组织工程与重建外科杂志

组织工程与重建外科杂志 ›› 2022, Vol. 18 ›› Issue (1): 62-.

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放射性溃疡严重程度分型及临床治疗分析

  

  • 出版日期:2022-02-01 发布日期:2022-06-22

Clinical analysis of the treatment and severity classification in radiation ulcer patients　

  • Online:2022-02-01 Published:2022-06-22

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摘要： 目的　按照自定义分型标准，分析不同程度放射性溃疡的临床特点及治疗结果。方法　将影响放射性溃疡严重程度的主要因素按不同权重计分，分为轻、中、重3型。以此为标准，对我院2014年4月至2020年9月收治的放射性溃疡患者进行回顾性分析，对不同严重程度及不同原发疾病患者的治疗及随访结果进行分组比较。结果　共31例患者纳入本研究。轻、中、重3型分别为3例（10.7%）、12例（38.7%）及16例（51.6%）。患者中9例（29.0%）行保守治疗，14例（45.2%）采用局部带蒂皮瓣修复，8例（25.8%）以游离皮瓣修复。3型患者中分型越重溃疡病程越久，采用皮瓣修复者越多，治疗费用越高，创面愈合时间越长（P＜0.05）。轻、中、重3型患者组的临床治愈率分别为87.5%、100%、100%，溃疡复发率分别为33.3%、25.0%、21.4%，差异无统计学意义（P＞0.05）。患者行放疗的原发病因包括乳腺癌12例（38.7%）、生殖系统恶性肿瘤5例（16.1%）、皮肤鳞癌4例（12.9%）、血管病变4例（12.9%）、皮肤纤维肉瘤3例（9.7%）、鼻咽癌2例（6.5%）、淋巴瘤1例（3.2%）。不同原发病因患者的溃疡严重程度不一（P＜0.05），但临床痊愈率及溃疡复发率无统计学差异（P＞0.05）。结论　不同严重程度放射性溃疡患者的溃疡病程、治疗方法、创面愈合时间及治疗费用有统计学差异，本分型标准对放射性溃疡的病情判断及临床治疗有指导作用。

关键词: 慢性溃疡, 　放射性, 　皮瓣, 　分型, 　标准, 　严重程度

Abstract: Objective　To analyze the clinical characteristics and treatment effects of different degrees radiation ulcers according to the self-defined classification standard. Methods　The main factors affecting the severity of radiation ulcers were scored according to different weighting, which were defined as mild, moderate, and severe. Based on this standard, the patients of radiation ulcer admitted to our hospital from April 2014 to September 2020 were analyzed retrospectively, in addition, the treatment and follow-up results of patients with different severity and different primary diseases were grouped and compared. Results　A total of 31 patients were enrolled in this study. There were 3 cases (10.7%) of mild type, 12 cases (38.7%) of moderate type and 16 cases (51.6%) of severe type. Among the patients, 9 cases (29.0%) were repaired with conservative treatment, 14 cases (45.2%) were repaired with local pedicle flaps, and 8 cases (25.8%) were repaired with free flaps. In these three types of patients, the more severe the classification, the longer the course of the ulcer, the more flaps were used to repair, the higher the cost of treatment, and the longer the wound healing time (P<0.05). The clinical cure rates were 87.5%, 100%, and 100% in the mild, moderate, and severe groups respectively, and the ulcer recurrence rates were 33.3%, 25.0%, and 21.4% respectively, with no significant difference (P>0.05). The primary causes of radiotherapy included breast cancer in 12 cases (38.7%), malignant tumors of the reproductive system in 5 cases (16.1%), cutaneous squamous cell carcinoma in 4 cases (12.9%), angiopathy in 4 cases (12.9%), dermatofibrosarcoma in 3 cases (9.7%), nasopharyngeal carcinoma in 2 cases (6.5%), and lymphoma in 1 case (3.2%). The severity of ulcers varied in patients with different primary causes (P<0.05), but there was no significant difference in the clinical recovery rate and ulcer recurrence rate (P>0.05). Conclusion　There are statistical differences in the ulcer course, treatment methods, wound healing time and treatment costs among patients with radiation ulcers of different severity. Moreover, this classification standard has a guiding effect on the disease judgment and clinical treatment.

Key words: Chronic ulcer, 　Radioactivity, 　Flap, 　Classification, 　Standard, 　Severity