激光序列治疗面部美容缝合术后早期瘢痕临床效果的回顾性研究

A retrospective study of sequential laser treatments for early stage of facial post-traumatic scars which were managed by plastic surgeons:outcome and time of intervention

目的探讨面部美容缝合术后瘢痕激光干预时间与预后之间的关系。方法回顾性分析2017年5月至2019年12月,在空军军医大学第一附属医院整形外科行面部美容清创缝合术后2~12周开始激光瘢痕序列治疗,且治疗3次的患者资料,共212例,男115例,女107例,年龄(25.50±10.67)岁。212例患者以开始激光治疗的时间不同分为4组,分别在术后2周(A组)、4周(B组)、8周(C组)、12周(D组)开始,采用595 nm染料激光进行瘢痕治疗,当瘢痕温哥华评分量表(VSS)中血管分布的评分低于2分时,更换为CO2点阵激光治疗,共3次,间期均为8周。整个激光治疗间期,所有患者均辅以硅凝胶制剂常规抗瘢痕治疗。末次激光治疗后2个月,各组内与组间瘢痕治疗前后VSS评分采用秩和(Friedman和Mann-Whitney U)检验进行统计;同时行患者满意度评价,统计临床色素沉着、水泡及瘢痕等不良反应发生例数,采用卡方和F检验的方法进行评估。结果212例均完成了3次激光治疗。治疗前VSS评分分别为A组3(3.00~5.00)分、B组4(3.00~4.00)分、C组6(5.00~6.00)分、D组6.5(6.00~7.75)分,3次治疗后评分分别降至2(2.00~3.00)、2(2.00~3.00)、4(3.00~4.00)、4(4.00~4.75)分,组内比较,各组均较治疗前明显降低(P<0.001)。组间两两比较,A、B组各时间点VSS评分差异均无统计学意义(P>0.05)。A与C组、A与D组、B与C组、B与D组间比较差异有统计学意义(P<0.001)。末次随访,A^D组患者非常满意率分别为80.77%(42/52)、75.61%(31/41)、56.41%(22/39)、47.50%(38/80),A、B组明显高于C、D组(P<0.05)。有3例出现水泡,其中2例出现中度色素沉着,末次治疗后6个月内均缓解。结论面部外伤术后2周至1个月内进行595 nm脉冲染料激光联合CO2点阵激光序列治疗瘢痕,临床效果及患者满意度均高于术后2~3个月开始激光治疗的瘢痕。

Objective To assess the efficacy and intervention time of sequential laser treatments for early stage of facial post-traumatic scars which were managed by plastic surgeons.Methods 212 patients in our department with facial post-traumatic scar which were managed by plastic surgeons within 2-12 weeks received 3-session of sequential 595 nm and CO2 ablative fractional lasertreatments at 8 weeks intervals.They were divided into four groups in this retrospective study.Traumatic scars were first treated by 595 nm pulsed dye laser at 2 weeks(group A),4 weeks(group B),8 weeks(group C),12 weeks(group D)post-operation respectively.Until the vascularity scores of Vancouver scar scale(VSS)fell below 2 points,then scars were treated with CO2 ablative fractional laser.During the study,all cases were treated with standard silicone gel.Photographs taken before and after each treatment session were independently evaluated and scored by two uninvolved doctors with Vancouver scar rating scale(VSS).Friedman test and Mann-Whitney U test were used for intragroup and intergroup comparison of the difference before and after each session treatment.Patients,self-satisfactory(on 0-100%)and adverse effects were recorded and Chi-square and Fisher’s exact test were used to compare the differences between groups.Results All 4 groups of patients completed 3-session laser treatments.The VSS score of A/B/C/D group was 3.0(3.00-5.00)/4.0(3.00-4.00)/6.0(5.00-6.00)/6.5(6.00-7.75)at baseline,and significantly decreased to 2(2.00-3.00)/2(2.00-3.00)/4(3.00-4.00)/4(4.00-4.75)at 2 months after 3-session treatment(P<0.001)respectively.Compared VSS score intergroup,there was no statistically difference between group A and B before(P>0.05)or after(P>0.05)treatment.In contrast,compared with group C or D,VSS score of group A or B was significantly lower at baseline(P<0.001)and final follow-up(P<0.001).And the excellent rate of patients,self-satisfaction were significantly different for group A(80.77%)vs.group C(56.41%)or D(47.50%),and group B(75.61%)vs.group C or D(P<0.05).No significant adverse effects were reported except for 3 patients with mild transient vesicles,and amonge the 3 cases,hyperpigmentation was observed in 2 cases which was faded within 6 months.Conclusions A combination of 595 nm pulsed dye laser and CO2 ablative fractional laser for facial traumatic scars starting from 2 weeks to 1 month post-operation could reach better clinical outcome by attenuating scar formation effectively and with higher patients,self-satisfaction than that from 2-3 months post-operation.