PDF(Pubmed)
Abstract：
This meta-analysis aims to evaluate and compare the effect of surgical excision followed by adjuvant radiotherapy and laser combined with steroids on keloids. Relevant studies reporting the recurrence rate or incidence of adverse events (AEs) were retrieved from the PubMed, Web of Science, Embase and Cochrane Library databases through August 2023. The quality of noncomparative single-arm clinical trials was evaluated using the methodological index for nonrandomised studies (MINORS) Methodological items. This meta-analysis was conducted utilizing Stata 12.0 statistical software. 26 studies involving 989 patients were included in the analysis. The recurrence rate in the laser combined with steroids therapy group (12.2%, 95% confidence interval [CI]: 5.9%-18.5%) was lower than that of the surgical excision combined with radiotherapy group (13.5%, 95% CI: 6.6%-22.2%). For the incidence of AEs, relatively low incidence of atrophy (0.0%, 95% CI: 0.0%-1.2%), telangiectasia (3.2%, 95% CI: 0.4%-7.6%), erythema (2.3%, 95% CI: 0.0%-10.6%), infection (0.2%, 95% CI: 0.0%-1.6%) and high hyperpigmentation rate (8.3%, 95% CI: 4.2%-13.4%) were obtained in the surgical excision combined with radiotherapy group. Compared with surgical resection followed by radiotherapy, the combination of laser and steroids for keloids showed a lower hyperpigmentation rate (6.5%), as well as a higher incidence of atrophy (22.7%), telangiectasia (6.4%), erythema (3.3%) and infection (3.3%). Only a hypopigmentation rate of 2.9% was obtained in patients treated with surgical excision plus radiotherapy. Current evidence revealed that surgical excision followed by adjuvant radiotherapy and laser combined with steroids therapy were effective and safe treatments for keloids, with relatively low recurrence rate and complication rate. Comparative studies are needed to further compare the effects of these two combination therapies on keloids.
摘要：
这项荟萃分析旨在评估和比较手术切除后辅助放疗和激光联合类固醇治疗瘢痕疙瘩的效果。报告复发率或不良事件（AE）发生率的相关研究来自PubMed，WebofScience,Embase和Cochrane图书馆数据库到2023年8月。使用非随机研究方法学指标（MINORS）方法学项目评估非比较单组临床试验的质量。本Meta分析采用Stata12.0统计软件进行。26项涉及989名患者的研究被纳入分析。激光联合类固醇治疗组的复发率（12.2%，95%置信区间[CI]:5.9%-18.5%)低于手术切除联合放疗组(13.5%,95%CI：6.6%-22.2%）。对于AE的发生率，萎缩发生率相对较低(0.0%，95%CI：0.0%-1.2%），毛细血管扩张(3.2%，95%CI：0.4%-7.6%），红斑（2.3%，95%CI：0.0%-10.6%），感染（0.2%，95％CI：0.0％-1.6％）和高色素沉着率（8.3％，手术切除联合放疗组获得95%CI:4.2%-13.4%)。与手术切除后放疗相比，激光和类固醇联合治疗瘢痕疙瘩的色素沉着率较低(6.5%)，以及较高的萎缩发生率（22.7%），毛细血管扩张(6.4%),红斑（3.3%）和感染（3.3%）。在接受手术切除加放疗的患者中，色素沉着率仅为2.9％。目前的证据表明，手术切除后辅助放疗和激光联合类固醇治疗是有效和安全的治疗瘢痕疙瘩。复发率和并发症发生率相对较低。需要进行比较研究，以进一步比较这两种联合疗法对瘢痕疙瘩的影响。
