CAJ | 학술논문

目的:观察自制32P敷贴器局部敷贴治疗不同类型瘢痕疙瘩的临床疗效.方法:105例瘢痕疙瘩患者中,39例病变厚度≤0.3 cm的行单纯敷贴治疗,病变厚度>0.3 cm的66例随机分为2组,单纯敷贴组36例,手术+敷贴组30例.单纯敷贴根据病变表面积大小及形状剪取敷贴片,根据剂量率和衰变校正计算每天敷贴时间,直接贴于病变表面,每天4.0～5.0 Gy/(部位·次),连续4 d为一疗程,每疗程间隔4周,总治疗4～6个疗程.幼儿单次剂量控制在每天4 Gy/(部位·次)以下.手术+敷贴组患者手术切除瘢痕疙瘩,待手术伤口无渗出后根据伤口形状剪取敷贴片对准伤口敷贴,剂量及疗程同单纯敷贴组.结果:单纯敷贴治疗对病变厚度≤0.3 cm的39例瘢痕疙瘩治愈32例(82%),总有效率98%;对病变厚度>0.3 cm的瘢痕疙瘩单纯敷贴和手术+敷贴两组治疗总有效率分别为56%和93%,两组差异有显著性意义(P<0.01),其中病程<9个月的患者治疗有效率分别为25%和75%,病程较长患者治疗有效率分别为13%和77%.治疗过程中有26例在敷帖过程中出现局部皮肤烧灼和刺痛感,均以炉甘石洗剂局部外用处理后缓解;5例出现Ⅰ度放射性皮炎,2例出现Ⅱ度放射性皮炎,以百多邦软膏局部外用后缓解,无出现Ⅲ度以上放射性皮炎病例.治愈患者局部皮肤均有不同程度的色素沉着或皮肤颜色改变.结论:32P敷贴治疗瘢痕疙瘩治疗安全有效,对病程较短或病变厚度小于0.3 cm的患者可单纯敷贴治疗,病程较长或病变厚度大于0.3 cm患者建议先手术后再敷贴治疗.
목적:관찰자제32P부첩기국부부첩치료불동류형반흔흘탑적림상료효.방법:105례반흔흘탑환자중,39례병변후도≤0.3 cm적행단순부첩치료,병변후도>0.3 cm적66례수궤분위2조,단순부첩조36례,수술+부첩조30례.단순부첩근거병변표면적대소급형상전취부첩편,근거제량솔화쇠변교정계산매천부첩시간,직접첩우병변표면,매천4.0～5.0 Gy/(부위·차),련속4 d위일료정,매료정간격4주,총치료4～6개료정.유인단차제량공제재매천4 Gy/(부위·차)이하.수술+부첩조환자수술절제반흔흘탑,대수술상구무삼출후근거상구형상전취부첩편대준상구부첩,제량급료정동단순부첩조.결과:단순부첩치료대병변후도≤0.3 cm적39례반흔흘탑치유32례(82%),총유효솔98%;대병변후도>0.3 cm적반흔흘탑단순부첩화수술+부첩량조치료총유효솔분별위56%화93%,량조차이유현저성의의(P<0.01),기중병정<9개월적환자치료유효솔분별위25%화75%,병정교장환자치료유효솔분별위13%화77%.치료과정중유26례재부첩과정중출현국부피부소작화자통감,균이로감석세제국부외용처리후완해;5례출현Ⅰ도방사성피염,2례출현Ⅱ도방사성피염,이백다방연고국부외용후완해,무출현Ⅲ도이상방사성피염병례.치유환자국부피부균유불동정도적색소침착혹피부안색개변.결론:32P부첩치료반흔흘탑치료안전유효,대병정교단혹병변후도소우0.3 cm적환자가단순부첩치료,병정교장혹병변후도대우0.3 cm환자건의선수술후재부첩치료.
OBJECTIVE: To investigate the clinical efficacy of self-made 32P applicator for treating different kinds of keloid. others were treated with surgical excision combined with self-made 32P applicator. The 32P applicator was shaped according to the size and shape of the diseased region and the application time was calculated according to the dose rate and the decay correction. 4.0-5.0 Gy was applied in every diseased region in each of the four days (one course), and 4-6 courses in total was required, with 4 weeks of intervals following each course. For children, dose was reduced to 4 Gy or less once a day in every diseased region. Patients in the operation combined with application group were performed keloids excision first. Then 32P applicators were applied to the wound without any exudation in the same way as above. RESULTS: Of all the 39 patients (lesion thickness≤0.3 cm, 32P applicator therapy only), 32 ones was cured (82.1%), with the total effective rate of 98%. For patients with lesion thickness > 0.3 cm, the total effective rate of 32P applicator therapy and surgical excision combined with self-made 32P applicator were 55.6% and 93.3% respectively, and the difference was ofsignificance (P < 0.01 ). Among these patients, those with disease course less than 9 months had the effective rates of 25.0% and75.0% corresponding to 32P applicator therapy only and surgical excision combined with self-made 32p applicator respectively.For those with long course of disease, the effective rates were 13% and 77% respectively. A total of 26 patients experienced local buming and slight pain during the 32P applicator treatment, and all the symptoms were relieved by using calamine lotion; 5 patients and 2 patients expedencad grade Ⅰ and Ⅱ radio dermatitis respectively, which were relieved by using Mupirocin Ointment. No radio dermatitis of grade Ⅲ or above occurred to any patient. In addition, pigmentation or color changing occurred at local skins of cured patients.CONCLUSION: 32P applicator therapy is safe and effective for treating keloid. For patients with short disease course and lesion thickness ≤0.3 cm, 32P applicator therapy only is enough. Otherwise, patients are suggested to use 32P applicator after operation.