超脉冲二氧化碳点阵激光配合果酸治疗凹陷性痤疮瘢痕的疗效观察

The treatment effect of ultrapulse fractional CO_2 laser combined with fruit acid treatment on depressed acne scars

目的探讨超脉冲二氧化碳点阵激光配合果酸疗法治疗凹陷性痤疮瘢痕的临床疗效。方法回顾性分析成都军区机关医院2014年4月至2015年12月收治的97例凹陷性痤疮瘢痕患者的临床资料,按照治疗方法的不同分为3组,激光组30例采用波长2 600~3 000nm,能量密度20~30J/cm2,脉宽8~12ms的二氧化碳点阵激光进行治疗,1次/月,共治疗5次;果酸组32例采用20%浓度的果酸涂抹于患处,治疗1次/月;联合治疗组35例采用点阵激光和果酸疗法联合交替治疗,点阵激光治疗1次后间隔2周进行果酸治疗,此为1个疗程。共治疗4个疗程,各疗程间隔2周。对比3组患者的临床疗效、不良反应发生情况及满意度。结果联合治疗组总有效率为77%,显著高于激光组的53%和果酸组的50%,差异均有统计学意义（P〈0.05）;联合治疗组不良反应发生率为29%,显著低于激光组的57%和果酸组的44%,差异均有统计学意义（P〈0.05）;联合治疗组患者非常满意率74%,显著优于激光组的60%和果酸组的62%,差异均有统计学意义（P〈0.05）。结论果酸可加速肌肤新陈代谢,促进角质栓脱落和胶原合成,点阵激光治疗痤疮瘢痕具有患者疼痛程度低、效果显著等优点,两者配合治疗凹陷性痤疮瘢痕可促进痊愈,且安全性高,不良反应少,值得临床推广应用。

Objective To explore the treatment effect of ultrapulse fractional CO_2 laser combined with fruit acid treatment on depressed acne scars.Methods From April 2014 to December 2015,97 patients with depressed acne scars treated at Chengdu Military region Hospital were retrospectively reviewed.By different treatment methods,they were divided into three groups.Ultrapulse fractional CO_2 laser group had 30 cases,which were treated by fractional CO_2 laser with a wave length of 2 600-3 000 nm,energy density of 20-30J/cm2,and pulse width of8-12 ms,once per month for 5months.Fruit acid treatment group had 32 patients,for which 20%fruit acid was applied to the scars,once per month.The combined treatment group had 35 cases,who were treated by ultrapulse fractional CO_2 laser and fruit acid alternately.One cycle of treatment consisted of ultrapulse fractional CO_2 laser treatment followed by 2weeks of rest before fruit acid treatment.Four cycles were administered,and the interval between two cycles was 2weeks.The treatment outcome,adverse events and satisfaction degree were compared among the three groups.Results The overall response rate of the combined treatment group was 77%,which was significantly higher than that of the ultrapulse fractional CO_2 laser group（53%）and fruit acid treatment group（50%）（P〈0.05）.The incidence of adverse events in the combined treatment group was 29%,which was significantly lower than that of the ultrapulse fractional CO_2 laser group（57%）and fruit acid treatment group（44%）（P〈0.05）.The percentage of patients who were very satisfied was 74% in the combined treatment group,which was considerably improved compared with the ultrapulse fractional CO_2 laser group（60%）and fruit acid treatment group（62%）（P〈0.05）.Conclusion Fruit acid can facilitate skin metabolism and promote exfoliation of keratin plugs and collagen synthesis.Ultrapulse fractional CO_2 laser has the advantages of less pain and substantial treatment effects.The combination of the two treatments can accelerate the recovery of depressed acne scars with high safety and low incidence of adverse events.