病理性瘢痕的发病机制及治疗进展

发布时间：2018-11-25 20:51

【摘要】：第一部分:综述:病理性瘢痕的发病机制及治疗进展瘢痕是各种创伤所引起的正常皮肤组织外观形态和组织病理学改变的统称,是人体创伤修复过程中必然的产物。伤口愈合过程中各种原因导致的瘢痕过度增生,即称之为病理性瘢痕,包括增生性瘢痕(HTS)和瘢痕疙瘩。病理性瘢痕不仅影响患者的美观,若生长过大且靠近关节等部位,还会对患者的机体功能造成一定的限制,此外,病理性瘢痕本身有时会伴有疼痛、瘙痒以及感觉过敏,对患者正常的生活质量的影响很大。增生性瘢痕和瘢痕疙瘩的治疗一直以来都是整形外科的重大难题之一,由于其发病机制尚不明确,虽然经过多年研究探索出的治疗方法很多,如药物治疗,物理治疗,手术治疗,综合治疗等,至今仍无一个令人满意的治疗方案。本文针对增生性瘢痕及瘢痕疙瘩,关注于两者的发病过程、分子基础、临床分类、治疗方法以及治疗流程。为增生性瘢痕和瘢痕疙瘩的临床综合治疗提供参考。第二部分:穿耳孔后瘢痕疙瘩综合治疗病例报道目的:探索穿耳孔后瘢痕疙瘩的综合治疗方案。方法:选取典型穿耳孔后出现耳部瘢痕疙瘩的患者,对耳部瘢痕疙瘩采取一次性手术切除,无张力缝合,术后3周应用曲安奈德(昆明积大)40mg+透明质酸酶(上海第一生化药业有限公司)1500u+2%利多卡因2ml+生理盐水lml,行预防性注射治疗。结果:患者瘢痕完全去除,随访44个月未复发。结论:耳部瘢痕疙瘩应用手术切除联合术后曲安奈德、透明质酸酶预防性注射治疗,可降低术后瘢痕疙瘩的复发,值得进一步探索与临床推广。
[Abstract]:Part I: the pathogenesis and treatment progress of pathological scar is a general term of normal skin appearance and histopathology caused by various kinds of trauma, and is an inevitable product in the process of wound repair. Scar hypertrophy caused by various causes during wound healing is called pathological scar, including hypertrophic scar (HTS) and keloid. Pathological scars not only affect the beauty of the patient, but also limit the function of the patient if they grow too large and close to the joints. In addition, the pathological scar itself is sometimes accompanied by pain, itching and feeling allergic. It has a great impact on the patient's normal quality of life. The treatment of hypertrophic scar and keloid has always been one of the major problems in plastic surgery, because the pathogenesis of hypertrophic scar and keloid is still unclear, although after many years of research, there are many treatment methods, such as drug therapy, physical therapy, Surgical treatment, comprehensive treatment, and so on, there is still no satisfactory treatment. This article focuses on the pathogenesis, molecular basis, clinical classification, treatment and treatment process of hypertrophic scar and keloid. To provide a reference for the clinical comprehensive treatment of hypertrophic scar and keloid. Part two: comprehensive treatment of keloid after perforating auricle objective: to explore the comprehensive treatment of keloid after perforating auricle. Methods: the typical patients with keloid after perforating auricular foramen were treated with one-off surgical excision and tension-free suture. Triamcinolone acetonide (Kunming Jida) 40mg hyaluronidase (Shanghai first biochemical Pharmaceutical Co., Ltd.) 1500u 2% lidocaine 2ml saline lml, was used for prophylactic injection 3 weeks after operation. Results: the scar was completely removed and no recurrence occurred after 44 months follow-up. Conclusion: surgical resection combined with triamcinolone acetonide and hyaluronidase injection can reduce the recurrence of keloid.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R622

【参考文献】

中国期刊全文数据库前10条

1 刘秀峰;潘文东;张元文;钟晖;陈永新;王继华;;增生性瘢痕的激光治疗进展[J];中国美容医学;2015年18期

2 蓝蔚;李孝建;纪雪亮;易先锋;刘衍智;涂荣梅;;细胞因子抑制剂吡非尼酮对体外培养人瘢痕成纤维细胞增殖的影响[J];中国组织工程研究;2015年24期

3 刘群英;段俊俊;邵家松;;维A酸涂膜剂对兔耳早期增生性瘢痕的影响[J];中华皮肤科杂志;2014年07期

4 周诚忠;夏海波;宋永浩;夏炎春;李定旺;;70例瘢痕疙瘩术后即时辅助电子线放疗的疗效观察[J];肿瘤基础与临床;2014年01期

5 高立伟;杨顶权;王继英;熊英;洛小林;贾P;赵克岭;;瘢痕疙瘩术后即时放疗83例临床分析[J];中日友好医院学报;2014年01期

6 陈彬;首家保;杨小辉;唐哲明;毛庆龙;柳大烈;;口服曲尼司特防治烧伤瘢痕增生的临床研究[J];中国美容医学;2014年03期

7 王庆国;李晓梅;张敏;李航;温冰;李洪振;高献书;;107例瘢痕疙瘩术后两种分割剂量放疗疗效分析[J];北京大学学报(医学版);2014年01期

8 钟珊;梅雪岭;赵俊英;;不同脉宽595nm染料激光治疗增生性瘢痕和瘢痕疙瘩的疗效[J];首都医科大学学报;2013年05期

9 冯红霞;辛燕;郝玉琴;金兰兰;;曲安奈德对瘢痕疙瘩成纤维细胞Ⅰ、Ⅲ型前胶原基因表达的影响[J];中国麻风皮肤病杂志;2012年11期

10 柯朝阳;曾凡倩;张静;龚桃根;刘明;;手术加放疗治疗耳部瘢痕疙瘩的疗效分析[J];中华耳科学杂志;2012年03期