手术与曲安奈德联合治疗瘢痕疙瘩的临床医学进展

Clinical Advances in the Combination of Surgery and Triamcinolone Acetonide in the Treatment of Keloids

摘要: 瘢痕疙瘩作为病理性瘢痕的典型类型，因其侵袭性生长和复发性特点，临床治疗面临挑战。近年来，手术联合曲安奈德局部注射的联合疗法因其协同增效作用成为研究热点。手术切除可快速去除病灶，但单纯手术复发率高达40%~80%，而术后辅以曲安奈德(糖皮质激素类药物)局部注射可通过抑制成纤维细胞增殖、减少胶原合成及调控炎症因子(如TGF-β、IL-6)表达，显著降低复发风险。临床研究表明，联合治疗可将复发率降至10%~20%，尤其适用于耳部、胸壁等高复发部位。技术进步推动了给药方式的优化，如超声引导下精准注射、纳米缓释载体(如脂质体曲安奈德)的应用，提高了药物渗透性并减少了全身副作用(如皮肤萎缩)。此外，联合疗法常与激光、硅酮贴片等辅助手段联用，形成多模式治疗方案。然而，个体疗效差异、激素相关副作用(如色素脱失)及长期安全性仍需关注。未来的研究方向包括基因分型指导个性化用药、长效缓释技术开发，以及联合免疫调节剂(如抗IL-10抗体)以增强疗效。综上，手术联合曲安奈德治疗在控制瘢痕疙瘩复发中展现出显著优势，但仍需更多高质量的临床试验验证其长期效果与安全性。

Abstract: As a typical type of pathological scar, keloids face challenges in clinical treatment due to their aggressive growth and recurrent characteristics. In recent years, the combination therapy of surgery combined with local injection of triamcinolone acetonide has become a research hotspot due to its synergistic effect. Surgical resection can quickly remove the lesion, but the recurrence rate of surgery alone is as high as 40%~80%, and postoperative adjuvant triamcinolone acetonide (glucocorticoid) local injection can significantly reduce the risk of recurrence by inhibiting fibroblast proliferation, reducing collagen synthesis and regulating the expression of inflammatory factors (such as TGF-β and IL-6). Clinical studies have shown that combination therapy can reduce the recurrence rate to 10%~20%, especially for high-recurrence sites such as ears and chest wall. Technological advancements have led to the optimization of drug delivery methods, such as ultrasound-guided precision injection, the use of nano-sustained-release carriers (e.g., liposomal triamcinolone acetonide), which have improved drug permeability and reduced systemic side effects (e.g., skin atrophy). In addition, combination therapy is often combined with adjunctive means such as lasers and silicone patches to form a multimodal treatment plan. However, individual differences in efficacy, hormone-related side effects (e.g., depigmentation), and long-term safety remain concerns. Future research directions include genotyping to guide personalized medicine, development of long-acting sustained-release technologies, and combination of immunomodulators (e.g., anti-IL-10 antibodies) to enhance efficacy. In conclusion, surgery combined with triamcinolone acetonide treatment has shown significant advantages in controlling keloid recurrence, but more high-quality clinical trials are still needed to verify its long-term efficacy and safety.