脉冲染料激光联合点阵二氧化碳激光治疗儿童增生性瘢痕效果的荟萃分析

吴婕; 张惠敏; 刘睿; 张楠馨; 崔荣涛

doi:10.3760/cma.j.cn501225-20241224-00502

脉冲染料激光联合点阵二氧化碳激光治疗儿童增生性瘢痕效果的荟萃分析

doi: 10.3760/cma.j.cn501225-20241224-00502

1.
山东第一医科大学附属省立医院烧伤与创面修复外科,济南　250021
2.
山东第二医科大学临床医学院,潍坊　261053

基金项目:

国家中医药管理局科技司共建科技项目 GZY-KJS-SD-2023-071

山东省自然科学基金项目 ZR2024MH021

山东省中医药科技面上项目 M-2023037

详细信息

通讯作者:
崔荣涛,Email：cuirt1986@outlook.com

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出版历程
- 收稿日期: 2024-12-24
- 网络出版日期: 2026-07-03

Meta-analysis of the effects of pulsed dye laser combined with fractional carbon dioxide laser in the treatment of hypertrophic scars in children

1.
Department of Burn and Wound Repair Surgery, Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
2.
School of Clinical Medicine, Shandong Second Medical University, Weifang 261053, China

Funds:

National Administration of Traditional Chinese Medicine Co-constructed Science and Technology Project GZY-KJS-SD-2023-071

Natural Science Foundation of Shandong Province ZR2024MH021

Shandong Traditional Chinese Medicine Science and Technology General Program M-2023037

More Information

Corresponding author: Cui Rongtao, Email: cuirt1986@outlook.com

摘要

摘要: 目的评价脉冲染料激光（PDL）联合点阵二氧化碳激光治疗儿童增生性瘢痕（HS）的效果。方法该研究为荟萃分析研究。检索PubMed、Embase、Cochrane Library、Web of Science、中国知网、万方数据知识服务平台和维普中文期刊服务平台等数据库自建库至2024年10月31日公开发表的关于PDL联合点阵二氧化碳激光治疗儿童HS的回顾性研究和前瞻性研究,结局指标包括患者与观察者瘢痕评估量表（POSAS）总评分和激光治疗相关不良反应。采用Stata 16.0软件进行荟萃分析。结果共纳入7篇文献348例HS患儿,其中烧伤所致HS患儿不少于296例。荟萃分析结果显示,PDL联合点阵二氧化碳激光可以显著降低儿童HS的POSAS总评分（标准化均数差=-7.76,95%CI为-10.91~-4.61,P<0.05）。亚组分析结果提示,地域分布、瘢痕病程、干预措施以及点阵二氧化碳激光能量参数可能是POSAS总评分的异质性来源。PDL联合点阵二氧化碳激光治疗儿童HS不良反应发生率较低,为0.04（95%CI为0.02~0.06,P<0.05）。POSAS总评分及其各亚组分析（包括地域分布、瘢痕病程、干预措施、点阵二氧化碳激光参数、评估者）和不良反应均不存在发表偏倚（P<0.05）。结论 PDL联合点阵二氧化碳激光治疗有利于儿童HS的恢复,并且治疗后不良反应发生率较低,具有良好的安全性。针对儿童HS可优先把握瘢痕形成后3个月内的早期干预窗口期,采用低能量点阵二氧化碳激光灵活搭配PDL方案,疗效更佳。
- 瘢痕 /
- 激光,染料 /
- 激光,气体 /
- 儿童 /
- 联合治疗 /
- 早期干预 /
- 荟萃分析
Abstract: Objective To evaluate the efficacy of pulsed dye laser (PDL) combined with fractional carbon dioxide laser for the treatment of hypertrophic scars (HSs) in children. Methods This study was a meta-analysis study. Databases including PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, and VIP Chinese Journal Service Platform were retrieved to obtain the publicly published retrospective and prospective studies on the efficacy of PDL combined with fractional carbon dioxide laser for pediatric HS from the establishment of each database to October 31, 2024. The outcome indexes included the total score of the patient and observer scar assessment scale (POSAS) and laser treatment-related adverse reactions. Stata version 16.0 software was used to conduct a meta-analysis. Results A total of 7 studies were included, involving 348 children with HSs, of whom at least 296 had burn-induced HSs. Meta-analysis result showed that PDL combined with fractional carbon dioxide laser significantly reduced the total POSAS score in pediatric HS (with standardized mean difference of -7.76, 95% CI of -10.91 to-4.61, P<0.05). Subgroup analysis results suggested that geographic distribution, scar duration, intervention measures, and fractional carbon dioxide laser energy parameters might be sources of heterogeneity for the total POSAS score. The incidence of adverse reactions of PDL combined with fractional carbon dioxide laser for pediatric HS was low, at 0.04 (with 95% CI of 0.02-0.06, P<0.05). There was no publication bias in total POSAS score or its subgroup analyses (including geographic distribution, scar duration, intervention measures, fractional laser parameters, and assessor) or adverse reactions (P<0.05). Conclusions PDL combined with fractional carbon dioxide laser is beneficial for the recovery of pediatric HS, with a low rate of adverse reactions and a favorable safety profile. For pediatric HS, the early intervention window within 3 months after scar formation should be prioritized, and a regimen combining low-energy (≤50 mJ) fractional carbon dioxide laser flexibly with PDL may yield better therapeutic outcomes.
- Cicatrix /
- Lasers, dye /
- Lasers, gas /
- Child /
- Combination therapy /
- Early intervention /
- Meta-analysis
吴婕：研究设计、资料整理、数据分析、论文撰写；张惠敏、刘睿、张楠馨：资料收集、文献检索与评价、数据提取；崔荣涛：研究指导、论文修改、经费支持

