| Background and Objective:Cutaneous wound healing is a complicated process that involves the combination of several molecular,cellular,physiological,biochemical and mechanical factors,Abnormal wound healing occurs as a result of perturbation of the intricate balance during the process of repair.Environmental factors and genetic factors have been proposed to contribute to abnormal skin scar formation.This may result in the formationofraiseddermalscars in the form of hypertrophic and keloid scars.Keloid scars(KS)are raised dermal lesions that spread beyond the boundaries of the original wound and invade the healthy surrounding tissue.They can affect any race but they occur more frequently in black individuals,Hispanics and Asians,populations.Keloids are benign skin tumors.Despite their benign nature,they can be aesthetically disabling.Also,They are often accompanied by unpleasant symptoms such as pain,burning and itching,and even affect the function having a greatly negative impact on the quality of life,so to bring a great damage on physical and mental of patients.Therefore,it is one of the hot topics to find an effective treatment.Presently,the treatment of KS can be divided into surgical treatment,laser treatment,physical therapy and drug treatment,but each treatment has its own advantages and disadvantages.Therefore,in order to complement various methods,comprehensive treatment is often used in clinical treatment.Common KS comprehensive treatment: surgery combined with radiotherapy,surgery combined with drug therapy,cryotherapy combined with drug therapy,etc.Surgical resection combined with radiotherapy is widely considered to be the best treatment.At the present stage,the main application of radiotherapy is 90Sr-90 Y and electron.In this study,we analyzed and compared the clinical efficacy of 90Sr-90 Y irradiation and postoperative electron beam irradiation in order to explore the differences of two therapeutic schemes for KS.Methods: 1.The Information is from January 2013 to December 2015 for treatment in the China-Japan Union hospital of Jilin University,clinically diagnosed of keloid.The number of the patients is 254.In this study,patients were randomly divided into two groups,Group A and Group B.Group A:Postoperative 90Sr-90 Y sticking therapy is applied to a total of 116 cases.Because of phone disconnected or the phone number errors,we lost 16 cases.Lost rate is 13.80%.Success cases are 100.Male cases are 42,while female cases are 86.Total of KS is 118.Distribution parts: craniofacial:7,neck:9,lobe :36,chest:26,shoulder back:7,abdomen:14,perineum:4,limbs: 15.Group B:Postoperative electron beam radiation therapy is applied to a total of 138 cases.Because of phone disconnected or the phone number errors,we lost 25 cases.Lost rate is 18.12%.Success cases are 113.Male cases are 25,while female cases are 88.Total of KS is 142.Distribution parts: craniofacial:4,neck:10,lobe :56,chest:38,shoulder back:13,abdomen:6,perineum:3,limbs: 12.2.Group A: The patients cut off the keloid in surgical department.Within 24 hours after operation,we use the rubber shielding with thickness of about 3mm to shield normal skin around keloid and the 90Sr/90 Y applicator provided by the China Atomic Hi-tech to be placed directly on the surface of incision for irradiation,7-8 days,once a day,a total of DT2000 c Gy-DT3000 c Gy.Group B:The patients cut off the keloid in surgical department.Within 24 hours after operation,we use Elekta Synergy linear accelerator to radiate the scars.Electron beam dose is 6Me V,It is source skin distance irradiation technology,and the radiation field covers the periphery of the lesion(Including the suture needle)2cm.A single dose of DT/f200 c Gy,a total of 10 times or 15 times,the total dose of DT2000 c Gy-DT3000 c Gy.3.Follow-up records: Get results outpatient review or by telephone after at least one year after radiotherapy.4.therapeutic evaluation:(1)Cure:No recurrence after operation fort 1 year,nothickening of the wound and conscious symptoms disappearing.(2)Markedly: No significant growth of keloid after operation for 1 year,KS formation of wound with flat appearance of the incision or higher than that of the skin <2 mm,local softening,Slight pigmentation and conscious symptoms disappearing.(3)Effective: Significant growth of keloid after operation for 1 year,KS formation of wound with the degree of KS hyperplasia better than before and higher than that of the skin>2 mm,local softening,pigmentation and conscious symptoms improved.(4)Significant: growth of keloid after operation for 1 year,KS formation of wound with the degree of KS hyperplasia worse than before,no sign improved and conscious symptoms improved.(5)Total effective rate: the number of cured and markedly percentage of total.5.Diverse reactions: On the basis of RTOG.6.Statistics: Using SPSS software.X2 method performed statistical analysis of the factors affecting the efficacy and adverse reaction,P <0.05 is considered statistically significant.Results: According to the criteria of the treatment of keloids:Total effective rate of Group A is 69.49% while that of Group B is 77.46%.There is no significant difference on the total efficiency rate between two group.Comparison of the curative effect of Group A between gender,male patients’ is 64.71%,while females’ is 71.43%,P>0.05.Gender has no significant difference on the efficiency rate.Comparison of the curative effect of Group B between gender,male patients’ is 72.09%,while females’ is 79.80%,P>0.05.Gender has no significant difference on the efficiency rate.Comparison of the curative effect of Group A between age,P>0.05.Age has no significant difference on the efficiency rate.Comparison of the curative effect of Group B between age,P>0.05,age has no significant difference on the efficiency rate.Comparison of the curative effect of Group A between parts,P>0.05,Parts have no significant difference on the efficiency rate.Comparison of the curative effect of Group B between parts,P>0.05,parts have no significant difference on the efficiency rate.Comparison of the curative effect of Group A between high-tension parts and low-tension parts,high-tension parts’ is 66.04% while low-tension parts’ is72.31%,P>0.05.Low-tension parts or not has no significant difference on the efficiency rate.Comparison of the curative effect of Group B between high-tension parts and low-tension parts,high-tension parts’ is 68.18% while low-tension parts’ is 85.53%,P<0.05.Low-tension parts or not has significant difference on the efficiency rate.Comparison of the curative effect of high-tension parts between two groups,P>0.05,there is no significant difference on the efficiency rate.Comparison of the curative effect of low-tension parts between two groups,P>0.05,there is no significant difference on the efficiency rate.According to RTOG,comparison of the curative effect of early side reaction between two groups,P<0.05,there is significant difference on the efficiency rate.Comparison of the curative effect of late side reaction between two groups,P>0.05,there is no significant difference on the efficiency rate.Conclusions: 1.The 90Sr-90 Y applicator,the same as accelerator,is the matrix of pure electric line.There is no significant difference in the total effective rate between 90Sr-90 Y applicator and accelerator.2.The recurrence rate of high tension parts is higher than that of low tension parts.3.Gender and age have nothing to do with the efficacy of radiotherapy. |
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