瘢痕防治及其研究进展

doi:10.3877/cma.j.issn.1674-0785.2019.06.012

瘢痕是当前医学研究的重点领域之一，尤其是评价指标和防治手段已经受到越来越多的关注。瘢痕一般分为表浅性瘢痕、萎缩性瘢痕、增生性瘢痕和瘢痕疙瘩。其发生机制一般认为是皮肤创伤愈合过程中，由于各种因素导致的伤口中成纤维细胞异常增生、胶原合成分泌和降解失衡，最终形成伤口皮肤组织异常过度增生。瘢痕严重程度主要依靠温哥华瘢痕量表（VSS）、患者和观察者瘢痕评估量表（POSAS）进行评测。其治疗手段主要有压力疗法、硅凝胶疗法、放射疗法、激光疗法、激素注射疗法以及手术切除治疗等，目前认为多种疗法联合治疗仍是瘢痕防治安全、有效的策略。

关键词: 瘢痕, 增生性, 瘢痕疙瘩, 手术, 联合治疗

At present, scar is one of the key areas of medical research, and its evaluation, prevention, and control methods have received more and more attention. Scar is generally divided into superficial scar, atrophic scar, hypertrophic scar, and keloid. The mechanism is thought to involve abnormal proliferation of fibroblasts and imbalance of secretion, synthesis, and degradation of collagen caused by various factors during the skin wound healing process, which eventually result in the formation of abnormal hypertrophic skin tissue. The severity of scar is measured mainly using the Vancouver scar scale (VSS), the Patient and Observer scar Assessment scale (POSAS) and so on. Its main treatments include pressure therapy, silicone gel therapy, radiation therapy, laser therapy, intralesional corticosteroids, and surgical therapy. Now it is believed that combination therapy is still the safe and effective strategy for the prevention and control of scar.

Key words: Scar, Hyperplastic, Keloid, Surgery, Combined therapy

表1 温哥华瘢痕量表指标及评分标准

指标	0分	1分	2分	3分	4分	5分
色泽	正常	较浅	深浅混合	较深	?	?
厚度	正常	<1 mm	<1~2 mm	<2~4 mm	>4 mm	?
血管分布	正常	肤色粉红	肤色偏红	肤色为紫色	?	?
柔软度	正常	柔软（最少阻力下皮肤变性）	柔顺（压力下变性）	较硬（不能变形，对压力有阻力）	弯曲（组织如绳状）	挛缩（致残或扭曲）

表1 温哥华瘢痕量表指标及评分标准

指标	0分	1分	2分	3分	4分	5分
色泽	正常	较浅	深浅混合	较深	?	?
厚度	正常	<1 mm	<1~2 mm	<2~4 mm	>4 mm	?
血管分布	正常	肤色粉红	肤色偏红	肤色为紫色	?	?
柔软度	正常	柔软（最少阻力下皮肤变性）	柔顺（压力下变性）	较硬（不能变形，对压力有阻力）	弯曲（组织如绳状）	挛缩（致残或扭曲）

图1 增生性瘢痕防治方案流程

图2 瘢痕疙瘩防治方案流程

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