不同脉宽595nm染料激光治疗增生性瘢痕和瘢痕疙瘩的疗效

Comparison of the effects of different pulse widths of 595 nm flashlamp-pumped pulsed dye laser in the treatment of hypertrophic scars and keloid

目的 确定595 nm染料激光治疗增生性瘢痕和瘢痕疙瘩的疗效,并比较应用0.45 ms和1.5 ms两种脉宽治疗的疗效.方法 应用595 nm染料激光治疗22例增生性瘢痕和瘢痕疙瘩患者,11例应用7 mm光斑,脉宽1.5 ms,能量密度7.0-8.5 J/cm^2,另11例应用10 mm光斑,脉宽0.45 ms,能量密度5.0-6.5 J/cm2,给予3次治疗,间隔4-6周.应用温哥华瘢痕量表（Vancouver scar scale,VSS）对瘢痕进行评价,并进行瘙痒和疼痛程度评分.结果 1.5 ms组和0.45 ms组患者平均VSS的评分在第一次、第二次和第三次治疗后均较治疗前差异有统计学意义,经过3次治疗VSS的改善率分别为45.45%,63.64%,100%和54.55%,90.90%,100%.1.5 ms组和0.45 ms组的瘙痒和疼痛评分均在第一次治疗后出现显著改善.1.5 ms组和0.45 ms组在治疗后各时间点上VSS评分、VSS各分项目评分和瘙痒及疼痛评分分值及改善率差异均无统计学意义.结论 595 nm染料激光治疗增生性瘢痕和瘢痕疙瘩安全有效,应用0.45 ms和1.5 ms脉宽疗效相当.

Objective To determine the efficacy and to compare the effects of different pulse widths of 595 nm flashlamp-pumped pulsed dye Laser（PDL） in the treatment of hypertrophic scars and keloid. Methods Eleven patients with hypertrophic scars and keloid were treated with 595 nm PDL at 1.5 ms with 7 - 8.5 J/cm^2 using a 7 mm spot size ; another 11 patients were treated with 595 nm PDL at 0. 45 ms with 5 - 6. 5 J/cm2 using a 10 mm spot size. Treatment composed of 3 sessions at 4-week to 6-week intervals. Scars were evaluated using the Vancouver scar scale（VSS）. Patients evaluated pain and pruritus using a scale from 0 to 10. Results The average sum of the VSS showed significant improvement after the first treatment using 1.5 ms and 0. 45 ms pulse 595 nm PDL. The improvement of the VSS after the first to the third treatment were 45.45% , 63.64% , 100% （using 1.5 ms pulse） and 54.55% , 90.90% , 100% （ using 0. 45 ms pulse） respectively. There was no significant difference between 1.5 ms and 0. 45 ms pulse treatment groups in the VSS, the individual parameters of the VSS, pain scale and pruritus scale. Conclusion The 595 nm PDL is a safe and effective treatment of hypertrophic scars and keloid. Both the 1.5 ms and 0. 45 ms pulse 595 nm PDL resulted in scar improvement, there was no significant difference between them.