From the Leicester Royal Infirmary, University Hospitals of Leicester.
University Hospitals Coventry & Warwickshire NHS Trust.
Plast Reconstr Surg. 2024 Jun 1;153(6):1318-1330. doi: 10.1097/PRS.0000000000010867. Epub 2023 Jun 20.
Keloids and hypertrophic scars cause physical and psychosocial problems. A combination of 5-fluorouracil (5-FU) and triamcinolone acetonide (TAC) may enhance the treatment of pathologic scars, although the evidence base is limited. The authors compared the efficacy and complication rates of combination intralesional TAC and 5-FU with those of monotherapy intralesional TAC or 5-FU for the treatment of keloids and hypertrophic scars.
Embase, MEDLINE, and CENTRAL were searched by two independent reviewers. The primary outcome was treatment efficacy (51% to 100% improvement). Study quality and risk of bias were assessed using the Cochrane risk of bias tool.
Of 277 articles screened, 13 studies were included, comprising 12 randomized control trials and one nonrandomized study. Six studies compared combination intralesional therapy versus monotherapy 5-FU, and nine studies compared combination intralesional therapy versus monotherapy TAC. The combined group demonstrated superior objective treatment efficacy compared with the monotherapy TAC group (OR, 3.45; 95% CI, 2.22 to 5.35; I 2 = 0%; P < 0.00001) and monotherapy 5-FU group (OR, 4.17; 95% CI, 2.21 to 7.87; I 2 = 0%; P < 0.0001). Telangiectasia was less frequent in combination therapy (OR, 0.24; 95% CI, 0.11 to 0.52; I 2 = 0%; P = 0.0003) compared with monotherapy TAC.
Combined intralesional TAC and 5-FU administration demonstrated superior treatment efficacy outcomes compared with monotherapy TAC or 5-FU. Patient-reported outcome measures should be incorporated in the design of future research to justify clinical recommendations.
Combined TAC and 5-FU has demonstrated superior treatment efficacy outcomes compared to monotherapy TAC or 5-FU in the treatment of hypertrophic scars and keloids.
瘢痕疙瘩和增生性瘢痕会导致身体和心理社会问题。 5-氟尿嘧啶（5-FU）和曲安奈德（TAC）联合使用可能会增强病理性瘢痕的治疗效果，尽管证据基础有限。作者比较了联合病灶内 TAC 和 5-FU 与单独病灶内 TAC 或 5-FU 治疗瘢痕疙瘩和增生性瘢痕的疗效和并发症发生率。
两位独立评审员通过 Embase、MEDLINE 和 CENTRAL 进行了搜索。主要结局是治疗效果（改善 51%至 100%）。使用 Cochrane 偏倚风险工具评估研究质量和偏倚风险。
在筛选出的 277 篇文章中，有 13 项研究被纳入，包括 12 项随机对照试验和 1 项非随机研究。6 项研究比较了联合病灶内治疗与单独病灶内 5-FU 治疗，9 项研究比较了联合病灶内治疗与单独病灶内 TAC 治疗。联合组与单独 TAC 组（OR，3.45；95%CI，2.22 至 5.35；I 2 = 0%；P < 0.00001）和单独 5-FU 组（OR，4.17；95%CI，2.21 至 7.87；I 2 = 0%；P < 0.0001）相比，具有更好的客观治疗效果。与单独 TAC 治疗相比，联合治疗的毛细血管扩张症发生率较低（OR，0.24；95%CI，0.11 至 0.52；I 2 = 0%；P = 0.0003）。
与单独 TAC 或 5-FU 治疗相比，联合病灶内 TAC 和 5-FU 治疗可获得更好的治疗效果。未来的研究应纳入患者报告的结局测量，以证明临床推荐的合理性。
与单独 TAC 或 5-FU 治疗相比，TAC 和 5-FU 联合治疗在治疗增生性瘢痕和瘢痕疙瘩方面具有更好的治疗效果。
