高能量脉冲CO2激光治疗眼睑部黑素痣

Orbit high energy ultrapuise CO2 laser in treatment of congenital melanocytic nevus

目的评价脉冲CO2激光去除眼睑部先天性黑素痣的方法和美容效果。方法用脉冲CO2激光气化去除眼睑部先天性黑素痣46例，共58块。病损最小面积0．3cm×0．3cm，最大面积3．0cm×6．0cm，平均面积1．3cm×2．0cm。尽可能保护正常的皮肤和睫毛毛囊组织，勿受损伤。术中没有焦痂产生及出血。结果46例患者中44例对激光手术效果满意，仅2例对激光手术效果欠满意。58块黑素损害，50块愈后创面瘢痕平整，欠平整6块，外眦粘连1块，内眦瘢痕收缩1块。疗效优84．5％（49／58），良10．3％（6／58），有改善5．2％（3／58）。总有效率94．8％（65／58），部分患者睑缘仍有睫毛生长。结论高能量脉冲CO2激光是去除眼睑部先天性黑素痣的较好方法，具有去除彻底、创面愈后瘢痕平整、眼睑活动正常、外观影响小等优点。但对于面积较大的、侵犯多个解剖区域的病损，激光手术的选择仍需谨慎。

Objective To valuate the effect of high energy ultrapulse CO2 laser on congenital melanocytic nevi of the orbit. Methods 46 patient with congenital melanocytic nevi of eyelid, 58 lesions were vaporized with high energy ultrapulse CO2 laser. The area of the largest one was 3.0 cm×6.0 cm, and the smallest one was0.3 cm ×0.3 cm, with average of 1.3 cm ×2.0 cm. The depth of the vaporizing reached the layer of lowest skin, even the orbicularis, aponeurosis and conjunctiva of tarsus, till no melanin on the wound in view, tried the best to reserve the normal follicle of eyelash. There was no eschar and bleeding on the wound during the procedure. Followed up lasted for 1 - 56 months, with average 12.9 months. Results 44 of 46 patients were satisfactory to the effect of the laser. The most of scars resulted from the vaporizing with the laser became evenness and smooth （50/58）. The edge of eyelid looked normal after the laser. The excellent result was observed in 84.5 %（49/58） lesions, good in 10.3 % （6/58）, and improved in 5.2% （3/58）. The overall effect was 94.8 % （55/58）. And eyelashes were getting growth. Conclusion The treatment of congenital melanoeytic nevus of eyelid with high energy ultrapulse CO2 is a good method. But to be careful in selecting the lesions that may not be too large.