【摘要】：第一部分:綜述:病理性瘢痕的發(fā)病機(jī)制及治療進(jìn)展瘢痕是各種創(chuàng)傷所引起的正常皮膚組織外觀形態(tài)和組織病理學(xué)改變的統(tǒng)稱,是人體創(chuàng)傷修復(fù)過程中必然的產(chǎn)物。傷口愈合過程中各種原因?qū)е碌鸟：圻^度增生,即稱之為病理性瘢痕,包括增生性瘢痕(HTS)和瘢痕疙瘩。病理性瘢痕不僅影響患者的美觀,若生長過大且靠近關(guān)節(jié)等部位,還會對患者的機(jī)體功能造成一定的限制,此外,病理性瘢痕本身有時(shí)會伴有疼痛、瘙癢以及感覺過敏,對患者正常的生活質(zhì)量的影響很大。增生性瘢痕和瘢痕疙瘩的治療一直以來都是整形外科的重大難題之一,由于其發(fā)病機(jī)制尚不明確,雖然經(jīng)過多年研究探索出的治療方法很多,如藥物治療,物理治療,手術(shù)治療,綜合治療等,至今仍無一個(gè)令人滿意的治療方案。本文針對增生性瘢痕及瘢痕疙瘩,關(guān)注于兩者的發(fā)病過程、分子基礎(chǔ)、臨床分類、治療方法以及治療流程。為增生性瘢痕和瘢痕疙瘩的臨床綜合治療提供參考。第二部分:穿耳孔后瘢痕疙瘩綜合治療病例報(bào)道目的:探索穿耳孔后瘢痕疙瘩的綜合治療方案。方法:選取典型穿耳孔后出現(xiàn)耳部瘢痕疙瘩的患者,對耳部瘢痕疙瘩采取一次性手術(shù)切除,無張力縫合,術(shù)后3周應(yīng)用曲安奈德(昆明積大)40mg+透明質(zhì)酸酶(上海第一生化藥業(yè)有限公司)1500u+2%利多卡因2ml+生理鹽水lml,行預(yù)防性注射治療。結(jié)果:患者瘢痕完全去除,隨訪44個(gè)月未復(fù)發(fā)。結(jié)論:耳部瘢痕疙瘩應(yīng)用手術(shù)切除聯(lián)合術(shù)后曲安奈德、透明質(zhì)酸酶預(yù)防性注射治療,可降低術(shù)后瘢痕疙瘩的復(fù)發(fā),值得進(jìn)一步探索與臨床推廣。
[Abstract]:Part I: the pathogenesis and treatment progress of pathological scar is a general term of normal skin appearance and histopathology caused by various kinds of trauma, and is an inevitable product in the process of wound repair. Scar hypertrophy caused by various causes during wound healing is called pathological scar, including hypertrophic scar (HTS) and keloid. Pathological scars not only affect the beauty of the patient, but also limit the function of the patient if they grow too large and close to the joints. In addition, the pathological scar itself is sometimes accompanied by pain, itching and feeling allergic. It has a great impact on the patient's normal quality of life. The treatment of hypertrophic scar and keloid has always been one of the major problems in plastic surgery, because the pathogenesis of hypertrophic scar and keloid is still unclear, although after many years of research, there are many treatment methods, such as drug therapy, physical therapy, Surgical treatment, comprehensive treatment, and so on, there is still no satisfactory treatment. This article focuses on the pathogenesis, molecular basis, clinical classification, treatment and treatment process of hypertrophic scar and keloid. To provide a reference for the clinical comprehensive treatment of hypertrophic scar and keloid. Part two: comprehensive treatment of keloid after perforating auricle objective: to explore the comprehensive treatment of keloid after perforating auricle. Methods: the typical patients with keloid after perforating auricular foramen were treated with one-off surgical excision and tension-free suture. Triamcinolone acetonide (Kunming Jida) 40mg hyaluronidase (Shanghai first biochemical Pharmaceutical Co., Ltd.) 1500u 2% lidocaine 2ml saline lml, was used for prophylactic injection 3 weeks after operation. Results: the scar was completely removed and no recurrence occurred after 44 months follow-up. Conclusion: surgical resection combined with triamcinolone acetonide and hyaluronidase injection can reduce the recurrence of keloid.
【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R622

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