A型肉毒素抑制内眦赘皮术后瘢痕的观察

Comparative observation of type A botulinum toxin inhibiting the postoperative scar formation of epicanthus

摘要:

目的：探讨A型肉毒毒素在内眦赘皮术中应用抑制瘢痕形成的安全性和疗效。

方法：选择2012-03/2014-03在我院眼部整形美容科接受内眦赘皮患者，按就诊顺序随机分为两组：术毕即刻进行A型肉毒毒素局部注射的39例患者作为治疗组； 另选取42例作为对照组。采用国际推荐的OSAS瘢痕评价量表，由两位经验丰富的整形医师对两组患者术前及术后6mo的瘢痕情况进行评估，分别从瘢痕颜色、平整度、弹性程度及瘢痕宽度4个方面对瘢痕的整体情况进行评估打分，对两组术后1，6mo的瘢痕情况评估后进行统计学分析。

结果：治疗组4例、对照组6例失访，其余患者按期回访评估。术后1mo瘢痕的颜色、弹性、平整性及宽度与对照组相比，差异有统计学意义(P<0.05)； 术后6mo瘢痕的颜色、弹性与对照组相比无统计学差异(P>0.05)； 而瘢痕的平整度及宽度与对照组相比，差异有统计学意义(P<0.05)。每组在不同的时间分别比较均发现，1mo时瘢痕的颜色、隆起度、宽度及硬度达到峰值，与6mo相比具有统计学差异。治疗组随诊期间无1例诉伤口牵扯痛及痒感，对照组于术后3mo内有5例患者伤口有轻微痒感； 无任何并发症发生。

结论：A型肉毒毒素可在一定程度上减轻内眦赘皮矫正术后短期的瘢痕形成，及术后炎症反应性痒感及牵扯痛，可达到远期切口平整的外观，降低瘢痕增生的风险，值得在临床上推广应用。

Abstract:

AIM:To study the efficacy and safety of botulinum toxin type A in inhibiting scar formation of epicanthus.

METHODS: Patients with epicanthus received by our plastic department from March 2012 to March 2014 were chosen and randomly divided into two groups: Treatment group, 39 patients injected botulinum toxin immediately after surgery; Control group, 42 patients received correction of epicanthus without injection of botulinum toxin. Two experienced plastic surgeons evaluate the scar of patients in each group 6mo after the surgery by using internationally recommended OSAS scar evaluation questionnaire from color, smoothness, elasticity and scar width. The scar of two groups in 1 and 6mo after surgery were assessed respectively and statistical analysis was done.

RESULTS: Four patients in the treatment group and 6 patients in the control group were lost to follow-up, while the others were on regular follow-up and evaluation. The postoperative scar scoring in color, smoothness, elasticity and scar width had statistical significance compared to the control group in 1mo after surgery(P<0.05). Postoperative scar scoring in 6mo after surgery had no statistically significant difference in the color and elasticity(P>0.05), but in the smoothness and scar width(P<0.05). The most obvious scar occurs after 1mo, and had a statistically significant difference compared to 6mo after surgery(P<0.05). During the follow-up, no one complained wound pain and itching in treatment group, while 5 patients had a slight wound itch within 3mo after surgery in the control group; no complications occurred in two groups.

CONCLUSION: Botulinum toxin can not only reduce the short-term postoperative scar formation and inflammatory reaction itching and pain to a certain extent, but also achieve long-term flat appearance of incision and reduce the risk of scarring, which deserves an application in clinical practice.