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瘢痕内核切除术联合A型肉毒毒素注射治疗瘢痕疙瘩的效果和安全性

Efficacy and safety of scar core excision combined with injection of botulinum toxin type A in treating keloids

    摘要
  • 摘要:
    目的 探讨瘢痕内核切除术联合A型肉毒毒素注射治疗瘢痕疙瘩的效果和安全性。
    方法 将2021年1月—2023年12月河北工程大学附属医院收治的186例瘢痕疙瘩患者随机分为对照组与研究组，每组93例。对照组采用瘢痕内核切除术治疗，研究组采用瘢痕内核切除术联合A型肉毒毒素注射治疗。比较2组温哥华瘢痕量表(VSS)评分、视觉模拟评分法(VAS)评分、疤痕面积、瘢痕厚度、实验室指标转化生长因子-β1(TGF-β1)、碱性成纤维细胞生长因子(bFGF)、骨成形蛋白7(BMP-7)、临床疗效、不良反应; 随访1年，比较2组复发率。
    结果 治疗后3、12个月, 2组VSS评分、VAS评分、疤痕面积、瘢痕厚度均减小，且研究组VSS评分、VAS评分、疤痕面积、瘢痕厚度小于对照组，差异均有统计学意义(P < 0.001)。治疗后3、12个月, 2组TGF-β1降低, bFGF、BMP-7升高，且研究组TGF-β1低于对照组, bFGF、BMP-7高于对照组，差异均有统计学意义(P < 0.001)。研究组总有效率为94.62%, 高于对照组的76.34%, 差异有统计学意义(P < 0.001)。研究组不良反应发生率为2.15%, 低于对照组的17.20%, 差异有统计学意义(P < 0.001)。研究组复发1例，复发率为1.08%; 对照组复发6例，复发率为6.45%; 研究组复发率低于对照组，但差异无统计学意义(P>0.05)。
    结论 瘢痕内核切除术联合A型肉毒毒素注射治疗瘢痕疙瘩的疗效较好，可减轻患者症状，减小瘢痕面积与厚度，改善实验室指标，降低复发率，不良反应较少。

     

    Abstract:
    Objective To investigate the efficacy and safety of scar core excision combined with injection of botulinum toxin type A in the treatment of patients with keloids.
    Methods A total of 186 patients with keloids in the Affiliated Hospital of Hebei University of Engineering from January 2021 to December 2023 were randomly divided into control group and study group, with 93 cases in each group. The control group was treated with scar core excision, while the study group was treated with scar core excision combined with injection of botulinum toxin type A. The Vancouver Scar Scale (VSS) score, the Visual Analogue Scale (VAS) score, scar area, scar thickness, laboratory indicators transforming growth factor-β1 (TGF-β1), basic fibroblast growth factor (bFGF), bone morphogenetic protein 7 (BMP-7), clinical efficacy, and adverse reactions were compared between the two groups. The patients were followed up for one year, and the recurrence rate of the two groups was compared.
    Results At 3 and 12 months after treatment, the VSS score, the VAS score, scar area, and scar thickness in both groups decreased significantly, and those in the study group were significantly lower than those in the control group (P < 0.001). At 3 and 12 months after treatment, TGF-β1 decreased significantly, while bFGF and BMP-7 increased significantly in both groups, and TGF-β1 in the study group was significantly lower than that in the control group, while bFGF and BMP-7 were significantly higher than those in the control group (P < 0.001). The total effective rate in the study group was significantly higher than that in the control group (94.62% versus 76.34%, P < 0.001). The incidence of adverse reactions in the study group was significantly lower than that in the control group (2.15% versus 17.20%, P < 0.001). There was 1 case of recurrence in the study group, with a recurrence rate of 1.08%; 6 cases of recurrence in the control group, with a recurrence rate of 6.45%. The recurrence rate in the study group was lower than that in the control group (P>0.05).
    Conclusion Scar core excision combined with injection of botulinum toxin type A has a good efficacy in the treatment of keloids, which can alleviate patients′ symptoms, shorten scar area and thickness, improve laboratory indicators, reduce the recurrence rate, and has few adverse reactions.

     

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