面部增生性瘢痕超脉冲CO_(2)点阵激光术后临床疗效影响因素分析

Analysis of Factors Influencing the Clinical Efficacy of Ultrapulse CO_(2) Fractional Laser Surgery in Treating Facial Hypertrophic Scar

目的分析面部增生性瘢痕超脉冲CO_(2)点阵激光术后临床疗效的影响因素。方法选取2020年9月至2022年9月南阳市中心医院收治的250例面部增生性瘢痕患者作为研究对象,所有患者均行超脉冲CO_(2)点阵激光治疗,观察患者新版温哥华瘢痕量表(VSS)评分变化情况及临床疗效,并收集患者性别、年龄、体重指数(BMI)、创伤原因、病程、新版VSS评分、皮肤类型等资料,根据治疗是否有效(包含痊愈、显效、有效)将患者分为有效组与无效组,分析影响治疗效果的因素。结果治疗6个月后,250例面部增生性瘢痕患者痊愈34例(136%)、显效120例(480%)、有效54例(216%)、无效42例(168%),总有效率为832%。根据治疗是否有效将患者分为有效组208例与无效组42例,单因素分析结果显示,无效组患者男性以及干性皮肤者比例明显高于有效组(χ^(2)=5376、13086,P=0020、P<0001),年龄明显大于有效组(t=6241,P<0001),病程明显长于有效组(t=6996,P<0001),治疗前新版VSS评分明显高于有效组(t=13850,P<0001);多因素Logistic回归分析结果显示,男性、年龄较大、病程较长、治疗前新版VSS评分较高、皮肤类型偏干性是面部增生性瘢痕超脉冲CO_(2)点阵激光治疗无效的独立危险因素(95%CI为1054~3233、1234~6280、1492~13090、1687~17516、1102~2641,P=0032、0013、0007、0005、0016)。结论超脉冲CO_(2)点阵激光虽能有效改善面部增生性瘢痕症状,但部分患者受性别、年龄、病程、瘢痕增生程度、皮肤类型影响效果不佳。

Objective To analyze the factors influencing the clinical efficacy of ultrapulse CO_(2) fractional laser surgery in the treatment of facial hypertrophic scar.Methods 250 patients with facial hypertrophic scars admitted to Nanyang Central Hospital from September 2020 to September 2022 were enrolled as research subjects.All patients were treated with ultrapulse CO_(2) fractional laser surgery.The changes of the new-edition Vancouver scar scale(VSS)scores of patients and clinical efficacy were observed,and patients’data were collected,including sex,age,body mass index(BMI),cause of trauma,duration of injury,new-edition VSS score,skin type,etc.Based on the treatment effectiveness(i e,cured,markedly effective and effective),the patients were divided into effective group and ineffective group to analyze the factors influencing the treatment effect.Results After six months of treatment,of the 250 patients with facial hyperplastic scars,34 cases(136%)were cured,120 cases(480%)were markedly effective,54 cases(216%)were effective,and 42 cases(168%)were ineffective,with the overall effective rate being 832%.The patients were divided into effective group(n=208)and ineffective group(n=42)according to whether the surgery was effective or not.Univariate analysis showed that the proportions of males and of patients with dry skin type were both significantly higher in the ineffective group compared with the effective group(χ^(2)=5376 and 13086,P=0020,P<0001),patients’age was significantly older(t=6241,P<0001),the duration of injury was significantly longer(t=6996,P<0001),and the new-edition VSS score before treatment was significantly higher(t=13850,P<0001)in the ineffective group.Multivariate Logistic regression analysis results showed that sex-male,older age,longer duration of injury,higher new-edition VSS score before treatment,and dry skin type were independent risk factors for the ineffectiveness of ultrapulse CO_(2) fractional laser surgery in the treatment of facial hypertrophic scar(95%CI:1054-3233,1234-6280,1492-13090,1687-17516 and 1102-2641,P=0032,0013,0007,0005 and 0016).Conclusion Although ultrapulse CO_(2)fractional laser can effectively improve the symptoms of facial hypertrophic scar,its effect can be affected by patients’sex,age,duration of injury,scar hyperplasia degree and skin type,resulting in poor treatment effect.