Department of Dermatology, Second Xiangya Hospital, Central South University, Changsha, China.
Department of Dermatology, The Third Hospital of Changsha, Changsha, China.
Int Wound J. 2024 Mar;21(3):e14449. doi: 10.1111/iwj.14449. Epub 2023 Nov 15.
This meta-analysis aims to evaluate and compare the effect of surgical excision followed by adjuvant radiotherapy and laser combined with steroids on keloids. Relevant studies reporting the recurrence rate or incidence of adverse events (AEs) were retrieved from the PubMed, Web of Science, Embase and Cochrane Library databases through August 2023. The quality of noncomparative single-arm clinical trials was evaluated using the methodological index for nonrandomised studies (MINORS) Methodological items. This meta-analysis was conducted utilizing Stata 12.0 statistical software. 26 studies involving 989 patients were included in the analysis. The recurrence rate in the laser combined with steroids therapy group (12.2%, 95% confidence interval [CI]: 5.9%-18.5%) was lower than that of the surgical excision combined with radiotherapy group (13.5%, 95% CI: 6.6%-22.2%). For the incidence of AEs, relatively low incidence of atrophy (0.0%, 95% CI: 0.0%-1.2%), telangiectasia (3.2%, 95% CI: 0.4%-7.6%), erythema (2.3%, 95% CI: 0.0%-10.6%), infection (0.2%, 95% CI: 0.0%-1.6%) and high hyperpigmentation rate (8.3%, 95% CI: 4.2%-13.4%) were obtained in the surgical excision combined with radiotherapy group. Compared with surgical resection followed by radiotherapy, the combination of laser and steroids for keloids showed a lower hyperpigmentation rate (6.5%), as well as a higher incidence of atrophy (22.7%), telangiectasia (6.4%), erythema (3.3%) and infection (3.3%). Only a hypopigmentation rate of 2.9% was obtained in patients treated with surgical excision plus radiotherapy. Current evidence revealed that surgical excision followed by adjuvant radiotherapy and laser combined with steroids therapy were effective and safe treatments for keloids, with relatively low recurrence rate and complication rate. Comparative studies are needed to further compare the effects of these two combination therapies on keloids.
本荟萃分析旨在评估和比较手术切除加辅助放疗与激光联合皮质类固醇治疗瘢痕疙瘩的效果。从 2023 年 8 月起，通过 PubMed、Web of Science、Embase 和 Cochrane Library 数据库检索报告复发率或不良事件（AE）发生率的相关研究。使用非随机研究方法学指数（MINORS）方法评估非比较性单臂临床试验的质量。该荟萃分析使用 Stata 12.0 统计软件进行。分析纳入了 26 项涉及 989 例患者的研究。激光联合皮质类固醇治疗组的复发率（12.2%，95%置信区间[CI]：5.9%-18.5%）低于手术切除联合放疗组（13.5%，95%CI：6.6%-22.2%）。对于 AE 的发生率，萎缩的发生率相对较低（0.0%，95%CI：0.0%-1.2%）、毛细血管扩张（3.2%，95%CI：0.4%-7.6%）、红斑（2.3%，95%CI：0.0%-10.6%）、感染（0.2%，95%CI：0.0%-1.6%）和高色素沉着率（8.3%，95%CI：4.2%-13.4%）。手术切除联合放疗组的色素减退发生率（6.5%）较低，而萎缩（22.7%）、毛细血管扩张（6.4%）、红斑（3.3%）和感染（3.3%）的发生率较高。手术切除加放疗组仅获得 2.9%的色素减退率。目前的证据表明，手术切除加辅助放疗和激光联合皮质类固醇治疗瘢痕疙瘩是有效且安全的方法，复发率和并发症率相对较低。需要进行比较研究以进一步比较这两种联合疗法对瘢痕疙瘩的效果。
