Clinical study of ear keloids with surgical excision and intraoperative low-energy X-ray irradiation therapy
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摘要: 目的 探讨手术切除联合术中低能X射线照射治疗耳部瘢痕疙瘩的临床疗效。方法 回顾性分析2019年3月—2022年11月在天津市第一中心医院耳鼻咽喉头颈外科接受单纯手术治疗或手术联合放射治疗的32例耳部瘢痕疙瘩病灶的临床资料。其中接受放疗10例，未接受放疗22例。放疗组接受大分割剂量50 kV低能X射线进行照射。分割方式为：第1次于术中放疗10 Gy，第2次于术后第3天放疗8 Gy，总量18 Gy。随访8~52个月，观察其局部疗效及皮肤放射反应。结果 中位随访26个月，截止最后一次随访日期，放疗组9例治愈，1例无效，有效率90%；未放疗组9例治愈，13例无效，有效率40.9%。耳部瘢痕疙瘩的复发与患者发病的侧别、部位、病因均无关(P>0.05)。复发与是否接受放疗有关(χ2=4.885，P＜0.05)，放疗组的复发率(10.0%)明显低于未放疗组(59.1%)。结论 手术切除联合低能X射线照射是治疗耳部瘢痕疙瘩的一种有效方法，尤其是采用术中放疗可取得较为满意的疗效。Abstract: Objective To explore the clinical efficacy of surgical excision combined with low-energy X-ray irradiation in the treatment of ear keloids.Methods Clinical data of 32 cases of ear keloid lesions that received surgical treatment alone or surgery combined with radiotherapy from March 2019 to November 2022 in the Department of Otorhinolaryngology Head and Neck Surgery of the Tianjin First Central Hospital were retrospectively analyzed. Among them, 10 cases received radiotherapy and 22 cases did not receive radiotherapy. The radiotherapy group received irradiation with a large divided dose of 50 kV low-energy X-rays. The mode of fractionation radiotherapy was as follows: the first was 10 Gy of intraoperative radiation therapy and the second was 8 Gy on the 3rd postoperative day for a total of 18 Gy. The local efficacy and skin radiation reaction were observed at a follow-up of 8-52 months.Results The median follow-up was 26 months, and as of the date of the last follow-up, 9 cases were cured and 1 case was ineffective in the radiotherapy group, with an effective rate of 90.0%, while 9 cases were cured and 13 cases were ineffective in the no-radiotherapy group, with an effective rate of 40.9%. The recurrence of ear keloids was not related to the side, site, or etiology of the patient's onset(P>0.05). Recurrence was related to whether or not the patients received radiotherapy(χ2=4.885, P < 0.05), and the recurrence rate in the radiotherapy group(10.0%) was significantly lower than that in the non-radiotherapy group(59.1%).Conclusion Surgical excision combined with low-energy X-ray irradiation therapy is an effective method of treating keloids in the ear, especially with intraoperative radiation therapy can achieve more satisfactory results.
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Key words:
- ear keloid /
- radiotherapy /
- intraoperative radiation therapy
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表 1 耳部瘢痕疙瘩患者治疗后复发情况
项目 例数 复发/例(%) χ2 P 性别 2.930 0.087 男 6 5(83.3) 女 26 9(34.6) 侧别 0.000 1.000 左 18 8(44.4) 右 14 6(42.9) 部位 5.206 0.157 耳垂 10 4(40.0) 耳轮 15 6(40.0) 耳后 5 4(80.0) 舟状窝 2 0(0) 病因 2.397 0.494 打耳洞 20 8(40.0) 外伤 4 2(50.0) 手术 4 3(75.0) 原因不详 4 1(25.0) 是否放疗 4.885 ＜0.05 是 10 1(10.0) 否 22 13(59.1) 
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