注射用A型肉毒毒素聯(lián)合曲安奈德加5-FU聯(lián)合注射在下頜角增生性瘢痕中的應(yīng)用

張怡 趙小暉 吳信峰

[摘要]目的：探討注射用A型肉毒毒素聯(lián)合曲安奈德加5-FU聯(lián)合注射治療下頜角痤瘡后增生性瘢痕的療效。方法：選擇2015年10月-2017年10月筆者科室診治的30例下頜角痤瘡后增生性瘢痕患者，均接受A型肉毒毒素聯(lián)合曲安奈德加5-FU聯(lián)合注射，增生性瘢痕面積0.3cm×0.5cm～2.0cm×3.0cm，高度0.5～1.5cm，評(píng)估咬肌肥大程度及頸闊肌緊張程度。使用注射用A型肉毒毒素注射咬肌及下頜緣，使用曲安奈德加5-FU行皮損內(nèi)低壓注射1次。間隔2周或3個(gè)月間斷行皮損內(nèi)低壓注射，直至無復(fù)發(fā)情況出現(xiàn)。治療后隨訪12～24個(gè)月，評(píng)價(jià)療效。結(jié)果：30例患者均全部緩解，18例患者治療1～2次后瘢痕完全萎縮，無復(fù)發(fā)情況;11例患者注射4～6次后瘢痕萎縮，隨訪1年，無復(fù)發(fā)情況;1例患者注射13次，隨訪1年，無復(fù)發(fā)。結(jié)論：注射用A型肉毒毒素聯(lián)合曲安奈德加5-FU聯(lián)合注射是治療下頜角痤瘡后增生性瘢痕較好的方法。

[關(guān)鍵詞]下頜角瘢痕;皮損內(nèi)注射;注射用A型肉毒毒素;曲安奈德;低壓注射

[中圖分類號(hào)]R619+.6 ? ?[文獻(xiàn)標(biāo)志碼]A ? ?[文章編號(hào)]1008-6455（2019）12-0053-03

Application of Injection of Botulinum Toxin Type A Combined with Triamcinolone Acetonide Plus 5-FU in Injection for Mandibular Angle Scar

ZHANG Yi，ZHAO Xiao-hui，WU Xin-feng

（Department of Plastic surgery， Dermatology Hospital， Chinese Academy of Medical Sciences & Peking Union Medical College，Nanjing 210042， Jiangsu， China）

Abstract： Objective ?To investigate the efficacy of injection of botulinum toxin type A combined with triamcinolone acetonide plus 5-Fu in the treatment of scar after mandibular acne. Methods ?From October 2015 to October 2017， 30 patients with scar after mandibular angle acne were injected with botulinum toxin type A combined with triamcinolone acetonide plus 5-Fu. The area of keloid was 0.3cm×0.5cm-2.0cm×3.0cm， height 0.5-1.5cm， assess the degree of masseter muscle hypertrophy and platysma muscle tension. The masseter muscle and the mandibular margin were injected with botulinum toxin type A for injection， and intralesional low pressure injection of triamcinolone acetonide 5-FU was used once. The intralesional low-pressure injection was broken between 2 weeks or 3 months until no recurrence occurred. Follow-up was followed up for 12 to 24 months to evaluate the efficacy. Results ?All the 30 patients were all relieved. In 18 patients， the scar was completely atrophied after 1-2 treatments， and there was no recurrence. 11 patients had scar atrophy after 4-6 injections， followed up for 1 year， no recurrence. One patient was injected 13 times and followed up for 1 year without recurrence. Conclusion ?Injection of botulinum toxin type A combined with triamcinolone acetonide plus 5-FU is a good method for the treatment of scar after acne in mandibular margin.

Key words： mandibular angle scar; intralesional injection; botulinum toxin A for injection; triamcinolone acetonide; low pressure injection

下頜角附近皮膚由于受到皮下咬肌及頸闊肌的雙重作用，痤瘡發(fā)生后通常留下增生性瘢痕。大部分程度較輕的患者隨時(shí)間推移，局部瘢痕萎縮變平;瘢痕面積較大者、痤瘡程度較重者，改善效果不明顯。治療通常比較頑固，復(fù)發(fā)率較高。筆者針對(duì)病因，采用局部注射肉毒毒素和皮損內(nèi)注射類固醇技術(shù)加上5-氟尿嘧啶（5-FU）的方法，使瘢痕周圍減張，局部血管被封閉，現(xiàn)將聯(lián)合治療的效果報(bào)道如下。

1 ?資料和方法

1.1 一般資料：選擇30例患者，其中男19例，女11例，年齡18～37歲?！?br>