超脉冲点阵二氧化碳激光治疗烧伤后轻中度小口畸形的临床疗效

周彪; 高仪轩; 巴特; 王凌峰; 曹胜军; 李全; 闫增强; 王宏宇; 黄瑞娟

doi:10.3760/cma.j.cn501225-20220620-00252

超脉冲点阵二氧化碳激光治疗烧伤后轻中度小口畸形的临床疗效

doi: 10.3760/cma.j.cn501225-20220620-00252

内蒙古包钢医院烧伤外科，内蒙古烧伤医学研究所，包头　　014010

基金项目:

重大疾病防治科技行动计划 2018-ZX-01S-001

详细信息

通讯作者:
王凌峰，Email：wlf7413@vip.sina.com

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出版历程
- 收稿日期: 2022-06-20

Clinical effects of ultra-pulsed fractional carbon dioxide laser in the treatment of mild to moderate microstomia after burns

Department of Burn Surgery, Inner Mongolia Baogang Hospital, Burn Medical Institute of Inner Mongolia, Baotou 014010, China

Funds:

Science and Technology Action Plan for Prevention and Treatment of Major Diseases 2018-ZX-01S-001

More Information

Corresponding author: Wang Lingfeng, Email: wlf7413@vip.sina.com

摘要

摘要: 目的探究超脉冲点阵二氧化碳激光（UFCL）治疗烧伤后轻中度小口畸形的临床疗效。方法对2018年1月—2022年1月内蒙古包钢医院收治的19例烧伤后轻中度小口畸形且接受UFCL治疗的患者进行回顾性观察性研究，其中男15例、女4例，年龄（35±14）岁，小口畸形平均病程为71 d，术前轻度张口受限者8例、中度张口受限者11例。患者2~3个月行1次UFCL治疗，直至患者对张口度满意或达到疗效瓶颈。记录患者行UFCL治疗的次数以及末次治疗到末次随访的时间间隔。统计患者首次治疗前和末次随访时的张口度（手指测量法）、口裂宽度和张口时上下切牙间距。采用新版温哥华瘢痕量表（VSS）评估患者首次治疗前、末次治疗后的瘢痕。末次随访，患者自行采用利克特5级评分量表对疗效满意度进行评价并计算满意比例；统计治疗区域出现色素沉着、水疱、感染、持续性红斑等不良反应情况。对数据行Mann-Whitney秩和检验或配对样本t检验。结果患者接受UFCL治疗3（2，6）次。患者的末次治疗到末次随访的时间间隔最长为26个月，最短为4个月。末次随访，患者的张口度较首次治疗前改善明显（Z=4.68，P<0.01）。末次随访，患者口裂宽度为（35±6）mm，张口时上下切牙间距为（3.2±0.4）cm，均较首次治疗前显著改善（t值分别为10.73、18.97，P<0.01）。末次治疗后瘢痕评分为（4.1±1.6）分，显著优于治疗前（t=22.96，P<0.01）。末次随访，患者对治疗的满意比例为18/19；所有患者治疗区未出现色素沉着、水疱、感染、持续性红斑等不良反应，但其中1例患者反映治疗后约半年病症复发。结论 UFCL可治疗烧伤后轻中度小口畸形，患者满意度高，具有进一步研究和推广的价值。
- 烧伤 /
- 瘢痕 /
- 激光疗法 /
- 皮肤 /
- 小口畸形
Abstract: Objective To investigate the clinical effects of ultra-pulsed fractional carbon dioxide laser (UFCL) in the treatment of mild to moderate microstomia after burns. Methods A retrospective observational study was conducted on 19 patients with mild to moderate microstomia after burns who were admitted to Inner Mongolia Baogang Hospital from January 2018 to January 2022, including 15 males and 4 females aged (35±14) years. Patients had an average course of 71 d of microstomia, with 8 cases of moderate microstomia and 11 cases of mild microstomia. All the patients received UFCL treatment every 2-3 months until the microstomia was corrected