Er-YAG 2940 nm激光联合曲安奈德治疗增生性瘢痕的疗效观察

Clinical observation of Er-YAG 2940 nm laser combined with glucocorticoid in the treatment of hypertrophic scar

目的 Er-YAG 2 940 nm 激光联合曲安奈德治疗增生性瘢痕的疗效观察。方法选取2019年1月至2020年12月来我院治疗的增生性疤痕患者60例,男根据治疗方法的不同分为对照组及观察组,对照组采用铒激光进行增生性疤痕给治疗,观察组在对照组的基础上采用增加曲安奈德治疗,比较两组患者的临床疗效和安全性。结果治疗两次后6个月随访,对照组患者瘢痕有所萎缩,但仍高于皮肤表面,颜色变浅,质地仍较硬;观察组瘢痕组织颜色、质地均接近周围正常皮肤。除治疗前、治疗第1次外,第2次、第2次治疗后3个月、6个月两组患者VSS评分比较,P均<0.05,差异具有统计学意义,观察组VSS评分均低于对照组。采用重复方差测量分析,治疗和时间的交互作用,F=29.238,P=0.000,提示随时间增长,临床效果改变;不同治疗方法比较,F=35.271,P=0.000,提示不同治疗方法对临床效果有影响。第2次治疗后6个月随访,两组患者临床疗效采用非参数检验,Z=2.670,P=0.008,差异具有统计学意义,观察组临床疗效优于对照组。治疗后,两组患者瘢痕长度、宽度和厚度比较,P均<0.05,差异具有统计学意义,且观察组患者瘢痕长度、宽度和厚度低于对照组。采用疼痛、红斑、水疱、感染、色素沉着、疤痕加重等不良反应发生率比较,两组患者仅疼痛、红斑比较,P<0.05,差异有统计学意义,但观察组患者的疼痛、红斑、水疱、感染、色素沉着、疤痕加重等不良反应发生率均低于对照组。结论Er-YAG 2 940 nm 激光联合曲安奈德治疗增生性瘢痕修复效果较好,安全性也较高,同时操作过程简单,适合临床增生性瘢痕的治疗。

Objective To explore the clinical effect of Er-YAG 2940 nm laser combined with glucocorticoid in the treatment of hypertrophic scar.Methods 60 patients with hypertrophic scar in our hospital from Jan.2019 to Dec.2020 were selected and divided into control group and observation group according to different treatment methods.The control group was treated with Er-YAG 2940 nm laser for hypertrophic scar,and the observation group was treated with triamcinolone acetonide on the basis of the control group.The clinical efficacy and safety of the two groups were compared.Results The scar in the control group was atrophic,but still higher than the skin surface,the color became lighter and the texture was still hard;the color and texture of scar tissue in the observation group were close to the surrounding normal skin for three months after two times of treatment.The difference of the VSS score of the patients in two groups for the second time,3 months and 6 months after the second time of treatment was statistically significant(P<0.05)except before treatment and the first time of treatment,the VSS score of the observation group was lower than the control group.It indicated that the interaction between treatment and time(F=29.238,P=0.000)and the interaction between treatment and the clinical effect(F=35.271,P=0.000)by the ANOVA analysis.The difference of the clinical efficacy of the two groups for six months after the second treatment,was statistically significant(Z=2.670,P=0.008),the clinical efficacy of the observation group was better than that of the control group.The difference of the scar length,width and thickness of the two groups after treatment was statistically significant(P<0.05),and the length,width and thickness of the scar the observation group were lower than those of the control group.The difference of the incidence for the pain,erythema in two groups was statistically significant(P<0.05),besides the incidence for the blisters,infection,pigmentation and scar aggravation,but the incidence of adverse reactions such as pain,erythema,blisters,infection,pigmentation and scar aggravation in the observation group was lower than that in the control group.Conclusions The effect of Er-YAG2940 nm laser combined with glucocorticoid in the treatment of hypertrophic scar repair is better,safety is also higher,and the operation process is simple,suitable for clinical treatment of hypertrophic scar.