1565 nm非剥脱点阵激光治疗外伤后瘢痕的临床效果

Clinical efficacy of 1565 nm nonablative fractional laser for treatment of immature scar

目的观察1565 nm非剥脱点阵激光治疗面部外伤后瘢痕的疗效,探讨非剥脱点阵激光治疗外伤后瘢痕的最佳时间。方法2017年1月至2018年12月,第四军医大学西京皮肤医院皮肤科就诊的面部外伤后瘢痕患者100例[男39例,女61例,年龄9个月至56(25.87±12.36)岁],用1565 nm非剥脱点阵激光治疗,共治疗3次,每次治疗间隔为1个月。根据患者面部外伤后瘢痕形成时间进行分组,分为≤3 d组、4~21 d组、22~90 d组、91~180 d组、181~365 d组5组,每组20例,分别由医师及患者或患儿监护人采用患者与观察者瘢痕评估量表(POSAS)对疗效进行评估。结果瘢痕分别位于额部12例、颞部17例、鼻部8例、面颊33例、口周19例、下颏11例。5组患者治疗后医师及患者对其瘢痕总体评估值均较治疗前明显下降(t=9.488,9.072,6.204,7.855,5.812,11.459,11.168,5.272,7.628,4.790,均P<0.001),其中≤3 d组治疗前、治疗后医师总体评估分值分别为(4.70±1.56)分、(1.30±0.80)分,与4~21 d组的治疗前、治疗后医师总体评估分值比较,差异无统计学意义,但是明显优于22~90 d组、91~180 d组、181~365 d组(Z=-2.721,-2.549,-3.663,P<0.01);治疗中均未发生严重不良反应。结论1565 nm非剥脱点阵激光治疗面部外伤后瘢痕安全、有效,疗效与瘢痕干预时间有关。

Objective To observe the efficacy of 1565 nm nonablative fractional laser for the treatment of scar after trauma and to explore the optimum time for therapy.Methods Retrospective analysis was performed on 100 patients with scars who were treated with 1565 nm nonablative fraction laser for 3 times at 4 weeks interval.Five groups(≤3 d,4-21 d,22-90 d,91-180 d)were divided according to the time of laser intervention after scar formation.The Patient and Observer Scar Assessment Scale(POSAS)was used to evaluate the efficacy by doctors and patients or family members of pediatric patients.Results After 3 times of treatment,the scores of patients'scar vascularity,pigmentation,thickness,relief,pliability,surface area,and overall valuation in POSAS by doctors and the scores of pain,itch,color,stiffness,thickness,irregularity,and overall valuation in POSAS by patients or family members of pediatric patients were all significantly lower than those before the first combined treatment(t=9.488,9.072,6.204,7.855,5.812,11.459,11.168,5.272,7.628,4.790,P<0.001).The overall evaluation scores by doctors were(4.70±1.56)and(1.30±0.80)points.Compared with group 4-21 d,the overall evaluation scores of physicians before and after treatment were not statistically different from those of the 4-21d group,but were significantly better than those of the 22-90 d group,the 91-180 d group,and the 181-365 d group.No serious adverse reactions were found in the treatment.Conclusions 1565 nm nonablative fractional laser is an effective and safe treatment for immature scars,and the improvement is associated with intervention time.