点阵二氧化碳激光联合微创瘢痕松解治疗痤疮后萎缩性瘢痕的临床效果

葛艳娜; 潘焕焕; 赵绛波; 陈娅

doi:10.3760/cma.j.cn501225-20220616-00238

点阵二氧化碳激光联合微创瘢痕松解治疗痤疮后萎缩性瘢痕的临床效果

doi: 10.3760/cma.j.cn501225-20220616-00238

河南中医药大学第一附属医院整形美容科，郑州　　450099

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赵绛波，Email：zjb2702@163.com

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- 收稿日期: 2022-06-16

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

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

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Corresponding author: Zhao Jiangbo, Email: zjb2702@163.com

摘要

摘要: 目的探讨点阵二氧化碳激光联合微创瘢痕松解治疗痤疮后萎缩性瘢痕的临床效果。方法采用回顾性观察性研究方法。2021年1—6月，河南中医药大学第一附属医院接诊60例符合入选标准的3、4级痤疮后萎缩性瘢痕患者。根据采用的治疗方法，将点阵二氧化碳激光联合微创瘢痕松解治疗的30例患者纳入联合治疗组［男19例、女11例，年龄（26±4）岁］，将单纯点阵二氧化碳激光治疗的30例患者纳入单纯激光组［男18例、女12例，年龄（25±6）岁］，每2个月治疗1次，共3次。首次治疗前及末次治疗后2个月，对瘢痕进行痤疮瘢痕临床评分量表（ECCA）评分；末次治疗后2个月，根据ECCA评分行疗效评价并计算治疗总有效率。记录患者治疗过程中的不良反应发生情况。对数据行独立样本t检验、Wilcoxon秩和检验、Mann-Whitney U检验、χ²检验、Fisher确切概率法检验。结果首次治疗前，2组患者ECCA评分相近（P>0.05）；末次治疗后2个月，联合治疗组患者ECCA评分明显低于单纯激光组（Z=-2.89，P<0.05）。联合治疗组、单纯激光组患者末次治疗后2个月ECCA评分均较首次治疗前明显降低（Z值分别为-4.81、-4.79，P<0.05）。末次治疗后2个月，单纯激光组患者瘢痕达到痊愈者2例、显效者13例、有效者7例、无效者8例，联合治疗组患者瘢痕达到痊愈者4例、显效者22例、有效者3例、无效者1例；联合治疗组患者瘢痕治疗总有效率为96.67%（29/30），明显高于单纯激光组的73.33%（22/30），P<0.05。治疗过程中，联合治疗组中有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，单纯激光组中有1例患者出现疼痛、2例患者出现色素沉着；2组患者创面均未发生感染。结论与单纯点阵二氧化碳激光治疗相比，点阵二氧化碳激光联合微创瘢痕松解治疗痤疮后萎缩性瘢痕，可获得更高的治疗总有效率，且操作简单，效果良好，值得临床推广。
- 瘢痕 /
- 激光疗法 /
- 寻常痤疮 /
- 瘢痕松解
Abstract: Objective To explore the clinical effects of fractional carbon dioxide laser combined with minimally invasive scar release in the treatment of post-acne atrophic scars. Methods 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 t test, Wilcoxon rank-sum test, Mann-Whitney U test, chi-square test, and Fisher's exact probability test. Results Before the first treatment, the ECCA scores of patients in the two groups were similar (P>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 (Z=-2.89, P<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 Z values of -4.81 and -4.79, respectively, P<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 (P<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. Conclusions 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.
- Cicatrix /
- Laser therapy /
- Acne vulgaris /
- Cicatrix release
葛艳娜：论文撰写、研究设计；潘焕焕、陈娅：临床操作、数据整理、统计学分析；赵绛波：研究指导、论文修改

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参考文献(31)

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1 点阵二氧化碳激光联合微创瘢痕松解治疗例1患者双侧颞部痤疮后萎缩性瘢痕。1A、1B.分别为首次治疗前右侧、左侧颞部，均萎缩性瘢痕明显，皮肤粗糙；1C、1D.分别为末次治疗后2个月右侧、左侧颞部，瘢痕明显变浅，边缘光滑

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2 采用点阵二氧化碳激光联合微创瘢痕松解治疗例2患者双侧面颊部痤疮后萎缩性瘢痕。2A.首次治疗前，右侧面颊部萎缩性瘢痕明显，U形及V形瘢痕多见，皮肤粗糙；2B.首次治疗前，左侧面颊部萎缩性瘢痕明显，U形瘢痕多见，皮肤粗糙；2C.末次治疗后2个月，右侧面颊部瘢痕明显变浅，边缘光滑，肤色均匀；2D.末次治疗后2个月，左侧面颊部瘢痕明显变浅，U形瘢痕减少明显，边缘光滑，肤色均匀

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表1 2组痤疮后萎缩性瘢痕患者临床资料比较

组别	例数	性别（例）		年龄（岁，x¯±s）	病程［年，M（Q₁，Q₃）］
组别	例数	男	女	年龄（岁，x¯±s）	病程［年，M（Q₁，Q₃）］
联合治疗组	30	19	11	26±4	3.0（2.0，7.0）
单纯激光组	30	18	12	25±6	3.5（1.0，8.0）
统计量值		χ²=0.07		t=0.02	Z=-0.43
P值		0.791		0.980	0.666
注：联合治疗组在单纯激光组的点阵二氧化碳激光基础上联合微创瘢痕松解治疗

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表2 2组痤疮后萎缩性瘢痕患者治疗前后ECCA评分比较[分，M（Q₁，Q₃）］

组别	例数	首次治疗前	末次治疗后2个月	Z值	P值
联合治疗组	30	60（60，75）	15（15，20）	-4.81	<0.001
单纯激光组	30	60（57，60）	25（15，40）	-4.79	<0.001
Z值		-0.33	-2.89
P值		0.745	0.004
注：ECCA为痤疮瘢痕临床评分量表；联合治疗组在单纯激光组的点阵二氧化碳激光基础上联合微创瘢痕松解治疗