中-大-超大型瘢痕疙瘩分次切除术后疗效及复发因素分析

Evaluation of the therapeutic efficacy and analysis of recurrence factors in staged excision surgery for medium to large and giant hypertrophic scars

摘要:

目的 对中-大-超大型瘢痕疙瘩病例分次切除治疗的疗效评估及其复发影响因素分析，为最佳治疗模式选择及复发评估提供支撑证据。方法 对2016年1月—2020年12月在北京大学第一医院接受分次瘢痕切除手术的101例中-大-超大型瘢痕疙瘩患者进行随访（随访时间≥ 18个月），收集临床特征、治疗方案、疗效及不良反应等资料；单因素及多因素Logistic回归分析筛选复发影响因素。结果 26例（25.8%）中-大-超大型瘢痕疙瘩患者出现术后复发，且均在术后1年内复发，平均复发时间为（5.70±3.80）个月。既往手术治疗失败史［O^R=14.509（95% CI：1.908，110.327）］是瘢痕疙瘩复发的危险因素（P <0.05），低张力部位（耳部/面颈部）［O^R=0.089（95% CI：0.009，0.919）］、术后放疗［O^R=0.161（95% CI：0.053，0.484）］是瘢痕疙瘩复发的保护因素（P <0.05）。结论 分次切除手术联合术后24 h内局部放疗方案对中-大-超大型瘢痕疙瘩具有较优控制效果及良好安全性。既往手术治疗失败史、术后未联合局部放疗及高张力部位（非耳部/头颈部位）是瘢痕疙瘩术后复发的相关因素。

Abstract:

Objective To assess the therapeutic efficacy of staged excision surgery for medium to large and giant hypertrophic scars and analyze factors influencing recurrence, aiming to provide evidence for optimal treatment modalities and recurrence evaluation.Methods We conducted follow-up on 101 patients with medium to large and giant hypertrophic scars who underwent staged excision surgery at Peking University First Hospital between January 2016 and December 2020 (follow-up duration ≥ 18 months). We collected data on clinical characteristics, treatment protocols, treatment outcomes, and adverse reactions. Single-factor and multiple-factor logistic regression analyses were performed to screen for factors influencing recurrence.Results Among the patients with medium to large and giant hypertrophic scars, 26 cases (25.8%) experienced postoperative recurrence, all within 1 year after surgery. The mean time to recurrence was (5.70 ± 3.80) months. A history of failed prior surgical treatment [O^R = 14.509 (95% CI: 1.908, 110.327) ] was identified as a risk factor for hypertrophic scar recurrence (P <0.05), whereas low-tension anatomical locations (e.g., ears/face and neck) [O^R = 0.089 (95% CI: 0.009, 0.919) ] and postoperative radiotherapy [O^R = 0.161 (95% CI: 0.053, 0.484) ] were protective factors against recurrence (P <0.05).Conclusion Staged excision surgery combined with local radiotherapy within 24 hours postoperatively demonstrates excellent control efficacy and safety for medium to large and giant hypertrophic scars. A history of failed prior surgical treatment, the absence of postoperative adjuvant local radiotherapy, and high-tension anatomical sites (excluding the ears/face and neck) are associated factors in hypertrophic scar recurrence.