Ann Plast Surg:二氧化碳激光器联合或不联合脉冲染料激光器治疗肥厚性烧伤疤痕的疗效

2022-09-16 MedSci原创 MedSci原创

该研究对不同年龄、病因和厚度的肥厚烧伤疤痕进行了检查,使用CO2、PDL或联合使用的所有激光模式,较厚的疤痕的早期减少程度较大。

近几十年来,烧伤治疗的进展极大地提高了存活率,反过来也突出了损伤的长期后遗症,其中最引人注目的是肥厚性烧伤疤痕(HTBSs)。当代治疗已经发展到使用二氧化碳激光器和/或脉冲染料激光器(PDL)来减少疤痕厚度(ST)和红斑。近日,发表于Ann Plast Surg的一项随机对照试验旨在比较CO2或PDL单独和联合治疗的疗效。

研究纳入接受激光治疗的HTBSs患者。3个3×3厘米的HTBSs方块随机接受CO2激光、PDL或CO2+PDL治疗。患者接受3次治疗,间隔4至6周,随访3至6个月。治疗前的每次就诊评估疤痕,包括照片、超声波、比色法以及患者和观察者的疤痕评估得分。

 

结果,有25名患者参加了治疗。20人完成了2次治疗(80%),11人完成了全部3次治疗(44%)。初始ST的中位数为0.3厘米。受伤后的中位时间为8个月。CO2或PDL治疗的肥厚烧伤疤痕显示,从第1次到第3次,患者和观察者的疤痕评估量表得分明显下降(分别为P = 0.01和0.01)。按ST分开时,厚的疤痕(≥0.3厘米)在使用所有激光模式的第1次和第2次就诊之间显示出厚度的明显减少(CO2+ PDL,P = 0.01;CO2,P = 0.02;PDL,P = 0.03)。薄的疤痕(<0.3厘米)在使用CO2+ PDL或单独使用PDL后,其厚度在第3次就诊时有所减少(分别为P = 0.01和0.04)。按年龄划分,新的疤痕(<9个月)在CO2治疗的第1次和第2次就诊之间(P = 0.04),以及CO2 + PDL治疗的第2次和第3次就诊之间(P = 0.04),显示出厚度的明显减少。PDL治疗的肥厚烧伤疤痕在第3次就诊前没有表现出厚度的明显减少(P = 0.002)。陈旧的疤痕(≥9个月)仅在CO2 + PDL治疗后,其厚度在第1次和第2次之间有明显减少(P = 0.01)。

综上所述,该研究对不同年龄、病因和厚度的肥厚烧伤疤痕进行了检查,使用CO2、PDL或联合使用的所有激光模式,较厚的疤痕的早期减少程度较大。然而,与单独治疗相比,联合治疗没有发现有临床意义的益处。这些数据支持使用激光来改善HTBS,但并不支持一种模式或模式组合优于其他模式。

原始出处:

Laura E Cooper, et al., Analysis of the Utility of CO2 and Pulse-Dye Lasers Together and Separately in the Treatment of Hypertrophic Burn Scars. Ann Plast Surg. 2022 Aug 1;89(2):166-172. doi: 10.1097/SAP.0000000000003240.

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    2023-05-02 侠胆医心 来自上海
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    2022-09-16 屋顶瞄爱赏月

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    2022-09-15 oliver169
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    2022-09-15 HinsMax
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