595nm可调脉宽染料激光与强脉冲光治疗毛细血管扩张

595nm tunable pulsed dye laser vs. intensive pulse light in the treatment of telangiectasia

目的:评价595nm可调脉宽染料激光与强脉冲光(IPL)治疗毛细血管扩张的疗效和不良反应。方法:用595nm可调脉宽脉冲染料激光仪与强脉冲光分组治疗毛细血管扩张共326例,按照就诊时间随机单盲将患者分为两组,A组:164例,应用595nm可调脉宽染料激光治疗;B组:162例,应用强脉冲光治疗。根据血管的粗细适当选择脉宽及能量密度,照射病变部位,观察局部治疗皮肤反应,即以照射部位皮肤变为紫灰色,扩张血管消失为适度。每月治疗1次,共治疗1～3次,分析两组患者的疗效和不良反应。结果:164例毛细血管扩张患者,经过595nm可调脉宽V-beam激光1～3次治疗后,85例痊愈,63例显效,总有效率90.2%;IPL组的总有效率在第1、2、3次治疗后分别为3.1%、21.6%和43.2%。与IPL组比较,595nm可调脉宽V-beam激光组的疗效要明显优于IPL组,两者的差异性有明显统计学差异(P<0.01)。同一类型皮肤与IPL组比较,595nm可调脉宽V-beam激光组的疗效要明显优于IPL组,两者的差异性有明显统计学差异(P<0.05)。两组治疗后皮肤反应轻微,595nm激光组治疗后会暂时出现局部水肿和紫癜,两组术后色素改变发生率无显著性差异(P<0.05)。结论:595nm可调脉宽脉冲染料激光治疗毛细血管扩张疗效明显优于强脉冲光,且皮肤反应轻微,疗效确切,临床效果满意。

Objective To evaluate the clinical efficacy and side effects of 595nm tunable pulsed dye laser vs.intensive pulse light（IPL） in treatment of telangiectasia.Methods Total 326 patients with telangiectasia were equally randomized into two groups,one group applying 595-nm tunable pulsed dye laser to the lesions for 1-3 sessions with an interval of 1 month,the other applying IPL to the lesions.The patients were evaluated for efficacy after 1-3 times of the initial treatment.We chose the proper pulse width and energy output according to the vascular thickness.The handle shaft should focus on the treatment locations when we treated the patient.The skin eruption turned dark purple and the dilation of blood vessels disappeared after laser irradiation.The efficiency were evaluated and compared.The adverse effects were also recorded at each group.Results 164 cases applied 595nm tunable pulsed dye laser for telangiectasis were cured after 1-3 times.The healing case was 85 and partly allevitiated case was 63.The total effective rate was 90.2% in 595nm group after 1-3 sessions of treatment.The total effective rate were 3.1%,21.6% and 43.2% in the IPL group one to three times respectively.These were statistically significant differences of cure rate and effectiveness rate between these two groups（P0.01）.These two lasers treated same skin type patients and these were statistically differences of cure rate and effectiveness rate between these two groups（P0.05）.The skin responses after treatment was very light in the two groups.The group with 595nm tunable pulsed dye laser appeared topical edema and purpura temporarily.There was no significant difference changing rate of pigment change between two groups（P0.05）.Conclusion The 595nm tunable dye laser has superior effect in treatment of telangiectasia compared to IPL.Topical 595nm tunable dye laser is a simple and effective treatment option for telangiectasia with minor skin side reaction.