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[二氧化碳点阵激光联合微创瘢痕松解术治疗痤疮后萎缩性瘢痕的临床疗效]

[Clinical effects of fractional carbon dioxide laser combined with minimally invasive scar release in the treatment of post-acne atrophic scars].

作者信息

Ge Y N, Pan H H, Zhao J B, Chen Y

机构信息

Department of Plastic Surgery and Cosmetology, the First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou 450099, China.

出版信息

Zhonghua Shao Shang Yu Chuang Mian Xiu Fu Za Zhi. 2023 Jan 20;39(1):53-58. doi: 10.3760/cma.j.cn501225-20220616-00238.

Abstract

To explore the clinical effects of fractional carbon dioxide laser combined with minimally invasive scar release in the treatment of post-acne atrophic scars. A retrospectively observational study was conducted. From January to June 2021, 60 patients with grade 3 and 4 post-acne atrophic scars who met the inclusion criteria were admitted to the First Affiliated Hospital of Henan University of Traditional Chinese Medicine. According to the adopted treatment methods, 30 patients treated with fractional carbon dioxide laser combined with minimally invasive scar release were included in combined treatment group (19 males and 11 females, aged (26±4) years), and 30 patients treated with fractional carbon dioxide laser alone were included in laser alone group (18 males and 12 females, aged (25±6) years). All the patients received the treatment once every two months, totally 3 times. Before the first treatment and 2 months after the last treatment, the scars were assessed by échelle d'évaluation clinique des cicatrices d'acné (ECCA). In 2 months after the last treatment, the curative effect was evaluated and the total effective rate was calculated according to the ECCA score. The adverse reactions of patients during the treatment were recorded. Data were statistically analyzed with independent sample test, Wilcoxon rank-sum test, Mann-Whitney test, chi-square test, and Fisher's exact probability test. Before the first treatment, the ECCA scores of patients in the two groups were similar (>0.05). In 2 months after the last treatment, the ECCA scores of patients in combined treatment group were significantly lower than those of laser alone group (=-2.89, <0.05). The ECCA scores of patients in combined treatment group and laser alone group in 2 months after the last treatment were both significantly lower than those before the first treatment (with values of -4.81 and -4.79, respectively, <0.05). In 2 months after the last treatment, the treatment in laser alone group cured the scars in 2 patients, and were markedly effective in 13 patients, effective in 7 patients, and ineffective in 8 patients; the treatment in combined treatment group cured the scars in 4 patients, and were markedly effective in 22 patients, effective in 3 patients, and ineffective in one patients. The total effective rate of scar treatment in combined treatment group (96.67%, 29/30) was significantly higher than 73.33% (22/30) in laser alone group (<0.05). During treatment, in combined treatment group, 3 patients had pain, one patient had redness and swelling, and one patient had pigmentation. In laser alone group, one patient had pain, and 2 patients had pigmentation. No infection occurred in the wounds of all the patients in the two groups. Compared with fractional carbon dioxide laser alone, fractional carbon dioxide laser combined with minimally invasive scar release for post-acne atrophic scars can result in a higher total effective rate, with simple operation and good effect, so it is worthy of clinical application.

摘要

探讨二氧化碳点阵激光联合微创瘢痕松解术治疗痤疮后萎缩性瘢痕的临床效果。进行一项回顾性观察研究。2021年1月至6月,将60例符合纳入标准的3、4级痤疮后萎缩性瘢痕患者收入河南中医药大学第一附属医院。根据所采用的治疗方法,将30例采用二氧化碳点阵激光联合微创瘢痕松解术治疗的患者纳入联合治疗组(男19例,女11例,年龄(26±4)岁),30例仅采用二氧化碳点阵激光治疗的患者纳入单纯激光组(男18例,女12例,年龄(25±6)岁)。所有患者每两个月接受1次治疗,共3次。在首次治疗前及末次治疗后2个月,采用痤疮瘢痕临床评估量表(ECCA)对瘢痕进行评估。在末次治疗后2个月,评估疗效并根据ECCA评分计算总有效率。记录患者治疗期间的不良反应。采用独立样本t检验、Wilcoxon秩和检验、Mann-Whitney U检验、卡方检验和Fisher确切概率法进行统计学分析。首次治疗前,两组患者的ECCA评分相似(P>0.05)。末次治疗后2个月,联合治疗组患者的ECCA评分显著低于单纯激光组(t=-2.89,P<0.05)。联合治疗组和单纯激光组患者在末次治疗后2个月的ECCA评分均显著低于首次治疗前(t值分别为-4.81和-4.79,P<0.05)。末次治疗后2个月,单纯激光组治疗使2例患者瘢痕治愈,13例显效,7例有效,8例无效;联合治疗组治疗使4例患者瘢痕治愈,22例显效,3例有效,1例无效。联合治疗组瘢痕治疗总有效率为96.67%(29/30),显著高于单纯激光组的73.33%(22/30)(P<0.05)。治疗期间,联合治疗组有3例患者出现疼痛,1例患者出现红肿,1例患者出现色素沉着。单纯激光组有1例患者出现疼痛,2例患者出现色素沉着。两组所有患者伤口均未发生感染。与单纯二氧化碳点阵激光相比,二氧化碳点阵激光联合微创瘢痕松解术治疗痤疮后萎缩性瘢痕可提高总有效率,操作简单,效果良好,值得临床应用。

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