皮损内注射曲安奈德序贯CO2点阵激光治疗增生性瘢痕疗效观察

Clinical Efficacy of Intralesional Injection of Triamcinolone Acetonide Plus Sequential Fractional CO_2 Laser for Hypertrophic Scars

目的探讨皮损内注射曲安奈德序贯CO_2点阵激光治疗增生性瘢痕的疗效及安全性。方法选取本院皮肤科瘢痕专题门诊增生性瘢痕患者33例,将其分为A组(予曲安奈德注射组)、B组(曲安奈德注射后予超脉冲CO_2激光联合新适确得乳膏外涂组)、C组(超脉冲CO_2激光联合新适确得乳膏外涂组)分别予以治疗,用温哥华瘢痕评分量表分别对这三组增生性瘢痕治疗前后的变化进行评分,并用超声波诊断仪测量治疗前后厚度的变化。结果 A组治疗前后VSS评分分别为(12.00±1.24)和(8.31±1.94);治疗前后瘢痕厚度分别为(0.44±0.18)cm和(0.28±0.12)cm;B组VSS评分分别为(10.63±2.39)和(5.13±2.52),瘢痕厚度分别为(0.33±0.06)cm和(0.17±0.04)cm;C组VSS评分为(10.83±2.15)和(9.83±2.37),瘢痕厚度为(0.38±0.10)cm和(0.30±0.07)cm。A组皮肤萎缩不良反应发生率为46.15%,其余两组未见皮肤萎缩情况发生。结论予曲安奈德注射后予超脉冲CO_2激光联合新适确得乳膏外涂这种分阶段疗法可以减少皮肤萎缩不良反应的发生,还可以使瘢痕痊愈后在柔软度、硬度、外观方面较为接近正常皮肤,仅留有部分色素沉着,值得临床应用。

Objective To investigate the efficacy and safety of intralesional injection of triamcinolone acetonide plus sequential fractional CO2 laser for hypertrophic scars. Methods Thirty-three patients with hypertrophic scar from our hospital were included in this study. Patients were divided into three groups： group A, triamcinolone injection ; group B ： injection of triamcinolone plus super pulsed fractional CO2 laser and halometasone triclosan cream; group C ： super pulsed fractional CO2 laser plus halometasone triclosan cream. Vancouver scar scale （VSS） score was used to evaluate the changes in scars before and after the treatment. In addition, the thickness of scars was also measured with ultrasound before and after treatment. Results Following the treatment, both VSS scores and scar thickness improved significantly [ group A： VSS score, （12.00 ±1.24） vs. （8.31 ±1.94）; thickness, （0.44 ±0.18）cm vs. （0.28 ±0.12）cm; group B： （10.63 ±2.39） vs. （5.13 ±2.52）; thickness,（0.33 ±0.06）cm vs. （0.17±0.04）cm; group C： （10.83 ±2.15） vs. （9.83 ±2.37）; thickness, （0.38 ±0.10） cmvs. （0.30 ±0.07）cm, P〈0.01 for all]. 46. 15% in group A developed skin atrophy, but no atrophy in groups B and C. Conclusion This phased therapy which injection of triamcinolone plus super pulsed fractional CO2 laser and halometasone triclosan cream can reduce the occurrence of adverse skin atrophy, can also make the scar healed in softness, hardness, appearance, leaving only some pigmentation. This treatment is worthy of clinical application.