Hansen Kristen, Kreiter Clarence D, Rosenbaum Marcy, Whitaker Duane C, Arpey Christopher J
Department of Dermatology, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242, USA.
Dermatol Surg. 2003 Jan;29(1):49-55. doi: 10.1046/j.1524-4725.2003.29010.x.
The rationale for treatment of patients with port-wine stain (PWS) birthmarks has focused on the belief that eventual soft-tissue hypertrophy and negative psychological effects might be diminished or avoided. Pulsed-dye laser (PDL) therapy has become widely accepted as the treatment of choice for PWS, and a variety of studies have been conducted that evaluate its short-term efficacy. Long-term data regarding outcome and patient satisfaction are lacking.
Our objective was to evaluate the long-term efficacy of pulsed-dye laser therapy from the patient's perspective.
A survey was mailed to all patients or parents of minor patients whose last known laser treatment was performed between January 1, 1989, and January 1, 1996. Patients were asked to quantify changes in their PWS as well as their psychological well-being. A formal qualitative analysis was performed on their written comments as well.
A total of 164 surveys were mailed to the most recent address available by the patient record. Fifty-two surveys were returned as undeliverable, and 55 evaluable surveys were returned, yielding a 49% overall return rate for patients who could be located. The mean age of respondents was 28.8 years, 96% of whom were white and 62% female. The mean number of years since last treatment was 7.04. The vast majority of patients noted little or no change in texture, height, or dimension of their PWS, whereas 62% noted color improvement. A majority or patients (60%) worried less about their appearance after treatment, whereas a similar number (61%) believed their ability to make friends or meet others was unaffected by treatment. Only 19% thought others looked at or treated them differently because of their PWS. Overall, 48% of patients indicated satisfaction with treatment, 24% dissatisfaction, and 28% neutral. On a 10-point scale indicating their likelihood of recommending treatment to someone similarly affected, the mean score was 7.42. Men were significantly and consistently less satisfied with treatment than women, despite rating the degree of color improvement similarly to women. Qualitative analysis of patient comments helped validate quantitative data and revealed gender differences in satisfaction, as well as correlations with adverse events from treatment, desire for additional treatment, and a trend toward more positive comments with the passage of time.
The pulsed-dye laser improves the color of PWS over long periods of time in a majority of patients. Patients tended to worry less about their appearance after treatment, although most believed treatment did not substantially affect their relationship with others or others' view of them. Most patients were satisfied or neutral with regard to satisfaction with therapy and would recommend treatment to others. A minority of patients was dissatisfied with treatment, and men were more likely to be dissatisfied. Additional long-term and prospective studies will be helpful in assessing the physical and psychosocial impact of PDL for PWS.
鲜红斑痣（PWS）胎记患者的治疗依据在于，人们认为最终可能会减轻或避免软组织肥大及负面心理影响。脉冲染料激光（PDL）疗法已被广泛认可为PWS的首选治疗方法，并且已经开展了多项研究来评估其短期疗效。然而，缺乏关于治疗效果和患者满意度的长期数据。
我们的目的是从患者角度评估脉冲染料激光治疗的长期疗效。
向所有在1989年1月1日至1996年1月1日期间接受过最后一次已知激光治疗的患者或未成年患者的家长邮寄了一份调查问卷。要求患者量化其PWS的变化以及他们的心理健康状况。还对他们的书面评论进行了正式的定性分析。
根据患者记录中的最新地址，共邮寄了164份调查问卷。52份调查问卷因无法投递而退回，55份可评估的调查问卷被退回，能够找到的患者的总体回复率为49%。受访者的平均年龄为28.8岁，其中96%为白人，62%为女性。自上次治疗以来的平均年数为7.04年。绝大多数患者指出其PWS的质地、高度或尺寸几乎没有变化，而62%的患者指出颜色有所改善。大多数患者（60%）治疗后对外表的担忧减少，而类似比例（61%）的患者认为治疗并未影响他们结交朋友或与他人交往的能力。只有19%的患者认为他人因他们的PWS而以不同的方式看待或对待他们。总体而言，48%的患者表示对治疗满意，24%不满意，28%持中立态度。在一个10分制的量表上，表明他们向有类似情况的人推荐治疗的可能性，平均得分为7.42分。尽管男性对颜色改善程度的评分与女性相似，但男性对治疗的满意度明显且始终低于女性。对患者评论的定性分析有助于验证定量数据，并揭示了满意度方面的性别差异，以及与治疗不良事件、额外治疗意愿的相关性，以及随着时间推移积极评论增多的趋势。
脉冲染料激光在大多数患者中可长期改善PWS的颜色。患者治疗后对外表的担忧往往会减少，尽管大多数人认为治疗对他们与他人的关系或他人对他们的看法没有实质性影响。大多数患者对治疗满意度为满意或中立，并会向他人推荐治疗。少数患者对治疗不满意，男性更有可能不满意。更多的长期和前瞻性研究将有助于评估PDL治疗PWS的身体和心理社会影响。
