Eremia Sorin, Li Cindy, Umar Sanusi H
Division of Dermatology, UCLA, Los Angeles, California, USA.
Dermatol Surg. 2002 Mar;28(3):224-30. doi: 10.1046/j.1524-4725.2002.01162.x.
Laser and intense pulsed light device treatments of leg veins have generally yielded disappointing results. Use of longer wavelengths, longer pulse widths, and better cooling devices have recently sparked renewed interests in these methods.
To prospectively compare, side by side, a 3-msec cryogen spray-equipped 755 nm alexandrite, a sapphire window cooled super-long-pulse 810 nm diode, and a variable pulse width, cryogen spray-equipped 1064 nm Nd:YAG laser for the treatment of 0.3-3mm leg veins.
Thirty female volunteers, skin types I-V, age 32-67 years with comparable sets of leg veins were treated with the Nd:YAG laser and either the diode laser, alexandrite laser, or both. In most patients two to three sets of comparable sites were treated. Treatment parameters varied with each laser and according to the size of veins being treated. Patients were examined 1 week after each treatment and at 1, 2, and 3 months after the last treatment. Pre- and posttreatment 35mm photographs were taken. Improvement was judged by two experienced physicians both visually on patients and by comparison of pre- and posttreatment photographs. Results were graded as percent resolution, in five groups, 0%, 0-25%, 25-50%, 50-75%, and 75-100%.
In the 22 patients completing the study, 36 leg vein sites were treated with the Nd:YAG laser, 18 leg vein sites were treated with the diode laser, and 12 leg vein sites were treated with the alexandrite laser. Greater than 75% improvement was observed at 88% of the Nd:YAG laser-treated sites, 29% of the diode laser-treated sites, and 33% of the alexandrite laser-treated sites. Greater than 50% improvement was observed at 94% of the Nd:YAG laser-treated sites, 33% of the diode laser-treated sites, and 58% of the alexandrite laser-treated sites. Less than 25% improvement was observed at 6% of the Nd:YAG laser-treated sites, 39% of the diode laser-treated sites, and 33% of the alexandrite laser-treated sites. Pain during treatment was variably perceived by patients, but occasionally sufficient for patients to decline further treatment. Posttreatment purpura and telangiectatic matting were a significant drawback for the alexandrite laser. Transient hemosiderin pigmentation, as seen with sclerotherapy, was common with larger vessels.
The cryogen spray-equipped 1064 nm Nd:YAG laser was remarkably effective and safe for the treatment of 0.3-3 mm leg veins. The use of topical anesthesia may be needed for some patients. The super-long-pulse 810 nm diode laser gave unpredictable results. Additional refinements of fluence and pulse width could improve its performance. The 3-msec, 755 nm alexandrite laser at fluences of 60-70 J/cm2 and an 8 mm spot can be effective, but inflammatory response, purpura, and matting limit its usefulness. Longer pulse widths might decrease these problems. For leg vein treatment, the 1064 nm wavelength is very safe for type V skin, the 810 nm wavelength at super-long pulse widths of 400-1000 msec is very safe for type IV and marginal for type V skin, and the 755 nm wavelength is limited to nontanned type I-III skin.
激光和强脉冲光设备治疗腿部静脉通常效果不佳。最近，使用更长波长、更长脉冲宽度以及更好的冷却设备引发了人们对这些方法的新兴趣。
前瞻性地并排比较配备3毫秒低温喷雾的755纳米翠绿宝石激光、配备蓝宝石窗口冷却的超长脉冲810纳米二极管激光以及配备低温喷雾的可变脉冲宽度1064纳米Nd:YAG激光治疗0.3 - 3毫米腿部静脉的效果。
30名年龄在32 - 67岁、皮肤类型为I - V型且腿部静脉情况相当的女性志愿者，接受Nd:YAG激光以及二极管激光、翠绿宝石激光中的一种或两种治疗。大多数患者治疗了两到三组可比较的部位。治疗参数因激光类型以及所治疗静脉的大小而异。每次治疗后1周以及最后一次治疗后1、2和3个月对患者进行检查。拍摄治疗前后的35毫米照片。由两名经验丰富的医生通过观察患者以及比较治疗前后照片来判断改善情况。结果分为五个等级，以消退百分比表示，分别为0%、0 - 25%、25 - 50%、50 - 75%和75 - 100%。
在完成研究的22名患者中，Nd:YAG激光治疗了36个腿部静脉部位，二极管激光治疗了18个腿部静脉部位，翠绿宝石激光治疗了12个腿部静脉部位。Nd:YAG激光治疗部位中88%改善超过75%，二极管激光治疗部位中29%改善超过75%，翠绿宝石激光治疗部位中33%改善超过75%。Nd:YAG激光治疗部位中94%改善超过50%，二极管激光治疗部位中33%改善超过50%，翠绿宝石激光治疗部位中58%改善超过50%。Nd:YAG激光治疗部位中6%改善不足25%，二极管激光治疗部位中39%改善不足25%，翠绿宝石激光治疗部位中33%改善不足25%。患者在治疗过程中对疼痛的感受各不相同，但偶尔会严重到使患者拒绝进一步治疗。治疗后紫癜和毛细血管扩张性网纹是翠绿宝石激光的一个显著缺点。与硬化疗法所见类似的短暂含铁血黄素色素沉着在较大血管中很常见。
配备低温喷雾的1064纳米Nd:YAG激光治疗0.3 - 3毫米腿部静脉非常有效且安全。部分患者可能需要使用局部麻醉。超长脉冲810纳米二极管激光的效果不可预测。进一步优化能量密度和脉冲宽度可能会改善其性能。能量密度为60 - 70 J/cm²、光斑为8毫米的3毫秒755纳米翠绿宝石激光可能有效，但炎症反应、紫癜和网纹限制了其应用。更长的脉冲宽度可能会减少这些问题。对于腿部静脉治疗，1064纳米波长对V型皮肤非常安全，超长脉冲宽度为400 - 1000毫秒的810纳米波长对IV型皮肤非常安全，对V型皮肤处于边缘适用，而755纳米波长仅限于未晒黑的I - III型皮肤。
