Zouboulis C C, Blume U, Büttner P, Orfanos C E
Department of Dermatology, University Medical Center Steglitz, Free University of Berlin, Germany.
Arch Dermatol. 1993 Sep;129(9):1146-51.
A variety of therapeutic regimens has been used in keloids and hypertrophic scars with unsatisfactory final results. Application of cryosurgery could be beneficial since it was reported to produce less scarring after treatment of skin tumors compared with other surgical procedures. We performed a prospective consecutive trial of randomly enrolled case series including 32 months of average follow-up to assess the outcomes of cryosurgical treatment in keloids and hypertrophic scars and to determine factors influencing the therapeutic result. Ninety-three white patients, aged 10 to 79 years (median age, 26 years) with keloids (n = 55; median duration, 36 months; median size, 4 cm2) and with hypertrophic scars (n = 38; median duration, 12 months; median size, 2 cm2) were treated using the contact method. One freeze-thaw cycle of 30 seconds per lesion and session was employed, and, if needed, treatment was repeated every 20 to 30 days.
Excellent responses (ER) were recorded in 30 subjects (32.3%), good responses (GR) in 27 (29.0%), poor responses (PR) in 27 (29.0%), while nine subjects (9.7%) did not respond at all. Hypertrophic scars responded better (n = 38; GR to ER, 76.3%) than keloids (n = 55; GR to ER, 50.9%; P < .005; odds ratio, 6.92). No progressions or recurrences occurred. Histologically, neovascularization, loss of the anarchic arrangement of collagen bundles, increased fibroblasts in a stroma running parallel to the skin surface, and mononuclear cells mostly arranged at the perivascular area were found in clinically responding lesions. Improved responses were detected in subjects treated with three or more sessions (n = 57; GR to ER, 78.9%) compared with subjects treated once or twice (n = 36; GR to ER, 33.3%; P < .001; odds ratio, 13.68). The cryosurgical treatment was generally well tolerated, with local pain during freezing and/or shortly after treatment (n = 32, 34.4%) and hypopigmentation or hyperpigmentation (n = 11, 11.8%) being the most frequent side effects.
Cryosurgery was found effective and safe in keloids and, especially, in hypertrophic scars, in an open, uncontrolled study. Satisfactory results could be obtained after at least three cryosurgical sessions of 30 seconds each, applied once monthly using the contact method of treatment.
多种治疗方案已用于瘢痕疙瘩和增生性瘢痕，但最终效果并不理想。冷冻手术的应用可能有益，因为据报道，与其他外科手术相比，其治疗皮肤肿瘤后产生的瘢痕较少。我们进行了一项前瞻性连续试验，纳入随机入组的病例系列，平均随访32个月，以评估冷冻手术治疗瘢痕疙瘩和增生性瘢痕的效果，并确定影响治疗结果的因素。93例白人患者，年龄10至79岁（中位年龄26岁），其中瘢痕疙瘩患者55例（中位病程36个月，中位大小4 cm²），增生性瘢痕患者38例（中位病程12个月，中位大小2 cm²），采用接触法进行治疗。每个皮损每次治疗采用30秒的一个冻融周期，如有需要，每20至30天重复治疗一次。
30例患者（32.3%）记录为优效反应（ER），27例（29.0%）为良好反应（GR），27例（29.0%）为差效反应（PR），9例患者（9.7%）完全无反应。增生性瘢痕的反应优于瘢痕疙瘩（38例；GR至ER为76.3%）（55例；GR至ER为50.9%；P <.005；优势比为6.92）。未发生进展或复发。组织学上，在临床有反应的皮损中发现有新生血管形成、胶原束无规则排列消失、与皮肤表面平行的基质中成纤维细胞增多以及单核细胞大多排列在血管周围区域。与接受一次或两次治疗的患者（36例；GR至ER为33.3%）相比，接受三次或更多次治疗的患者（57例；GR至ER为78.9%）反应有所改善（P <.001；优势比为13.68）。冷冻手术治疗一般耐受性良好，最常见的副作用是冷冻期间和/或治疗后不久的局部疼痛（32例，34.4%）以及色素减退或色素沉着（11例，11.8%）。
在一项开放、非对照研究中，发现冷冻手术治疗瘢痕疙瘩尤其是增生性瘢痕有效且安全。采用接触法治疗，每月一次，每次30秒，至少进行三次冷冻手术后可获得满意结果。
