Alster T S, Lupton J R
Washington Institute of Dermatologic Laser Surgery, Washington, DC, USA.
Dermatol Clin. 2001 Jul;19(3):453-66. doi: 10.1016/s0733-8635(05)70286-2.
The short-pulsed Er:YAG laser system is an excellent ablative tool for cutaneous resurfacing. This system is most efficacious for patients with milder cutaneous involvement, including mild photoinduced facial rhytides, mildly atrophic scars, and textural changes caused by fibrosis and dermatochalasis. The Er:YAG laser cannot achieve the same dramatic clinical and histologic improvements produced with the CO2 laser but does offer some distinct advantages that make it a valuable addition to the laser surgeon's armamentarium. The Er:YAG laser, because of its higher affinity for water-containing tissues, effects a much finer level of tissue ablation. Although erbium laser resurfacing results in decreased postoperative morbidity with a shorter recovery period, it cannot effect the same degree of improvement in photodamaged skin as can the CO2 laser. Excellent results, however, can be achieved with this laser, up to 50% or more overall clinical improvement, in patients with milder photodamage and scarring (Glogau classes I and II). In darker-skinned patients, the Er:YAG laser is often the preferred treatment modality. Continued research in the field has already led to the development of longer-pulsed Er:YAG lasers, which offer a compromise between the CO2 laser and the short-pulsed Er:YAG lasers in terms of clinical benefits while maintaining the safety profile of the traditional short-pulsed system. In addition, many surgeons now use a combination approach with the CO2 and Er:YAG lasers in an effort to maximize collagen contraction in certain areas and limit postoperative morbidity. As more research is conducted within the field of cutaneous resurfacing, newer systems will be developed in the continuing effort to create the ideal laser system--one which ameliorates the signs of photoaging without risk of major side effects or significant postoperative recovery.
钇铝石榴石激光系统是用于皮肤磨削的一种出色的剥脱工具。该系统对皮肤受累较轻的患者最为有效，包括轻度光致面部皱纹、轻度萎缩性瘢痕以及由纤维化和皮肤松弛引起的质地改变。铒：钇铝石榴石激光无法达到二氧化碳激光所产生的同样显著的临床和组织学改善效果，但确实具有一些明显优势，使其成为激光外科医生的有用工具。铒：钇铝石榴石激光由于对含水组织具有更高的亲和力，能实现更精细的组织剥脱水平。尽管铒激光磨削术后发病率降低且恢复期较短，但它在改善光损伤皮肤方面无法达到二氧化碳激光的同等程度。然而，对于光损伤和瘢痕较轻（Glogau I级和II级）的患者，使用这种激光可取得出色效果，总体临床改善可达50%或更高。在肤色较深的患者中，铒：钇铝石榴石激光通常是首选的治疗方式。该领域的持续研究已促使开发出长脉冲铒：钇铝石榴石激光，其在临床益处方面介于二氧化碳激光和短脉冲铒：钇铝石榴石激光之间，同时保持了传统短脉冲系统的安全性。此外，现在许多外科医生采用二氧化碳激光和铒：钇铝石榴石激光联合使用的方法，以在某些区域最大限度地促进胶原蛋白收缩并限制术后发病率。随着皮肤磨削领域开展更多研究，将开发更新的系统，继续努力打造理想的激光系统——一种能改善光老化迹象而无重大副作用风险或显著术后恢复期的系统。
