点阵激光联合复方倍他米松注射液治疗增生性瘢痕20例疗效观察

Clinical Observation of Fractional CO_2 Laser Combined with Compound Betamethasone Injection in Treating 20 Cases of Hypertrophic Scars

目的评价CO2点阵激光联合复方倍他米松注射液局部注射治疗增生性瘢痕的疗效及不良反应。方法选择60例温哥华烧伤瘢痕评分（VSS）总分为7-12分的增生性瘢痕患者为受试者，随机分成3组，各20例，分别接受CO2点阵激光联合复方倍他米松注射液局部注射（治疗组），CO2点阵激光单一疗法（对照1组）及复方倍他米松注射液局部注射单一疗法（对照2组）。于每次治疗后1个月及疗程（4次治疗）结束后半年随访，参照VSS对受试者进行综合评分，并评估有效率。记录不良反应发生情况。结果所有三组受试者VSS评分治疗后均较治疗前有一定改善，差异有统计学意义（P〈0．05）。组间改善情况差异有统计学意义（P〈0．05）。三组均有部分患者术后出现色素沉着、皮肤萎缩及毛囊炎等局部不良反应，可自行缓解，未发生严重的不良反应。结论CO2点阵激光及复方倍他米松注射液对增生性瘢痕均有一定的疗效，且两者联合治疗的效果最佳。整个治疗过程无严重不良事件，安全可靠。

Objective To evaluate the efficacy and safety of a novel therapy,combing an ablative fractional CO2 laser and local injection of compound betamethasone in treating hypertrophic scars. Methods Sixty patients with hypertrophic scars, the total score of Vancouver scar scale （VSS）ranging from 7 to 12 points,were randomly divided into three groups,20 cases per group. The patients in the treatment group were given the combination of fractional CO2 laser and intralesional injection of compound betamethasone. Subjects in control group 1 received the fractional CO2 laser alone while control group 2 received intralesional injection of betamethasone alone. Follow-up visits were conducted one month after each treatment and half a year after the completion of full course of treatment （4 treatments）. VSS, therapeutic response and adverse events were evaluated. Results VSS scores were significantly improved in all groups after treatment （P 〈 0. 05）. The improvement in VSS scores varied significantly among groups （ P 〈 0. 05 ）. Local adverse reactions included hyperpigmentation, skin atrophy and folliculitis,all of which remitted spontaneously. Conclusion Both the fractional CO2 laser and intralesional injection of compound betamethasone are effective for hypertrophic scar. Combination of these two therapies is more effective without severe adverse events.