Huang P S, Chang C J
Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taipei, Chang Gung University, Taoyuan, Taiwan, R.O.C.
Chang Gung Med J. 2001 Aug;24(8):469-75.
When a cryogen spurt is applied to the skin surface for an appropriately short period of time, the spatial distribution of cooling remains localized in the normal overlying epidermis, while leaving the temperature of deeper port wine stain (PWS) blood vessels unchanged. Furthermore, cooling continues after pulsed laser exposure as cryogen remaining on the surface evaporates and removes heat deposited by light absorption in epidermal melanin. The objective of this study was to evaluate the efficacy and advantages of cryogen spray cooling plus flashlamp-pumping in conjunction with dye laser treatment (CSC-LT) of PWS.
From 1996 to 2000, a retrospective study was conducted on 63 patients, consisting of 43 women and 20 men, between the ages of 8 and 62 years treated with pulsed dye laser (lambda = 585 nm, tau p = 450 microseconds) over a 4-year period. The duration of cryogen spurts and the delay period between cryogen delivery and laser illumination were controlled. An infrared focal plane array thermodetector measured changes of lesion surface temperature which were recorded. The subject was asked to score discomfort during treatment using a pain scale. The primary efficacy measure was the quantitative assessment of a blanching response score.
The ambient skin surface temperature of PWS was 33.31 +/- 1.55 degrees C. The mean pain score for uncooled sites was 39.85 +/- 0.23 compared to 20.18 +/- 0.15 for cooled sites. There was a statistically significant difference in pain elimination between cooled and uncooled sites (p = 0.001). The mean blanching response score of CSC-LT was 3.70. A significant blanching response of PWS when receiving CSC-LT was noted.
Our clinical studies demonstrate the feasibility of selective epidermal cooling while achieving photothermolysis of blood vessels during pulsed dye laser treatment of PWS.
当在皮肤表面适当短时间喷射制冷剂时，冷却的空间分布局限于正常覆盖的表皮，而深层葡萄酒色斑（PWS）血管的温度保持不变。此外，在脉冲激光照射后，由于残留在表面的制冷剂蒸发并带走表皮黑色素中光吸收所沉积的热量，冷却仍会持续。本研究的目的是评估制冷剂喷雾冷却加闪光灯泵浦联合染料激光治疗（CSC-LT）PWS的疗效和优势。
1996年至2000年，对63例患者进行回顾性研究，其中包括43名女性和20名男性，年龄在8至62岁之间，在4年期间接受脉冲染料激光（波长=585nm，脉冲宽度=450微秒）治疗。控制制冷剂喷射的持续时间以及制冷剂输送与激光照射之间的延迟时间。使用红外焦平面阵列热探测器测量病变表面温度的变化并进行记录。要求受试者使用疼痛量表对治疗期间的不适进行评分。主要疗效指标是对白化反应评分的定量评估。
PWS周围皮肤表面温度为33.31±1.55℃。未冷却部位的平均疼痛评分为39.85±0.23，而冷却部位为20.18±0.15。冷却部位和未冷却部位在疼痛消除方面存在统计学显著差异（p = 0.001）。CSC-LT的平均白化反应评分为3.70。接受CSC-LT时PWS出现了显著的白化反应。
我们的临床研究证明了在脉冲染料激光治疗PWS期间选择性表皮冷却并实现血管光热解的可行性。
