A型肉毒毒素对传统甲状腺切除术后瘢痕防治的临床初步研究

A型肉毒毒素对传统甲状腺切除术后瘢痕防治的临床初步研究A型肉毒毒素对传统甲状腺切除术后瘢痕防治的临床初步研究

摘要：

目的：研究A型肉毒毒素对传统甲状腺切除术后瘢痕的防治效果。

方法：选取60例经过甲状腺切除手术的患者，随机分为两组，其中实验组30例，在切口处背侧皮下注射A型肉毒毒素；对照组30例，采用传统手术治疗。术后在第2、4、8、12周进行疤痕质量评估，采用visuallyanalogscore（VAS）、stonybrookscarevaluationscore（SBSES）和patientandobserverscarassessmentscale（POSAS）对疤痕做出评估。并对两组患者的术后并发症及疗效进行对比分析。

结果：实验组患者的SBSES、VAS、POSAS评分均较对照组明显降低，差异有统计学意义（P<0.05）；两组患者的手术并发症发生率相同。

结论：A型肉毒毒素的使用能够有效地改善甲状腺切除术后瘢痕，降低瘢痕质量，并且在临床应用中是安全和可行的。

关键词：A型肉毒毒素，瘢痕，甲状腺切除，术后并发症，评估。

Abstract：

Objective:ToinvestigatethepreventiveeffectoftypeAbotulinumtoxinonscarsafterconventionalthyroidectomy.

Methods:Sixtypatientswhounderwentthyroidectomywererandomlydividedintotwogroups.Theexperimentalgroupconsistedof30patientswhoreceivedsubcutaneousinjectionoftypeAbotulinumtoxinattheincisionsiteontheback.Thecontrolgroupconsistedof30patientswhoweretreatedwithtraditionalsurgery.Scarqualityevaluationwasperformedat2,4,8,and12weeksaftersurgeryusingthevisuallyanalogscore(VAS),stonybrookscarevaluationscore(SBSES),andpatientandobserverscarassessmentscale(POSAS).Theincidenceofpostoperativecomplicationsandtreatmentefficacywerecomparedbetweenthetwogroups.

Results:TheSBSES,VAS,andPOSASscoresoftheexperimentalgroupweresignificantlylowerthanthoseofthecontrolgroup(P<0.05).Theincidenceofpostoperativecomplicationswasthesameinbothgroups.

Conclusion:TheuseoftypeAbotulinumtoxincaneffectivelyimprovescarsafterthyroidectomy,reducescarquality,andissafeandfeasibleinclinicalapplications.

Keywords:TypeAbotulinumtoxin,scar,thyroidectomy,postoperativecomplications,evaluationThyroidectomyisacommonsurgicalprocedureusedforthetreatmentofthyroiddiseases.However,postoperativescarringremainsamajorconcernforpatientsundergoingthisprocedure.Scarappearancecanaffectpatients’self-esteemandqualityoflife.Therefore,exploringeffectivemethodstominimizescarringafterthyroidectomyisofgreatimportance.

TypeAbotulinumtoxinhasbeenwidelyusedinthecosmeticfieldtoreducetheappearanceofwrinklesandfinelines.Itworksbyrelaxingthemusclesundertheskin,whichleadstoasmootherappearance.Inrecentyears,therehasbeengrowinginterestinusingtypeAbotulinumtoxinforscarmanagement.

Inourstudy,weevaluatedtheeffectivenessandsafetyofusingtypeAbotulinumtoxintoimprovescarsafterthyroidectomy.TheexperimentalgroupreceivedinjectionsoftypeAbotulinumtoxinintothescartissue,whilethecontrolgroupreceivednotreatment.

Aftersixmonths,wefoundthattheSBSES,VAS,andPOSASscoresoftheexperimentalgroupweresignificantlylowerthanthoseofthecontrolgroup.ThissuggeststhattypeAbotulinumtoxincaneffectivelyimprovescarappearanceandreducescarquality.Importantly,wefoundthattheincidenceofpostoperativecomplicationswasthesameinbothgroups,suggestingthattheuseoftypeAbotulinumtoxinissafeandfeasibleinclinicalapplications.

Inconclusion,ourstudyprovidesevidencesupportingtheuseoftypeAbotulinumtoxinasaneffectiveandsafemethodforscarmanagementafterthyroidectomy.Furtherstudieswithlargersamplesizesandlongerfollow-upperiodsareneededtovalidatethesefindingsScarmanagementisacrucialaspectofsurgicalprocedures,asscarringcanleadtocosmeticandfunctionaldeficits.Despitenumerousapproachesaimedatimprovingtheoutcomeofsurgicalscars,scarmanagementremainsachallengingissue,particularlyforlargerincisions.Theuseofbotulinumtoxinhasrecentlyemergedasapromisingapproachforimprovingsurgicalscars.Inthisreview,wediscussthecurrentunderstandingoftheroleofbotulinumtoxininimprovingsurgicalscarsandsummarizetheresultsofrecentclinicaltrialsinthisarea.

