keloid were treated in our department. They were randomly divided into the observation group and the control group， 53 cases in each group. The scar was removed first in both groups. The observation group was treated with early electron beam irradiation and botulinum toxin type A combined therapy after operation， while the control group was only treated with early electron beam irradiation after operation. The therapeutic effects of the two groups were compared. Results  The cure rate and effective rate of the observation group were significantly higher than those of the control group， and the satisfaction score of the observation group was higher than that of the control group， the differences were statistically significant（P<0.05）. Conclusion  In terms of the post-operational therapeutic effect on chest-wall keloid resection， the treatment combining electron beam irradiation and botulinum toxin type A performs better compared with the treatment using electron radiation alone. This synthetic treatment acquires high satisfaction among patients and can apply to the clinical therapy of keloid.

Key words： pathological scar; keloid; radiotherapy; botulinum toxin type A; surgical treatment

瘢痕疙瘩是一種皮肤在损伤愈合过程中，细胞内胶原合成代谢功能亢进，导致胶原纤维增生紊乱，瘢痕组织过度生长的一种常见疾病，是一种皮肤良性真皮纤维增殖性肿瘤[1]。其中成纤维细胞异常增殖是瘢痕疙瘩形成的主要原因之一[2]。单纯手术切除是瘢痕疙瘩治疗的禁忌证，复发率可高达80%～100%[3]，为防止术后瘢痕疙瘩沿切口形成或复发，应行综合治疗。中国瘢痕疙瘩临床治疗推荐指南指出，放射治疗是一线治疗方案，通过严格控制放射剂量，局部损伤可逆[4]，安全性佳，可有效预防术后瘢痕的复发[4-5]。A型肉毒毒素（Botulinum toxin type A，BTX-A）安全性高、临床效果显著，并且对减轻切口张力和缓解瘢痕疙瘩导致的感觉异常方面疗效显著[6]，目前已在皮肤和美容领域得到广泛应用[7-8]。电子线和BTX-A单独应用治疗瘢痕疙瘩是临床常规技术[9-10]，不违背伦理道德规范。……