点阵激光及PDL不同治疗方案对兔耳增生性瘢痕的疗效观察

The curative effects of different schemes through lattice laser and PDL in the treatment of scar hyperplasia

目的探讨点阵激光联合脉冲染料激光(pulse dye laser,PDL)对兔耳增生性瘢痕的抑制效果,为临床治疗提供理论依据。方法选取潍坊医学院动物实验中心提供的健康清洁级新西兰白兔12只,制作耳廓增生性瘢痕模型,造模成功后随机分为6组。A组:点阵激光,每4周1次,共2次;B组:Cynergy激光,每4周1次,共2次;C组:先行1次点阵激光照射,结痂脱落后再行Cynergy激光,每4周1次,共2次。D组:先行Cynergy激光1次,结痂脱落后再行点阵激光,每4周1次,共2次;E组:每次点阵激光后涂曲安奈德,每4周1次,共2次;F组:空白对照。术后80 d取材,制片,分别行HE染色,改良VG染色、SV0002-兔IgG等染色观察并比较胶原纤维面密度值、微血管密度及肌成纤维细胞转化率等。结果肉眼及HE染色观察各实验组与空白对照组形态差异较大:空白对照组瘢痕部位明显高于周围正常皮肤,质硬,色暗红。治疗后,A、B、C、D、E组瘢痕厚度、胶原纤维面密度、瘢痕周围微血管密度、肌成纤维细胞转化率均低于F组(P<0.05)。组间比较显示,A组和B组、C组和D组比较差异无统计学意义,其余各组比较差异有统计学意义(P<0.05)。结论CO2点阵激光、Cynergy双波长激光以及两者联合对治疗增生性瘢痕均有效,均能使瘢痕微血管生成减少,胶原含量下降,瘢痕变平变软,且联合治疗组的效果明显优于单一激光治疗组。

Objective To expore the curative effect of dot laser combined with pulsed dye laser(PDL)for treating hypertrophic scar of rabbit ear,as to provide theoretical basis for guiding clinical treatment.Methods 12 healthy and clean New Zealand white rabbits provided by the Animal Experimental Center of Weifang Medical College were selected to make auricle hypertrophic scar model,and then were randomly divided into six groups after the successful modeling.Group A:The lattice laser therapy was performed once every 4 weeks,a total of 2 times.Group B:Cynergy laser therapy was performed once every 4 weeks,a total of 2 times.Group C:First,it was treated by lattice laser once,then Cynergy laser treatment once after the scab fell off,once every 4 weeks,a total of 2 times.Group D:First,it was treated by Cynergy laser once,then lattice laser treatment once after the scab fell off,once every 4 weeks,a total of 2 times.Group E:it was treated by triamcinolone acelonide after lattice laser,once every 4 weeks,a total of 2 times.Group F:it was setted as blank control group.The collagen fiber density value,microvascular density and fibroblast conversion of the tissue after 80 days of treatment and microsection observation were observed and compared by HE stain,modified VG staining,SV0002-rabbit IgG stain separately.Results There was morphological difference between observation group and blank control group in the gross morphological observation and HE stain observation.The scar which was hard with kermesinus of blank control group was significantly higher compared to the surrounding normal skin.After treatment,the scar thickness,collagen fiber area density,microvessel density around the scar,and myofibroblast transformation rate in groups A,B,C,D,and E were all lower than those in group F(P<0.05).Pairwise comparisons showed that there was no statistically significant difference between group A and group B,group C and group D,and the other groups had statistically significant difference(P<0.05).Conclusion CO2 lattice laser,PDL and the combination can effectively treat hypertrophic scar,decline the angiogenesis of sacr,cut down the content of collagen,make the scar flatten and softening,and the effect of combination group was better than simple laser group.