Wong Thian-Sze, Li John Zeng-Hong, Chen Siqi, Chan Jimmy Yu-Wai, Gao Wei
Department of Surgery, The University of Hong Kong , Pokfulam , Hong Kong.
Department of Surgery, The University of Hong Kong, Pokfulam, Hong Kong; Department of Otolaryngology, The First People's Hospital of Foshan, Foshan, Guangdong, China.
Front Med (Lausanne). 2016 Dec 27;3:71. doi: 10.3389/fmed.2016.00071. eCollection 2016.
Keloid is a cutaneous dermal outgrowth resulting from uncontrolled deposition of collagen and glycosaminoglycan around the wound. The uncontrolled and persistent growth of keloids scar will result in cosmetic disfigurement, functional impairment, and affect the quality of life. Triamcinolone acetonide (TAC) is traditionally employed in treating keloid scars. In this study, we aim to evaluate the effectiveness of TAC and compare it with other common therapy employed in keloid treatment. Only randomized controlled trial (RCT) and controlled trial were included. Inverse variance risk ratio, weighted mean difference, and corresponding 95% confidence intervals were calculated to evaluate the effect of intervention. Meta-analysis indicated that TAC treatment significantly reduced the size of keloid compared to untreated control. Reduction in size was statistically different in favor of TAC compared to silicone gel sheet. Significant difference in favor of TAC was observed compared with verapamil in term of vascularity and scar pliability. TAC treatment was more effective in reducing scar thickness in comparison with cryotherapy. However, the current meta-analysis has several limitations. Only a limited number of trials with the same comparison are available. Most trials recruited a small number of patients and used inconsistent outcome assessment. Most trials did not provide detail information on allocation concealment and blinding. Therefore, further evaluation in multi-center RCTs with consistent comparisons and outcome measurements are warrant to reach a consensus on the selection between TAC and different treatment modalities.
瘢痕疙瘩是一种皮肤真皮增生，由伤口周围胶原蛋白和糖胺聚糖的不受控制沉积所致。瘢痕疙瘩瘢痕的不受控制和持续生长会导致外观毁容、功能障碍，并影响生活质量。曲安奈德（TAC）传统上用于治疗瘢痕疙瘩瘢痕。在本研究中，我们旨在评估TAC的有效性，并将其与瘢痕疙瘩治疗中使用的其他常见疗法进行比较。仅纳入随机对照试验（RCT）和对照试验。计算逆方差风险比、加权平均差及相应的95%置信区间以评估干预效果。荟萃分析表明，与未治疗的对照组相比，TAC治疗显著减小了瘢痕疙瘩的大小。与硅胶片相比，TAC在减小瘢痕疙瘩大小方面具有统计学差异。在血管分布和瘢痕柔韧性方面，与维拉帕米相比，TAC具有显著差异。与冷冻疗法相比，TAC治疗在减少瘢痕厚度方面更有效。然而，当前的荟萃分析存在若干局限性。仅有数量有限的具有相同对照的试验。大多数试验招募的患者数量较少，且使用了不一致的结局评估方法。大多数试验未提供关于分配隐藏和盲法的详细信息。因此，有必要在多中心RCT中进行进一步评估，采用一致的对照和结局测量方法，以就TAC与不同治疗方式之间的选择达成共识。