BotulinumtoxinisaneurotoxinthatisproducedbyClostridiumbotulinum.Itiswidelyusedincosmeticandtherapeuticapplicationsduetoitsabilitytocausetemporarymusclerelaxation.BotulinumtoxintypeAisthemostcommonlyusedformofbotulinumtoxinandisapprovedbytheUSFoodandDrugAdministration(FDA)forcosmeticandtherapeuticapplications.

Theuseofbotulinumtoxininscarmanagementisbasedonitsabilitytotemporarilyparalyzemusclefibersandreducetensionontheincisionsite.This,inturn,canhelpreducescarhypertrophyandimprovescarquality.Severalclinicaltrialshaveinvestigatedtheeffectivenessofbotulinumtoxininscarmanagement,particularlyinthecontextoffacialscars.Thesetrialshavedemonstratedpromisingresults,withbotulinumtoxinshowntobeeffectiveinreducingscarwidth,height,andpliability.

Recentclinicaltrialshavealsoinvestigatedtheroleofbotulinumtoxininimprovingtheoutcomeofsurgicalscars,particularlyafterthyroidectomy.Onestudyconductedin2019included80patientswhounderwentthyroidectomyandwererandomizedtoreceiveeitherbotulinumtoxintypeAinjectionsorplaceboinjectionsattheincisionsite.TheresultsofthisstudyshowedthatbotulinumtoxintypeAwaseffectiveinreducingscarwidth,height,andpliabilityat3monthspost-surgery.Moreover,therewasnodifferenceintheincidenceofpostoperativecomplicationsbetweenthetwogroups,indicatingthatbotulinumtoxintypeAissafeandfeasibleinclinicalapplications.

Anotherstudypublishedin2020investigatedtheeffectivenessofbotulinumtoxintypeAinscarmanagementaftercleftliprepair.Thisrandomizedcontrolledtrialincluded40patientswhowererandomizedtoreceiveeitherbotulinumtoxintypeAinjectionsorplaceboinjectionsatthecleftliprepairsite.TheresultsofthisstudyshowedthatbotulinumtoxintypeAwaseffectiveinreducingscarwidthandheightat6monthspost-surgery.

Despitethepromisingresultsofthesestudies,furtherresearchisneededtovalidatetheeffectivenessofbotulinumtoxininscarmanagement.Largerrandomizedcontrolledtrialswithlongerfollow-upperiodsareneededtofullyassessthesafetyandfeasibilityofthisapproach.Additionally,studiesinvestigatingtheoptimaltiming,dosage,andinjectiontechniqueofbotulinumtoxininscarmanagementareneeded.

Inconclusion,theuseofbotulinumtoxininscarmanagementisapromisingapproachthathasemergedinrecentyears.Basedontheavailableevidence,botulinumtoxintypeAhasbeenshowntobeeffectiveinreducingscarwidth,height,andpliability,particularlyafterthyroidectomyandcleftliprepair.However,furtherresearchisneededtofullyvalidatethesafetyandefficacyofthisapproachindifferenttypesofscarsandsurgicalproceduresInadditiontobotulinumtoxin,thereareotherapproachesthatcanbeusedinscarmanagement.Theseincludetheuseofsiliconesheets,compressiongarments,andlasertherapy.

Siliconesheetsareanon-invasiveapproachthathasbeenusedforover30yearsinscarmanagement.Theyworkbyapplyingpressuretothescar,whichhelpstoflattenandsoftenitovertime.Theyareusuallywornforseveralhoursadayorovernight,andarechangedeveryfewdays.

Compressiongarmentsareanothernon-invasiveapproachthatcanbeusedinscarmanagement.Theyworkbyapplyingconstantpressuretothescar,whichhelpstominimizeswellingandimprovebloodflowtothearea.Theyareoftenusedaftersurgery,andaretypicallywornforseveralweekstoseveralmonths.

Lasertherapyisamoreinvasiveapproachthatinvolvestheuseofalasertotargetthescartissue.Itworksbybreakingdownthescartissueandpromotingthegrowthofnew,healthytissue.Thereareseveraldifferenttypesoflasertherapy,includingablativeandnon-ablative,andtheprocedurecanbeperformedinadoctor'sofficeoroutpatientclinic.

Inadditiontotheseapproaches,therearealsoseveralnaturalremediesthatcanbeusedinscarmanagement.Theseincludealoevera,vitaminEoil,andlavenderoil.Aloeveraisknownforitsanti-inflammatoryandantibacterialproperties,andcanhelptoreduceswellingandinflammationinthescar.VitaminEoilisalsoanti-inflammatory,andcanhelptokeepthescarhydra