目的 评估环钻切除术联合外用曲安奈德治疗瘢痕疙瘩的临床效果及安全性。

方法 回顾性分析2024年6月至2025年3月，广西医科大学第一附属医院医疗美容科收治的瘢痕疙瘩患者临床资料。先进行环钻切除术，术后即刻以及术后前2日再联合曲安奈德局部外用治疗，术后前2日每日换药，此后改为隔日换药，直至创面结痂愈合。治疗结束后6个月，随访观察瘢痕恢复情况，采用温哥华瘢痕量表(VSS)和患者与观察者瘢痕评估量表(POSAS)对瘢痕评分。根据《中国瘢痕疙瘩临床治疗推荐指南》中的标准评价疗效(分为痊愈、显效、有效、无效)，治疗有效率＝(痊愈＋显效＋有效)例数/总例数×100%；患者进行满意度评价，包括非常满意、满意和不满意，满意率＝(非常满意＋满意)例数/总例数×100%；记录治疗后不良反应。治疗前、后VSS和POSAS评分采用配对样本 t检验， P<0.05为差异有统计学意义。

结果 纳入23例患者，共31个病变部位，男14例，女9例，年龄5~54岁，病程1~30年。治疗结束后随访6个月，患者所有部位的瘢痕疙瘩均较治疗前变平、变软，疼痛和瘙痒情况改善。治疗后6个月与治疗前VSS评分[(6.61±1.62)分比(10.91±2.61)分]、POSAS评分[(34.91±4.79)分比(61.07±5.65)分]比较，差异均有统计学意义( P均<0.01)。瘢痕评估：显效7例、有效15例、无效1例，治疗有效率为95.65%(22/23)。患者满意度：非常满意5例，满意17例，不满意1例，满意率为95.65%(22/23)。随访期间出现溃疡1例、色素沉着1例，其余患者均未发生并发症。

结论 环钻切除术联合外用曲安奈德治疗瘢痕疙瘩效果良好，具有创伤小、安全性高、满意度高以及不良反应少的优点。

基金项目： 国家自然科学基金地区科学基金项目（82160381）；广西医科大学高水平创新团队及杏湖学者计划项目（2022）；广西医科大学“四新”类项目（SX202306）

Evaluation of punch excision combined with topical triamcinolone acetonide in the treatment of keloids

Zhan Xu1,2, Liao Mingde1, Chen Ziliang1, Luo Shulin1, Hu Jinglu1, Li Chunyan1, Li Yingchun1, Lin Bojie1

1Department of Medical Cosmetology, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China;  2Department of Burn and Plastic Surgery, the Second People’s Hospital of Yulin, Yulin 537000, China

Corresponding author: Lin Bojie, Email:  linbojie@stu.gxmu.edu.cn

  【Abstract】

Objective To evaluate the clinical efficacy and safety of punch excision combined with topical triamcinolone application in the treatment of keloids.

Methods A retrospective analysis was performed on the clinical data of patients with keloids treated in the Department of Medical Cosmetology at the First Affiliated Hospital of Guangxi Medical University between June 2024 and March 2025. All patients underwent punch excision followed immediately and for the first two postoperative days by topical application of triamcinolone. Dressings were changed daily for the initial two days and then every other day until the wound crusted and healed. Six months after treatment, scar recovery was evaluated during follow-up using the Vancouver scar scale (VSS)and the patient and observer scar assessment scale (POSAS). Efficacy was assessed according to the criteria recommended in the Chinese clinical treatment guidelines for keloids, categorized as cured, excellent, effective, or ineffective. The total effective rate was calculated as (number of cured + excellent + effective cases)/total cases × 100%. Patient satisfaction was graded as very satisfied, satisfied, or dissatisfied, and the satisfaction rate was calculated as (number of very satisfied + satisfied cases)/total cases × 100%. Adverse reactions after treatment were recorded. Paired sample t-test was used to compare VSS and POSAS scores before and after the treatment, with P< 0.05 considered statistically significant.

Results A total of 23 patients (14 males, 9 females) with 31 lesions were included. The age range was 5-54 years, and disease duration ranged from 1 to 30 years. After 6 months of follow-up, all treated keloids became flatter and softer compared to before treatment, with improvement in pain and itching. Significant differences were observed between pre- and post-treatment scores: VSS scores [(6.61 ± 1.62) points vs. (10.91 ± 2.61) points, P < 0.01] and POSAS scores [(34.91 ± 4.79) points vs. (61.07 ± 5.65) points, P < 0.01]. Scar assessment showed excellent efficacy in 7 cases, effective in 15 cases, and ineffective in 1 case, yielding a total effective rate of 95.65% (22/23). Regarding satisfaction, 5 patients were very satisfied, 17 were satisfied, and 1 was dissatisfied, resulting in a total satisfaction rate of 95.65% (22/23). During follow-up, one case of ulceration and one case of hyperpigmentation were recorded; no other complications occurred in the remaining patients.

Conclusion Punch excision combined with topical triamcinolone application demonstrates favorable outcomes in the treatment of keloids, with the advantages of minimal trauma, high safety, high patient satisfaction, and few adverse reactions.

Fund program: Regional Science Foundation Project of National Natural Science Foundation of China (82160381); High-Level Innovation Team and Xinghu Scholars Program of Guangxi Medical University (2022); “Four New-Type Initiatives” Project of Guangxi Medical University (SX202306)

Disclosure of Conflicts of Interest: The authors have no financial interest to declare in relation to the content of this article.

Ethical Approval: Ethical approval was given by the Medical Ethics Committee of First Affiliated Hospital of Guangxi Medical University（2025-E0421）.