所有作者声明不存在利益冲突

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参考文献(38)

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Table 1. 纳入荟萃分析的7篇关于PDL联合点阵二氧化碳激光治疗儿童HS效果的文献的基本信息

第1作者	研究类型	患儿国家	例数	性别（例）		年龄（岁）	瘢痕成因	瘢痕病程（月）	瘢痕面积（cm²）	干预措施	激光仪器参数
第1作者	研究类型	患儿国家	例数	男	女	年龄（岁）	瘢痕成因	瘢痕病程（月）	瘢痕面积（cm²）	干预措施	激光仪器参数
周念^[11]	单组自身前后对照试验	中国	45	—	—	3~15	—	3~12	—	共4次治疗,均为联合治疗,治疗间隔8周	585 nm PDL能量密度为4~6 mJ/cm²,10 600 nm UFCL能量为15~30 mJ
雷颖^[12]	单组自身前后对照试验	中国	120	78	42	4.2±0.8	烧伤	1~3	100.3±0.7	共4次治疗,分别为联合治疗、PDL治疗、PDL治疗和联合治疗,治疗间隔1个月	595 nm PDL能量密度为6~12 J/cm²,10 600 nm UFCL能量为30~50 mJ
张小林^[13]	非随机平行对照试验	中国	30	19	11	3~12	烧伤	1~3	>100	均为联合治疗,治疗间隔3个月,未说明治疗次数	—
Matuszczak^[14]	单组自身前后对照试验	波兰	25	16	9	1~17	烧伤	2~36	—	共4次治疗,均为联合治疗,治疗间隔6~8周	595 nm PDL能量密度为5~10 J/cm²,10 600 nm AFCL能量为54~80 mJ
Liu^[15]	单组自身前后对照试验	中国	60	38	22	2.95±1.50	烧伤	2.13±0.35	107.53±2.92	共4次治疗,分别为联合治疗、PDL治疗、PDL治疗和联合治疗,治疗间隔1个月	595 nm PDL能量密度为6~12 J/cm²,10 600 nm UFCL能量为30~50 mJ
Zuccaro^[16]	单组自身前后对照试验	加拿大	51	—	—	—	烧伤	—	—	大多数患者接受2次或3次治疗,每次根据患者瘢痕情况选择行联合治疗或AFCL治疗或PDL治疗,前2次治疗间隔均值为4.8个月	595 nm PDL能量密度为5~9 J/cm²,10 600 nm AFCL能量为53~78 mJ
Elrod^[17]	单组自身前后对照试验	瑞士	17	8	9	11.37±4.82	烧伤和外科手术	4.32~149.88	—	共102次治疗,其中94%（96次）为联合治疗,6%（6次）为UFCL治疗,前2次治疗间隔均值为2个月	595 nm PDL能量密度为6~8 J/cm²,10 600 nm UFCL能量为70~120 mJ
注：PDL为脉冲染料激光,HS为增生性瘢痕,UFCL为超脉冲点阵二氧化碳激光,AFCL为剥脱性点阵二氧化碳激光；“—”表示无此项；文献[11,13, 14]年龄数据以范围表示,文献[12,15,17]年龄数据以x¯±s表示；文献[11, 12, 13, 14,17]瘢痕病程数据以范围表示,文献[15]瘢痕病程数据以x¯±s表示；文献[13]瘢痕面积数据以范围表示,文献[12,15]瘢痕面积数据以x¯±s表示；联合治疗为脉冲染料激光联合点阵二氧化碳激光治疗

