面部不同亚解剖区域葡萄酒色斑激光治疗效果差异的病理学基础

Histopathological Basis of Different Anatomic Subunit of Facial Port-Wine Stain Treated by Pulsed Dye Laser

目的探讨面部不同亚解剖区域葡萄酒色斑(Port-wine stain,PWS)脉冲染料激光(Pulsed dye laser,PDL)治疗效果差异的病理学基础。方法 6例患者按面部不同亚解剖区域(A、B区)行PWS的病理活检,对PWS血管的管径及深度进行测量,并给予脉冲染料激光治疗。术后2个月光度计测量(ΔE和Δa*值),进行疗效评估,并对各区域结果进行比较分析。结果患者均接受脉冲染料激光治疗,光度计测量示B区PWS的平均Δa*和ΔE值分别为(4.63±2.24)及(8.81±2.24),而A区PWS的平均Δa*及ΔE值分别为(-0.19±2.40)及(3.55±1.46),两者差异显著(P<0.05)。组织学表现示B区PWS扩张的血管主要分布于真皮浅层,而A区PWS扩张的血管分布于真皮浅层至深层,部分累及皮下。皮尔森相关系数显示PWS血管深度、血管管径与PDL疗效呈负相关。结论对同一位患者,相比于面部偏中心区域PWS,PDL对偏外周区域PWS具有更佳疗效;PWS血管的组织学差异特别是血管深度,可能是面部不同亚解剖区域PWS疗效差异的重要原因之一。

Objective To explore the histopathological basis of different anatomic subunit of facial port-wine stain（PWS）treated by pulsed dye laser（PDL） and to illustrate the possible explanation for the discrepancy of therapeutic efficacy. Methods Six PWS patients had biopsies and underwent PDL treatments in different anatomic subunit of facial PWS（A and B area）. The diameter and depth of PWS vessels were analyzed and the clinical efficacy were evaluated by chromameter assessment 2 months after treatment. Results All patients were treated on both sites, according to the chromameter evaluation, average Δa^＊ and average ΔE were 4.63±2.24 and 8.81±2.24 for B area, while-0.19±2.40 and 3.55±1.46 for A area respectively（P〈0.05）. Histopthological observation showed that ectatic vessels in B area were primarily distributed in super dermis,while the ectatic vessels in A area were distributed extensively from capillaries to the reticular dermis, and even deep into the subcutaneous tissue. The Pearson correlation coefficient suggested that the depth and diameter of PWS vessels were negatively related to efficacy outcomes of PDL treatment. Conclusion Better results can be obtained in lateral facial PWS compared to central facial PWS on the same patient. The differences in histopathological manifestation, especially the depth of vessels,may be responsible for the discrepancy of therapeutic efficacy.