Clinical effect of surgery combined with photodynamic therapy for ear keloid
10.3760/cma.j.cn114453-20231031-00171
- VernacularTitle:手术联合光动力治疗耳部瘢痕疙瘩的临床效果
- Author:
Baoyan ZHANG
1
;
Li LI
1
;
Huimin WANG
1
;
Huirong CHEN
1
Author Information
1. 晋中市第一人民医院皮肤性病科，晋中 030600
- Publication Type:Journal Article
- Keywords:
Keloid;
Ear auricle;
Photodynamic therapy;
Isotope;
90Sr- 90Y applicator
- From:
Chinese Journal of Plastic Surgery
2024;40(12):1322-1330
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the clinical effect of surgery combined with photodynamic therapy on ear keloid.Methods:The clinical data of patients with ear keloid admitted to the Department of Dermatology and Venereology, the First People’s Hospital of Jinzhong were analyzed retrospectively. According to the treatment methods, they were divided into surgery combined with isotope therapy group (isotope group) and surgery combined with photodynamic therapy group (photodynamic group). Patients in both groups underwent surgical excision of keloid core first. In the isotope group, stitches were removed on the 7th day after the operation. After stitches were removed, 90Sr- 90Y applicator was applied to the skin close to the incision for 5 min each time, once every other day, with a dose of 6 Gy each time and a total dose of 18 Gy for three times, and the second course was conducted after an interval of 3 months. In the photodynamic group, photodynamic therapy was performed on the third day after the operation. The prepared 5-aminolevulinic acid solution with a concentration of 20% was applied to the incision of ear keloid surgery, and then it was sealed in the dark for 3 hours. After that, it was irradiated with a photodynamic laser therapeutic instrument with a wavelength of 635 nm, with an irradiation distance of 10 cm, an energy density of 80-100 J/cm 2, an irradiation time of 30 min. The treatment was performed 3 times with an interval of 7-10 days. Before the operation and one year after treatment, two dermatologists who participated in the treatment used Vancouver scar scale (VSS) to score scars, with a total score of 0-10 points. The higher the score, the more serious the scar. The patients scored the scar by the patient scar assessment scale (PSAS), with a total score of 6-60 points. The higher the score, the more serious the scar. One year after the end of treatment, the therapeutic effect (including cured, effective and ineffective) was evaluated, and the total effective rate [(cured cases+ effective cases)/total cases ×100%] and the recurrence rate (recurrent cases/total cases ×100%) were analysed. The treatment process and complications of the two groups were recorded. SPSS 22.0 software was used to analyze the data. The measurement data in accordance with normal distribution were expressed as Mean±SD. Comparisons between the groups were performed using t-test, and comparisons within the groups were performed using paired t-test. The counting data was expressed by the number of cases and percentage. Chi-square test was used for the comparison between groups. P<0.05 indicated that the difference was statistically significant. Results:Thirty-one patients (6 males and 25 females) were included in the isotope group. The age was (35.0±1.1) years. The course of disease was (2.0±1.1) years. The volume of keloid was (1.8±0.1)cm 3. Thirty cases were included in photodynamic group, 6 males and 24 females. The age was (34.0±4.8) years, the course of disease was (2.0±0.5) years, and the volume of keloid was (1.7±0.3) cm 3. There was no significant difference in general data between the two groups ( P>0.05). The ear keloids of 61 patients were all removed and the incision healed well. The VSS score in isotope group was (2.72±0.06) points one year after treatment, which was significantly lower than that before treatment [(8.36±0.12) points] ( t=2.75, P<0.001). The VSS score in photodynamic group was (2.81±0.04) points one year after treatment, which was also significantly lower than that before treatment [(8.21±0.34) points] ( t=2.77, P<0.001). There was no significant difference in VSS scores between the two groups before treatment and one year after treatment ( P>0.05). PSAS score in isotope group was (8.80±0.02) points one year after treatment, which was significantly lower than that before treatment [(44.51±0.15) points] ( t=2.83, P<0.001). The PSAS score in photodynamic group was (8.80±0.06) points one year after treatment, which was also significantly lower than that before treatment [(44.60±0.27) points] ( t=2.90, P<0.001). There was no significant difference in PSAS scores between the two groups before treatment and one year after treatment ( P>0.05). One year after treatment, 22 cases were cured, 7 cases were markedly effective and 2 cases were ineffective in the isotope group, with a total effective rate of 93.5% (29/31) and a recurrence rate of 6.5% (2/31). In the photodynamic group, 19 cases were cured, 8 cases were markedly effective and 3 cases were ineffective. The total effective rate was 90.0% (27/30) and the recurrence rate was 10.0% (3/30). There were no significant differences in the total effective rate, and the recurrence rate between the two groups ( P>0.05). All patients in the isotope group had itchy skin on the second day of treatment, and 22 cases were accompanied by desquamation. Symptoms disappeared in 25 cases after symptomatic treatment. Six patients developed radiation dermatitis, and the skin healed after symptomatic treatment. However, 2 patients with skin ulceration showed depigmentation at the skin lesions. The patients in the photodynamic group showed mild redness and swelling on the second day after treatment, accompanied by slight itching and desquamation, and the symptoms subsided spontaneously in 1-3 days. Pigmentation appeared in 12 cases at 1 week, and subsided spontaneously 1 week after treatment. No skin ulceration and depigmentation occurred. Conclusion:Surgery combined with photodynamic therapy can improve the appearance of ear keloids, relieve the clinical symptoms of patients and reduce the recurrence rate. Its curative effect is equivalent to isotope therapy, but there are fewer complications and higher safety.
