Kang W H, Kim N S, Kim Y B, Shim W C
Department of Dermatology, Ajou University School of Medicine, Suwon, Korea.
Dermatol Surg. 1998 Dec;24(12):1370-4.
Although syringoma represents a benign tumor of skin appendage, multiple and diffuse facial lesions can cause cosmetic problems for the affected individuals. Scarring, recurrence and postinflammatory hyperpigmentation can be serious troubles, especially for oriental people receiving various therapeutic modalities.
The purpose of this study was to evaluate the histopathologic and clinical efficacy of a new therapeutic approach for syringoma, consisting of combination of carbon dioxide (CO2) laser and 50% trichloroacetic acid (TCA).
Eighty skin biopsy specimens (45 patients) were evaluated to determine the depth of syringoma lesion. Among these, 28 specimens were obtained after a single test-pulse of CO2 laser (focused, superpulsed mode, power setting of 0.7-2 watts, beam diameter of 0.1 mm, pulse duration of 0.1 seconds), and 3 specimens after one pass of CO2 laser and 50% TCA. The depths of laser-induced vaporization and TCA-induced tissue necrosis were measured. Twenty patients were treated with the combination therapy of CO2 laser (two passes of laser) and 50% TCA. Clinical effectiveness and complications of combination therapy were evaluated by direct observation and photographs.
Tumor depth: Analysis of eight specimens revealed tumor depth of 0.70 +/- 0.20 mm (mean +/- SD), ranging from 0.4-1.2 mm. There were no correlations between tumor depth and age of onset or duration of the tumor. Laser penetration depth: CO2 laser irradiation, 0.7-2 watts, induced vaporization of 0.29 +/- 0.12 mm in depth with carbonized rim of 0.1 +/- 0.03 mm width (n = 28 from 15 patients). With laser power of 1 watt, vaporization ranged from 0.17-0.45 mm in depth. Laser and TCA induced necrosis: TCA application resulted in extra tissue necrosis of 0.22-0.25 mm in depth beyond the level achieved by laser vaporization.
Among the 20 patients treated with the combination therapy, therapeutic effect for 11 patients was excellent, 6 patients showed good clinical response, and 3 patients were fair. There were no serious complications resulting from this procedure such as infection, scarring or textural change.
The application of 50% TCA after CO2 laser irradiation was effective for removing deep-seated syringoma cells and for reducing the side effects, especially scarring. To the best of our knowledge, this is the first study introducing the combination of CO2 laser and TCA for removal of syringoma.
虽然汗管瘤是一种皮肤附属器良性肿瘤，但面部多发弥漫性损害会给患者带来美容问题。瘢痕形成、复发及炎症后色素沉着可能成为严重问题，尤其对于接受各种治疗方式的东方人。
本研究旨在评估一种新的汗管瘤治疗方法的组织病理学及临床疗效，该方法为二氧化碳（CO2）激光与50%三氯乙酸（TCA）联合应用。
对80份皮肤活检标本（45例患者）进行评估以确定汗管瘤损害深度。其中，28份标本在CO2激光单次试验脉冲后获取（聚焦、超脉冲模式，功率设置0.7 - 2瓦，光束直径0.1毫米，脉冲持续时间0.1秒），3份标本在CO2激光单次照射及50% TCA处理后获取。测量激光诱导汽化深度及TCA诱导组织坏死深度。20例患者接受CO2激光（两次照射）与50% TCA联合治疗。通过直接观察及拍照评估联合治疗的临床疗效及并发症。
肿瘤深度：对8份标本分析显示肿瘤深度为0.70±0.20毫米（均值±标准差），范围为0.4 - 1.2毫米。肿瘤深度与发病年龄或肿瘤病程之间无相关性。激光穿透深度：CO2激光照射，功率0.7 - 2瓦，诱导汽化深度为0.29±0.12毫米，碳化边缘宽度为0.1±0.03毫米（n = 28，来自15例患者）。激光功率为1瓦时，汽化深度范围为0.17 - 0.45毫米。激光及TCA诱导坏死：应用TCA导致超出激光汽化深度的额外组织坏死深度为0.22 - 0.25毫米。
在接受联合治疗的20例患者中，11例治疗效果极佳，6例临床反应良好，3例效果尚可。该治疗方法未引发如感染、瘢痕形成或质地改变等严重并发症。
CO2激光照射后应用50% TCA对于清除深部汗管瘤细胞及减少副作用尤其是瘢痕形成有效。据我们所知，这是第一项介绍CO2激光与TCA联合用于去除汗管瘤的研究。