or the treatment bottleneck was reached. The times of UFCL treatment for patients and the time interval from the last treatment to the last follow-up were recorded. Before the first treatment and at the last follow-up, the opening degree of mouth (finger measurement method), oral gap width, and the distance between the upper and lower incisors during mouth opening were recorded. Before the first treatment and at the last treatment, the new Vancouver scar scale (VSS) was used to evaluate the scar. At the last follow-up, the degree of satisfaction was evaluated by the Likert 5 scale by the patients themselves, and the satisfaction ratio was calculated; the adverse reactions such as pigmentation, blisters, infection, and persistent erythema in the treatment area were counted. Data were statistically analyzed with Mann-Whitney rank sum test or paired sample t test. Results Patients received UFCL treatment of 3 (2, 6) times. The interval from the last treatment to the last follow-up was 26 months at most and 4 months at least. At the last follow-up, the opening degree of mouth of patients was significantly improved than that before treatment (Z=4.68, P<0.01). At the last follow-up, the oral gap width of patients was (35±6) mm, and the distance between upper and lower incisors during mouth opening was (3.2±0.4) cm, which was significantly improved compared with those before treatment (with t values of 10.73 and 18.97, respectively, P<0.01). The VSS score after the last treatment was 4.1±1.6, which was significantly better than that before treatment (t=22.96, P<0.01). At the last follow-up, the satisfaction ratio of patients with treatment was 18/19, and no pigmentation, blisters, infection, persistent erythema, and other adverse reactions of all patients in the treatment area occurred, however, one of the patients reported that the disease recurred about half a year after treatment. Conclusions UFCL is an effective method for treating mild to moderate microstomia after burns, with which patients are highly satisfied, and it is worth of further study and promotion.
- Burns /
- Cicatrix /
- Laser therapy /
- Skin /
- Microstomia
周彪：研究整体设计和实施、数据采集、论文撰写；高仪轩：数据采集和分析；巴特、曹胜军、李全、闫增强、王宏宇、黄瑞娟：论文修改、统计分析；王凌峰：研究整体设计、指导、对文章的知识性内容做批评性审阅

