van de Kar Annekatrien L, Kreulen Mick, van Zuijlen Paul P M, Oldenburger Foppe
Amsterdam and Beverwijk, The Netherlands From the Departments of Plastic, Reconstructive, and Hand Surgery and Radiotherapy, Academic Medical Center; and Department of Plastic, Reconstructive, and Hand Surgery and the Burns Center, Red Cross Hospital.
Plast Reconstr Surg. 2007 Jun;119(7):2248-2254. doi: 10.1097/01.prs.0000260751.20217.28.
There is no consensus on the best way to treat keloids, because adequate studies on this subject are sparse. Surgical excision in combination with radiotherapy is considered the most efficacious treatment available in severe keloids following the International Clinical Recommendations on Scar Management. Unfortunately, the recommendations are mainly based on retrospective studies that do not define recurrence.
The authors evaluated the recurrence rate of therapy-resistant keloids treated with excision followed by radiotherapy (1200 Gy in three or four fractions). The minimum follow-up period was 12 months. The therapeutic outcome was judged as recurrence (elevation of the lesion not confined to the original wound area) or nonrecurrence. An evaluation of the outcome of the scars was obtained by using the Patient and Observer Scar Assessment Scale.
Twenty-one patients with 32 keloids were evaluated. The recurrence rate was 71.9 percent after a mean follow-up period of 19 months.
This high recurrence rate suggests that radiotherapy might be less efficacious than suggested by other studies. On the basis of the authors' results, surgical excision combined with radiotherapy should be reserved as a last resort in the treatment of therapy-resistant keloids.
对于瘢痕疙瘩的最佳治疗方法尚无共识，因为关于该主题的充分研究较少。根据国际瘢痕管理临床建议，手术切除联合放射治疗被认为是重度瘢痕疙瘩最有效的治疗方法。不幸的是，这些建议主要基于未明确复发情况的回顾性研究。
作者评估了采用切除后放疗（分三或四次给予1200戈瑞）治疗难治性瘢痕疙瘩的复发率。最短随访期为12个月。治疗结果判定为复发（病变隆起不限于原伤口区域）或未复发。通过使用患者和观察者瘢痕评估量表对瘢痕结果进行评估。
对21例患者的32个瘢痕疙瘩进行了评估。平均随访19个月后，复发率为71.9%。
如此高的复发率表明，放射治疗的效果可能不如其他研究所显示的那样好。根据作者的研究结果，手术切除联合放射治疗应留作治疗难治性瘢痕疙瘩的最后手段。
