ﺑﺮرﺳﻲ اﺛﺮ ﺗﺎﻣﻮﻛﺴﻴﻔﻦ در ﭘﻴﺸﮕﻴﺮي از اﻳﺠﺎد اﺳﻜﺎر ﻫﻴﭙﺮﺗﺮوﻓﻴﻚ ﻣﺘﻌﺎﻗﺐ ﺑﺮش ﻫﺎي ﺟﺮاﺣﻲ

Evaluating Tamoxifen Effect in the Prevention of Hypertrophic Scars Following Surgical Incisions

ﺯﻣﻴﻨﻪ ﻭ ﻫﺪﻑ: ﺍﻳﺠﺎﺩ ﺍﺳﻜﺎﺭ ﻫﻴﭙـﺮﺗﺮﻭﻓﻴﻚ ])Hypertrophic Scars (HTS[ ﻣﺘﻌﺎﻗﺐ ﺑﺮﺵ ﻫﺎﻱ ﺟﺮﺍﺣﻲ ﻛﻪ ﻧﺎﺷﻲ ﺍﺯ ﺍﺧﺘﻼﻝ ﻋﻤﻠﻜﺮﺩ ﻓﻴﺒﺮﻭﺑﻼﺳﺖ ﻫﺎ ﺩﺭ ﻃﻲ ﭘﺮﻭﺳﻪ ﺗﺮﻣﻴـﻢ ﺯﺧﻢ ﻣﻲ ﺑﺎﺷﺪ، ﺁﺛﺎﺭ ﺭﻭﺍﻧﻲ ﻭ ﺍﺟﺘﻤﺎﻋﻲ ﻗﺎﺑﻞ ﻣﻼﺣﻈﻪ ﺍﻱ ﺭﺍ ﺑﺎﻋـﺚ ﻣﻲ ﺷﻮﺩ. ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﺷﻮﺍﻫـﺪ ﻗﺒﻠﻲ ﺩﺍﻝ ﺑﺮ ﺍﺛﺮ ﺗﺎﻣﻮﻛﺴﻴﻔـﻦ ﺩﺭ ﻓـﺮﺍﻳﻨﺪ ﺭﺷﺪ ﻓﻴﺒﺮﻭﺑﻼﺳﺖ ﻫﺎ ﺩﺭ ﻣﻄﺎﻟﻌﺎﺕ ﺳﻠﻮﻟﻲ، ﺍﻳﻦ ﻣﻄﺎﻟﻌﻪ ﺟﻬﺖ ﺍﺭﺯﻳﺎﺑﻲ ﺍﺛﺮ ﺑﺎﻟﻴﻨﻲ ﺩﺍﺭﻭﻱ ﺗﺎﻣﻮﻛﺴﻴﻔﻦ ﺩﺭ ﭘﻴﺸﮕﻴـﺮﻱ ﺍﺯ ﺍﻳﺠـﺎﺩ HTS، ﺩﺭ ﺑﻴﻤﺎﺭﺳﺘﺎﻥ ﻫﺎﻱ ﺷﻬﺪﺍﻱ ﺗﺠﺮﻳﺶ ﻭ ﻃﺎﻟﻘﺎﻧﻲ ﺩﺭ ﺳﺎﻝ 81 ﺗﺎ 1382 ﺍﻧﺠﺎﻡ ﺷﺪﻩ ﺍﺳﺖ. ﻣﻮﺍﺩ ﻭ ﺭﻭﺵ ﻫﺎ: ﺩﺭ ﻳﻚ ﻛﺎﺭ ﺁﺯﻣﺎﻳﻲ ﺑﺎﻟﻴﻨﻲ ﺩﻭﺳﻮﻛﻮﺭ ﺗﺼﺎﺩﻓﻲ ﺷـﺪﻩ ﺑﺎ ﭘﻼﺳﺒﻮ، 300 ﺑﻴﻤﺎﺭ ﺑﺎ ﺳﺎﺑﻘﺔ HTS، ﻛﻪ ﺗﺤﺖ ﻋﻤﻞ ﺟﺮﺍﺣﻲ ﺑﺎ ﺑﺮﺵ ﻫﺎﻱ ﻣﺨﺘﻠﻒ ﻗـﺮﺍﺭ ﮔﺮﻓﺘﻨﺪ ﭘﺲ ﺍﺯ ﻛﺴﺐ ﺭﺿﺎﻳﺖ ﺍﺯ ﺁﻧﻬﺎ ﺑﻄﻮﺭ ﺗﺼﺎﺩﻓﻲ ﺑﻪ ﺩﻭ ﮔـﺮﻭﻩ ﺗﻘﺴﻴﻢ ﺷﺪﻧﺪ. ﺑﻪ ﮔﺮﻭﻩ ﻣـﻮﺭﺩ، ﭘﺲ ﺍﺯ ﻋﻤﻞ ﺟـﺮﺍﺣﻲ ﻗﺮﺹ ﺗﺎﻣﻮﻛﺴﻴﻔﻦ ﺑﺮﺍﺳﺎﺱ ﭘﺮﻭﺗﻜﻞ ﻭ ﺑﻪ ﮔﺮﻭﻩ ﺷﺎﻫـﺪ، ﺑﺎ ﻫﻤﺎﻥ ﺩﻭﺯ ﭘﻼﺳﺒـﻮ ﺩﺍﺩﻩ ﺷﺪ. ﭘﺲ ﺍﺯ 2 ﻣﺎﻩ ﻣﻴﺰﺍﻥ ﺍﻳﺠـﺎﺩ HTS ﺩﺭ ﻫـﺮ ﺩﻭ ﮔﺮﻭﻩ ﺑﺮﺭﺳﻲ ﻭ ﻧﺘﺎﻳﺞ ﻣـﻮﺭﺩ ﻗﻀﺎﻭﺕ ﻗـﺮﺍﺭ ﮔﺮﻓﺘﻨﺪ. ﻳﺎﻓﺘﻪ ﻫﺎ: ﺩﺭ ﺟﻤﻌﻴﺖ ﻣـﻮﺭﺩ ﻣﻄﺎﻟﻌﻪ 235 ﻧﻔﺮ )78/3 ﻣـﺮﺩ ﻭ 65 ﻧﻔـﺮ )21/7 ﺯﻥ ﺑﻮﺩﻧﺪ. ﻣﻴﺎﻧﮕﻴـﻦ ﺳﻨﻲ ﺟﻤﻌﻴﺖ ﻣـﻮﺭﺩ ﻣﻄﺎﻟﻌﻪ 40/2 ﺳﺎﻝ ﺑﻮﺩ. ﺍﺯ ﻛﻞ ﺟﻤﻌﻴﺖ ﻣﻮﺭﺩ ﻣﻄﺎﻟﻌﻪ 216 ﻧﻔﺮ ﻣﺘﻌﺎﻗﺐ ﺑﺮﺵ ﺟـﺮﺍﺣﻲ ﺩﭼﺎﺭ HTS ﺷﺪﻧﺪ، ﻛﻪ ﺍﻳﻦ ﺗﻌﺪﺍﺩ ﺷﺎﻣﻞ، 138 ﻧﻔﺮ ﺩﺭ ﮔﺮﻭﻩ ﺷﺎﻫﺪ ﻭ 78 ﻧﻔﺮ ﺩﺭ ﮔﺮﻭﻩ ﻣـﻮﺭﺩ ﺑﻮﺩﻩ ﺍﻧﺪ. ﻧﺘﻴﺠﻪ ﮔﻴـﺮﻱ: ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﻓـﺮﺍﻭﺍﻧﻲ ﻣﻌﻨﻲ ﺩﺍﺭ ﺍﻳﺠﺎﺩ HTS ﺩﺭ ﮔﺮﻭﻩ ﺷﺎﻫـﺪ ﺩﺭ ﻣﻘﺎﻳﺴﻪ ﺑﺎ ﮔﺮﻭﻩ ﻣﻮﺭﺩ ﺑﻪ ﻧﻈﺮ ﻣﻲ ﺭﺳﺪ ﻛﻪ ﺩﺍﺭﻭﻱ ﺗﺎﻣـﻮﻛﺴﻴﻔﻦ ﺩﺭ ﭘﻴﺸﮕﻴـﺮﻱ ﺍﺯ ﺍﻳﺠﺎﺩ HTS ﻣﺘﻌﺎﻗﺐ ﺑﺮﺵ ﺟﺮﺍﺣﻲ ﻣـﺆﺛﺮ ﻣﻲ ﺑﺎﺷﺪ.

Introduction & Objective: Hypertrophic scars (HTS) following surgical incisions develop mainly due to fibroblast dysfunction in wound healing process, and it may cause significant psychological and social consequences in various patient populations. With regard to growing evidence on tamoxifen effects on fibroblast growth patterns at the cellular level, this study was designated to evaluate the clinical utility of tamoxifen in the prevention of hypertrophic scars, which had been carried out in Shohadaye Tajrish and Ayatollah Taleghani Medical Centers in the 2000-2001 time interval. Materials & Methods: In a double-blind randomized clinical trial after obtaining informed consent, of 300 patients with a history of HTS, who had undergone surgical operations with different skin incisions were assigned randomly into two groups. The first group received tamoxifen tablets postoperatively according to a standard protocol while the control group received placebo. After two months the two groups were compared according to the development of HTS and the result was statistically analyzed. Results: The studied population, comprised of 235 men (78.7%) and 65 women (21.7%), developed HTS following surgical incision. Of these 138 patients (92%) were in the study group, while 78 patients (52%) belonged to control group. Conclusions: Regarding the significant difference of HTS development between the study and control groups (92% vs. 52%), tamoxifen seems to be an effective agent in the prevention of Hypertrophic scars following surgery.