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Table 2. 纳入荟萃分析的7篇关于PDL联合点阵二氧化碳激光治疗儿童HS效果的文献的结局指标

第1作者	例数	POSAS总评分（分,x¯±s）		激光治疗相关不良反应
第1作者	例数	治疗前	治疗后	激光治疗相关不良反应
周念^[11]	45	—	—	无
雷颖^[12]	120	8.2±0.8（患者）/8.1±0.8（观察者）	2.4±0.5（患者）/2.7±0.6（观察者）	5例患者出现瘙痒伴红疹,3例患者出现色素沉着,1例患者出现水疱伴瘙痒
张小林^[13]	30	—	—	1例患者出现红疹
Matuszczak^[14]	25	28.83±9.21	14.26±5.98	无
Liu^[15]	60	44.87±5.73（患者）/39.62±1.17（观察者）	10.39±0.84（患者）/11.73±0.84（观察者）	3例患者出现瘙痒伴红疹,1例患者出现色素沉着,1例患者出现水疱伴瘙痒
Zuccaro^[16]	51	—	—	1例患者出现水疱
Elrod^[17]	17	7.42±1.78（患者）/5.88±1.57（观察者）	4.67±2.06（患者）/3.33±1.27（观察者）	1例患者出现水疱伴创面感染
注：PDL为脉冲染料激光,HS为增生性瘢痕,POSAS为患者与观察者瘢痕评估量表；“—”表示无此项；文献[14]POSAS总评分仅出1组数据,文献[12,15,17]POSAS总评分中患者、观察者各出1组数据

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Table 3. 纳入荟萃分析的7篇关于PDL联合点阵二氧化碳激光治疗儿童HS效果的文献中POSAS总评分异质性来源的亚组分析

分组因素与亚组	研究数（项）	统计模型类型	Ⅰ²值（%）	异质性检验P值	标准化均数差	95%CI	P值
地域分布
中国组	4	随机	97.40	<0.001	-12.23	-15.58~-8.87	<0.001
非中国组	3	随机	0.00	0.670	-1.71	-2.14~-1.28	<0.001
瘢痕病程
<3个月组	4	随机	97.40	<0.001	-12.23	-15.58~-8.87	<0.001
≥3个月组	2	随机	0.00	0.526	-1.60	-2.15~-1.05	<0.001
干预措施
均为联合激光治疗组	3	随机	0.00	0.670	-1.71	-2.14~-1.28	<0.001
部分联合激光治疗组	4	随机	97.40	<0.001	-12.23	-15.58~-8.87	<0.001
点阵二氧化碳激光能量参数
低能量组	4	随机	97.40	<0.001	-12.23	-15.58~-8.87	<0.001
高能量组	3	随机	0.00	0.670	-1.71	-2.14~-1.28	<0.001
评估者
观察者组	3	随机	99.20	<0.001	-11.88	-18.92~-4.84	0.001
患者组	3	随机	99.00	<0.001	-6.17	-11.22~-1.12	0.017
注：PDL为脉冲染料激光,HS为增生性瘢痕,POSAS为患者与观察者瘢痕评估量表；低能量组点阵二氧化碳激光能量≤50 mJ,高能量组点阵二氧化碳激光能量＞50 mJ