不同脉宽595 nm染料激光治疗增生性瘢痕和瘢痕疙瘩的疗效比较

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

目的探讨不同脉宽595 nm染料激光在增生性瘢痕(HS)和瘢痕疙瘩治疗中的疗效。方法选择2016年2月至2017年6月深圳市龙华中心医院皮肤科收治的82例HS和瘢痕疙瘩患者为研究对象,根据随机数表法将患者分为两组,A组40例采用7 mm光斑,1.5 ms脉宽595染料激光治疗,B组42例采用10 mm光斑,30 ms脉宽595染料激光治疗,治疗3次,每次间隔一个月。比较两组治疗前后温哥华瘢痕量表(VSS)、视觉模拟评分法(VAS)及治疗效果的差异。结果两组患者的瘢痕组织色泽、厚度、血管分布、柔软度VSS评分均较术前明显下降,差异均有统计学意义(P<0.05);三次治疗后,A组患者的柔软度VSS评分分别为(2.05±0.53)分、(1.56±0.35)分、(1.49±0.17)分,B组柔软度VSS评分分别为(2.53±0.65)分、(1.76±0.42)分、(1.62±0.37)分,A组柔软度VSS评分低于B组,差异均有统计学意义(P<0.05),其他指标组间比较差异均无统计学意义(P>0.05);两组患者的瘢痕部位疼痛、瘙痒程度VAS评分均较术前明显下降,差异均有统计学意义(P<0.05),但组间比较差异均无统计学意义(P>0.05);A组和B组患者的治疗有效率(90.00%vs 95.24%)、复发率(5.00%vs 7.14%)比较差异均无统计学意义(P>0.05)。结论应用1.5 ms和30 ms脉宽595 nm染料激光治疗HS和瘢痕疙瘩疗效相当,均可显著改善临床症状,减少复发,安全性可靠,其中1.5 ms脉宽对瘢痕组织的柔软度改善效果更好。

Objective To investigate the effect of different pulse width of 595 nm flashlamp-pumped pulsed dye laser in the treatment of hypertrophic scar(HS) and keloid. Methods A total of 82 patients with HS and keloid treated in Department of Dermatology and Venereology, Shenzhen Longhua Central Hospital from February 2016 to June 2017 were selected as research objects. They were divided into two groups(group A and group B) according to the random number table. In group A, 40 cases were treated with 7 mm facula and 1.5 ms pulse width 595 dye laser. In group B, 42 patients were treated with 10 mm facula and 30 ms pulse width 595 dye. Treatment composed of 3 sessions at one month intervals. The differences of Vancouver Scar Scale(VSS), Visual Analogue Scale(VAS) and therapeutic effects between the two groups before and after treatment were compared. Results The VSS scores of scar tissue color,thickness, vascular distribution and softness of scar tissue between the two groups were significantly lower than those before operation(P<0.05). After three treatments, the VSS scores of softness in group A were(2.05±0.53),(1.56±0.35),(1.49 ± 0.17), respectively, which were significantly lower than(2.53 ± 0.65),(1.76 ± 0.42),(1.62 ± 0.37) in group B(P<0.05). There was no significant difference in other indexes between the two groups(P>0.05). The VAS scores of scar pain and itching between the two groups were significantly lower than those before operation(P<0.05), but there was no significant difference between the two groups(P>0.05). There was no significant difference in the effective rate(90.00%vs 95.24%) and recurrence rate(5.00% vs 7.14%) between the group A and group B(P>0.05). Conclusion The treatment of HS and keloid with 1.5 ms and 30 ms pulse width 595 nm dye laser has the same effect. It can significantly improve clinical symptoms, reduce recurrence, and is safe and reliable. Among them, 1.5 ms pulse width has better effect on softening of scar tissue.