| Objective: Keloid is a common disease in clinical,which is the skin of the high density ,and the abnormalities excessive proliferation of the fibrosis scar tissue after wound, and which local often accompanies erythema, pain and itch as the clinical symptoms.Because its pathogenesis has been uncleared,the current treatment ways are so many, but the cure rate of the single method is not very high.The clinical practice has been showed that the combination therapy can effectively reduce the recurrence rate,and the surgical resection combined with local radiotherapy to keloid has been achieved a satisfactory clinical effect, and that has become the main method of scar pimple treatment nowadays. In 1970,King firstly reported the treatment for keliod with the good clinical effects,by operation excision with electron beam irradiation. In this retrospective study, we analyse the clinical efficacy of the 70 cases ,who had been treated with the surgical resection combined electron beam irradiation, to probes into the the clinical efficacy with the different radiation dose of the therapeutic effect and the factors of the clinical efficacy, intends to find a clinical best radiation dose, besides, we analyzed the factors, to increase the clinical efficacy in the future clinical work.Methods:1 Data collection: we collected 88 cases with keliod, treated in the Department of Plastic Surgery in the Third Affiliated Hospital in Hebei Medicine College between January 2007 and December 2009,and treated by the operation excision with postoperative electron beam irradiation, losting to follow-up 18 cases owing to the wrong telephone number, lost to follow-up rate of 20.5%. Successful follow-up 70 cases, 25 males and 45 females aged from 18 to 71 years old, course of the disease is 1-50 years. The total number of keliod is 84, multiple 14 ,single 70,distribution areas: chest 18, earlobe 22, shoulder department 16, facial 11, perineal 3, limb 16, abdomen 5,the area size of the krliods is 0.5×0.8cm~2-1.5×8 cm~2,the thickness is 0.2-0.8cm.Preoperative received injection drug or surgical resection of the treatment is 27, initial therapy is 57.2 The surgical excision: the keloid was outlined with gentian violet, prepared with 2 or 1% lidocaine to do the local infiltrating anesthesia, along the incision mark line cut skin, subcutaneous tissue to subcutaneous fat layer, complete resection the keloid, free the subcutaneous tissue layers in the two flanges to incision, loose the skin with sufficient to reduce the tension to suture subcutaneous, with the Proline lines or monofilament line suture skin, for the excision defect is too larger, tension larger to be suture, to give the Z local angioplasty or local skin metastasis, in order to reduce the tension.3 Postoperative radiotherapy within 24 hours: adopt the VARIAN CLINAC ix (6MeV), treated at a distance of 10 cm form the wound, radiation fields range includes lesions and marginal 0.5-1.0 cm. According to the radiation dose divided into two groups, A and B. Group A: the total dose 20Gy, the single dose 2Gy, once a day,continuous 10 times; Group B: total dose 15Gy,the single dose 5Gy, once a day ,continuous 3 times .Two groups in age, gender, duration, and the lesions size has non-significance difference (P > 0.05).4 According to the document criteria efficacy to judge the effect assessment criterion: cure standard: clinical symptoms had been disappeared, such the scar become soft, the local back to normal, what's more, the scar thickness and normal skin is flat or local lesion significantly improved the thickness of thinning, scar, and its thickness is less than the original thickness of 1/2. Improvement standard: unconcerned clinical symptoms such as partial improved, local lesion get a degree of improvement, the thickness of the scar, its ply thinner than 2mm.Invalid standard: symptoms improved or aggravating, or the scar bulge the skin,thicher than 2mm,and show the progressive growth.The cure rate +the improvement rate=the effective rate. 5 By the telephone visit or outpatient review follow-up at least 12 months.6 Use statistical software SPSS13.0 for Windows to follow-up data results statistical analysis.Results:1 19cases is relapsed,the total recurrence is 20.2%.2 The efficient of Group A of is 65.7%, Group B is 87.8%,there is the statistically significant by SPSS10.0 statistical software analysis (p < 0.05).3 The clinical efficacy of patients treated with sex, anatomical has no significant difference,besides, with the multiple and preoperative treated and the radiotherapy dose has significant difference. The clinical efficacy of the non- predilection sites has difference, and the predilection sites or the multiple and preoperative treated has no difference.Conclusions: The postoperative radiotherapy electron beam irradiation of keliod is a kind of effective method.In this study, it is considered that the radiation total dose 15Gy, a single dose 5Gy, once a day , and successive 3, has the better clinical curative effect, especially the non- predilection sites of keliod .
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