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参考文献(20)

[1]	沙里木江·胡纳皮亚,牙生·买买提. 胃镜口垫改制为开口器防治烧伤后小口畸形[J]. 中华烧伤杂志,2005,21(4):312. DOI: 10.3760/cma.j.issn.1009-2587.2005.04.041.
[2]	ZweifelCJ, GuggenheimM, JandaliAR, et al. Management of microstomia in adult burn patients revisited[J]. J Plast Reconstr Aesthet Surg, 2010,63(4):e351-e357. DOI: 10.1016/j.bjps.2009.10.026.
[3]	张振光, 王宽, 刘雅, 等. 扩张后颞浅动脉双蒂皮瓣矫正小口畸形及胡须再造术9例[J].中国美容医学,2018,27(2):41-43.
[4]	ThakurA, ChauhanD, SinglaNK, et al. Prosthetic management of microstomia with customized dynamic splint[J]. Int J Prosthodont, 2020,33(3):347-353. DOI: 10.11607/ijp.6325.
[5]	李丽香, 江晓声, 连丽娜, 等. 颌面部烧伤患者预防小口畸形的护理体会[J].中国美容医学,2017,26(6):122-124.
[6]	黄伟琪, 赵耀华, 邓海涛, 等. 应用多功能口腔矫形器防治烧伤后小口畸形[J/CD].全科口腔医学电子杂志,2014(4):33-34.
[7]	喜雯婧, 张铮, 李洁, 等. 点阵二氧化碳激光治疗挛缩性瘢痕的临床疗效[J].中华烧伤杂志,2021,37(8):711-717. DOI: 10.3760/cma.j.cn501120-20210624-00225.
[8]	弓辰, 何素霞, 李永林. 超脉冲二氧化碳点阵激光联合强脉冲光早期治疗深Ⅱ度烧伤后瘢痕的效果评价[J].中华整形外科杂志,2020,36(10):1080-1084. DOI: 10.3760/cma.j.cn114453-20200217-00050.
[9]	张清彬. 张清彬谈张口受限[J].国际口腔医学杂志,2017,44(5):495-502. DOI: 10.7518/gjkq.2017.05.001.
[10]	李丽香, 江晓声, 连丽娜, 等. 颌面部烧伤患者预防小口畸形的护理体会[J].中国美容医学,2017,26(6):122-124.
[11]	曹谊林,祁佐良,王炜,等. 整形外科学高级教程[M]. 北京:人民军医出版社, 2014.
[12]	MakiguchiT, YokooS, KoitabashiA, et al. Treatment of microstomia caused by burn with a nasolabial flap--an ingenious approach for tugging and fixation of the oral commissure[J]. J Craniofac Surg, 2014,25(2):568-570. DOI: 10.1097/SCS.0000000000000533.
[13]	JinX, TengL, ZhaoM, et al. Reconstruction of cicatricial microstomia and lower facial deformity by windowed, bipedicled deep inferior epigastric perforator flap[J]. Ann Plast Surg, 2009,63(6):616-620. DOI: 10.1097/SAP.0b013e3181955c9f.
[14]	KumarS, GuptaSH, ViswambaranM, et al. Management of postburn perioral contracture using a customized static commissural splint and intralesional injections of triamcinolone[J]. J Prosthet Dent, 2018,119(3):488-491. DOI: 10.1016/j.prosdent.2017.05.010.
[15]	DavisS, ThompsonJG, ClarkJ, et al. A prototype for an economical vertical microstomia orthosis[J]. J Burn Care Res, 2006,27(3):352-356. DOI: 10.1097/01.BCR.0000216458.36764.3F.
[16]	张晨颖, 张高飞, 娄涵潇, 等. 剥脱性二氧化碳点阵激光在烧烫伤瘢痕中的临床应用研究进展[J].实用医学杂志,2021,37(19):2554-2558. DOI: 10.3969/j.issn.1006-5725.2021.19.024.
[17]	StumppOF, BediVP, WyattD, et al. In vivo confocal imaging of epidermal cell migration and dermal changes post nonablative fractional resurfacing: study of the wound healing process with corroborated histopathologic evidence[J]. J Biomed Opt, 2009,14(2):24018. DOI: 10.1117/1.3103316.
[18]	逯艳. 二氧化碳点阵激光治疗增生性瘢痕的研究进展[J]. 中国美容医学, 2018,27(12):153-157.
[19]	雷颖,李石峰,喻亿玲,等 . 不同超脉冲二氧化碳点阵激光模式联合治疗面颈部增生性瘢痕的临床效果[J]. 中华烧伤杂志,2016, 32(8): 474-478. DOI: 10.3760/cma.j.issn.1009-2587.2016.08.007.
[20]	喜文婧,张铮,李洁,等 . 点阵二氧化碳激光治疗挛缩性瘢痕的临床疗效[J]. 中华烧伤杂志,2021,37(8):711-717.DOI: 10.3760/cma.j.cn501120-20210624-00225.

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1 超脉冲点阵二氧化碳激光治疗烧伤后中度小口畸形患者效果。1A.首次治疗前闭口时外观，可见口周增生性瘢痕较厚、呈暗红色，口裂缩窄，口角条索状瘢痕挛缩；1B.第3次治疗前，口周增生性瘢痕充血较前减轻，瘢痕厚度较前减轻，口角条索状瘢痕较前松解，但张口时仍较明显；1C. 第3次治疗后即刻，闭嘴状态；1D. 第3次治疗后即刻，可见人工点阵切割后口角（注：口角处为人工点阵技术下采用超脉冲二氧化碳准直手具治疗后开大的口角，并非患者功能锻炼的裂伤），张口状态明显改善；1E. 第4次治疗前，口周瘢痕软化，口角条索状瘢痕较前松解；1F. 第4次治疗后1个月，口角条索状瘢痕基本完全松解，开口度基本达正常范围

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