瘢痕疙瘩三联疗法临床疗效分析

发布时间：2018-05-11 14:10

本文选题：瘢痕疙瘩 + 发病机制　；参考：《吉林大学》2017年硕士论文

【摘要】：目的:通过对近5年吉林大学第二医院皮肤科收治的瘢痕疙瘩患者临床资料的回顾性分析、总结,从瘢痕疙瘩患者的发病年龄、诱发因素、发病部位、瘢痕面积、预后等方面,探讨三联疗法与瘢痕疙瘩的临床特征及预后的相关性。方法:采用回顾性临床分析的方法,将2011年至2016年吉林大学第二医院皮肤科采用三联疗法治疗的瘢痕疙瘩患者,即采用手术治疗、术中局部注射复方倍他米松联合术后90Sr-90Y敷贴器治疗的192例患者入组进行系统分析。探讨三联疗法的临床疗效与瘢痕疙瘩临床特征的相关性。结果:1、瘢痕疙瘩的临床特征:瘢痕疙瘩的发病高峰年龄为21岁-30岁,平均年龄为(29.36±12.35)岁,不同性别平均发病年龄差异无统计学意义(P0.05)。感染引起的瘢痕疙瘩有81例,手术(包括穿刺耳孔)引起的有60例,诱发因素不明确的有27例,外伤引起的有24例。前胸48例,耳部44例,四肢33例,面部(下颌缘)30例,颈部12例,腹部10例,会阴部8例,背部7例。小瘢痕130例,中瘢痕54例,大瘢痕8例。无家族史169例,有家族史23例。2、三联疗法临床疗效与临床特征的相关性:三联疗法的临床治愈率为82.8%。男性、女性三联疗法的治愈率差别无统计学意义(P0.05)。不同年龄段的三联疗法治愈率差异有统计学意义(P0.05)。不同诱发因素引起的瘢痕疙瘩,三联疗法的治愈率无显著差异(P0.05)。不同部位之间三联疗法的治愈率差异有统计学意义(P0.05)。不同面积瘢痕疙瘩,三联疗法治愈率有显著差异(P0.05)。有家族史的患者治愈率低于无家族史患者,二者差异有统计学意义(P0.05)。手术方式与三联疗法临床疗效有关,不同手术方式的治愈率差别有统计学意义(P0.05)。结论:1、瘢痕疙瘩患者的高发年龄为21岁-30岁,男女平均发病年龄相同。瘢痕疙瘩的诱发因素主要为感染,其余依次为手术、诱因不明确、外伤,其中男性以感染为主,女性以手术为主。瘢痕疙瘩的好发部位为前胸部、耳部、面部(下颌缘)、四肢、颈部、腹部、背部、会阴部,发病部位与年龄有关。瘢痕疙瘩患者以小面积瘢痕为主,有家族史患者瘢痕疙瘩面积较大。2、性别、诱发因素与三联疗法疗效无关。小于20岁的患者三联疗法治疗效果最差。耳部、面部(下颌缘)、颈部治愈率明显高于躯干及四肢(前胸、背部、腹部、会阴)。小瘢痕治愈率高于中、大瘢痕治愈率。有家族史患者治愈率低于无家族史患者。直接切缝的治愈率高于局部皮瓣和全厚皮片移植。3、三联疗法临床疗效显著,副作用小,值得广泛应用于临床。
[Abstract]:Objective: to analyze retrospectively the clinical data of keloid patients admitted in the Department of Dermatology of the second Hospital of Jilin University in recent 5 years, and to summarize the incidence age, inducing factors, location, area and prognosis of keloid patients. To explore the correlation between triple therapy and the clinical features and prognosis of keloid. Methods: the patients with keloid treated by triple therapy from 2011 to 2016 in Department of Dermatology, second Hospital of Jilin University, were treated with surgical treatment. A systematic analysis was carried out in 192 patients who were treated with local injection of compound betamethasone combined with postoperative 90Sr-90Y application. To explore the correlation between the clinical effect of triple therapy and the clinical characteristics of keloid. Results the clinical characteristics of keloid: the peak age of keloid was 21 to 30 years old, the average age was 29. 36 卤12. 35 years old. There were 81 cases of keloid caused by infection, 60 cases of operation (including puncture of auricle), 27 cases of unclear inducing factors and 24 cases of trauma. There were 48 cases of anterior chest, 44 cases of ear, 33 cases of extremities, 30 cases of facial (mandibular margin), 12 cases of neck, 10 cases of abdomen, 8 cases of perineum and 7 cases of back. Small scar 130 cases, medium scar 54 cases, big scar 8 cases. There were 169 cases without family history and 23 cases with family history. The correlation between the clinical efficacy and clinical characteristics of triple therapy was as follows: the cure rate of triple therapy was 82.8%. There was no significant difference in cure rate between male and female patients with triple therapy (P 0.05). The cure rate of triple therapy in different age groups was significantly different (P 0.05). There was no significant difference in the cure rate of triple therapy for keloid caused by different inducing factors (P 0.05). There was significant difference in the cure rate among different parts of triple therapy (P 0.05). In different areas of keloid, the cure rate of triple therapy was significantly different (P 0.05). The cure rate of patients with family history was lower than that without family history, and the difference was statistically significant (P 0.05). The operative method is related to the clinical effect of triple therapy, and the difference of cure rate among different surgical methods is statistically significant (P 0.05). Conclusion the high incidence age of keloid patients was 21-30 years old, and the mean age of onset was the same in males and females. The main inducing factors of keloid were infection, the others were surgery, the inducement was not clear, trauma, in which the male was the main infection, the female was the operation. The predilection sites of keloid were anterior chest, ear, face (mandibular margin, extremities, neck, abdomen, back, perineum). The keloid patients were mainly small scar, the area of keloid was larger than that of family history, sex and inducing factors were not related to the curative effect of triple therapy. Triple therapy was the worst treatment for patients under 20 years of age. The cure rate of ear, face (mandibular margin) and neck was higher than that of trunk and extremities (chest, back, abdomen, perineum). The cure rate of small scar was higher than that of middle scar, and the cure rate of big scar was higher. The cure rate of patients with family history was lower than that without family history. The cure rate of direct suture is higher than that of local flap and full thickness skin graft.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R751

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