张佳琦 陈程 葛鋆 石芬 王永振 张金明 梁伟强

本文来源：《中华整形外科杂志》2023年12月 第39卷 第12期

DOI:10. 3760 / cma.j.cn114453-20230511-00104

作者单位：中山大学孙逸仙纪念医院整形外科， 广州510000梁伟强，Email：lweiq@mail.sysu.edu.cn

通信作者：梁伟强，Email：lweiq@mail.sysu.edu.cn

【摘要】 

目的 探究胸壁瘢痕疙瘩切除后通过真皮锚定法减张缝合，联合低能量电子线照射的疗效及安全性。

方法 回顾性分析2015年5月至2021年5月于中山大学孙逸仙纪念医院整形外科治疗的中大型胸壁瘢痕疙瘩患者临床资料。术中于浅筋膜层完整切除瘢痕疙瘩，同时在瘢痕疙瘩中央部位保留一小块瘢痕真皮组织，缝合切缘时锚定该真皮组织，做皮下减张缝合；于术后24 h内进行首次低能量电子线照射治疗，照射范围为切口边缘5～10 mm，深度为皮下2 cm，共照射3次，每次间隔24 h，总照射剂量为20 Gy。术后3、6、12个月分别记录瘢痕疙瘩宽度、增生程度(用高度表示)及复发情况；术后1年评价患者满意度(总分为10分，0～3分为不满意，4～7分为一般满意，8～10分为非常满意)及电子线照射治疗后的并发症(红斑、切口延迟愈合、色素沉着等)发生情况。采用SPSS 25.0软件对数据进行统计分析，计量资料采用x±s表示，同一变量在不同时期的比较采用重复测量的方差分析，计数资料用百分数或例表示，组间比较采用 χ 2检验，以 P<0.05表示差异有统计学意义。

结果 共纳入39例患者39处瘢痕疙瘩，男15例，女24例，年龄(30.9±9.5)岁，术前瘢痕疙瘩宽度为(43±5)mm(38～48 mm)，体积为20.0 mm×38.0 mm×7.5 mm～80.0 mm×48.0 mm×1.6 mm。瘢痕疙瘩切除术后即刻伤口呈轻度隆起状态，渗液少，电子线照射治疗后伤口干洁。术后3、6、12个月随访，瘢痕宽度分别为(1.3±0.5)、(1.8±0.5)及(2.9±0.5) mm，差异有统计学意义( P<0.01)；瘢痕增生程度分别为(0.9±0.3)、(1.3±0.3)及(1.8±0.3) mm，差异有统计学意义( P<0.01);瘢痕疙瘩复发率分别为12.8%(5例)、23.1%(9例)和25.6%(10例)，差异无统计学意义( P>0.05)。术后1年患者满意度评分为2～10分，平均7分，其中不满意4例(10%)，一般满意10例(26%)，非常满意25例(64%)。所有患者电子线照射治疗后均未发生并发症。

结论 胸壁瘢痕疙瘩切除真皮锚定法减张缝合联合低能量电子线照射能够获得良好的治疗效果，瘢痕疙瘩复发率低，患者满意度高。

基金项目： 广东省医学科学技术研究基金项目（A2022532，A2020250）

Observation on the therapeutic effect of dermis anchoring method combined with low energy electron beam irradiation after keloid excision on chest wall

Zhang  Jiaqi, Chen  Cheng, Ge  Jun, Shi  Fen, Wang  Yongzhen, Zhang  Jinming, Liang  Weiqiang

Department of Plastic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510000, China

Corresponding author: Liang Weiqiang, Email: lweiq@mail.sysu.edu.cn

  【Abstract】

Objective To investigate the efficacy and safety of dermal anchoring method combined with low energy electron beam irradiation in the removal of chest wall keloids.

Methods Clinical data of patients with medium and large-sized chest wall keloids treated in Plastic Surgery Department of Sun Yat-sen Memorial Hospital of Sun Yat-sen University from May 2015 to May 2021 were analyzed retrospectively. The keloid was completely removed from the superficial fascia layer, and a small patch of scar dermis tissue was retained in the center of the keloid. When the cutting edge was sutured, the above-mentioned dermis tissue was anchored to achieve tension reduction. Then low energy electron beam irradiation treatment was carried out within 24 h after surgery, with an irradiation range of 5-10 mm from the incision edge and a subcutaneous depth of 2 cm. The lesions were irradiated for 3 times, with a 24 h interval between each exposure. The total irradiation dose was 20 Gy. The width, severity of hyperplasia (expressed in height), and recurrence of keloids at 3, 6, and 12 months after surgery were recorded. Patient satisfaction was evaluated one year after surgery (with a total score of 10 points, 0-3 points of dissatisfaction, 4-7 points of general satisfaction, 8-10 points of great satisfaction), and the incidence of radiation complications was observed. SPSS 25.0 software was used for statistical analysis of the data, with measurement data represented by Mean±SD. Repeated measurement analysis of variance was conducted for the same variable at different periods, and counting data was represented by %. χ 2 test was used for group comparison. P<0.05 indicated the difference with statistical significance.

Results A total of 39 patients with 39 scars were included. There were 15 males and 24 females, aged (30.9±9.5) years. The preoperative scar width was (43±5) mm (rang 38-48 mm), and the scar volume was 20.0 mm×38.0 mm×7.5 mm-80.0 mm×48.0 mm×1.6 mm. After the surgery, the wound showed a mild protrusion with minimal exudation, and the wound was dry and clean after irradiation. The scar width at 3, 6, and 12 months after surgery was (1.3±0.5), (1.8±0.5), and (2.9±0.5) mm, respectively, with statistically significant difference ( P<0.01); the severity of scar hyperplasia was (0.9±0.3), (1.3±0.3), and (1.8±0.3) mm, with statistically significant difference ( P<0.01); the recurrence rates of keloids were 12.8% (5 cases), 23.1% (9 cases), and 25.6% (10 cases), respectively, with no statistically significant difference ( P>0.05). The patient satisfaction score at 1 year after surgery was 2-10, average of 7. There were 4 cases (10%) of dissatisfaction, 10 cases (26%) of general satisfaction, 25 cases (64%) of great satisfaction. No radiotherapy complications occurred.

Conclusion Dermal anchoring method combined with low energy electron beam irradiation can achieve good therapeutic effects in the removal of chest wall keloids. The recurrence rate of keloids is low, and patient satisfaction is high.

Fund program: Guangdong Medical Science and Technology Research Fund Project (A2022532, A2020250)

Disclosure of Conflicts of Interest: The authors have no financial interest to declare in relation to the content of this article.

Ethical Approval: Ethical approval was given by the Medical Ethics Committee of Sun Yat-sen Memorial Hospital (SYSKY-2023-419-01).