Clinical efficacy of fractional carbon dioxide laser combined with wet compresses using latanoprost ophthalmic solution in treating old self-injury scars with hypopigmentation
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摘要:
目的 探讨点阵二氧化碳激光联合拉坦前列素滴眼液湿敷治疗陈旧性自伤瘢痕伴色素减退的临床效果。 方法 该研究为回顾性队列研究。2018年1月1日—2025年10月31日,空军军医大学第一附属医院整形外科收治136例符合入选标准的陈旧性自伤瘢痕伴色素减退患者,其中男41例、女95例,年龄13~25岁。根据采用的瘢痕治疗方法,将患者分为行单纯点阵二氧化碳激光治疗的单纯激光组（79例,602个瘢痕）及行点阵二氧化碳激光联合拉坦前列素滴眼液湿敷治疗的联合治疗组（57例,530个瘢痕）,共行4次激光治疗。首次治疗前（以下简称治疗前）和末次治疗后6个月（以下简称治疗后6个月）,采用改良观察者瘢痕评估量表（OSAS）,从瘢痕的厚度、粗糙度、柔软度、宽度4个维度独立对每个瘢痕进行评分,参考温哥华瘢痕量表中对色泽的评分原则评估瘢痕色素减退程度并计算瘢痕色素减退改善率。治疗后6个月,统计患者或其家属对瘢痕治疗效果的满意度,并计算满意率。记录患者治疗过程中出现的不良反应并计算不良反应发生率。 结果 单纯激光组、联合治疗组患者治疗后6个月改良OSAS中瘢痕厚度、粗糙度、柔软度评分（t值分别为35.381、29.184、37.659及36.158、29.995、38.596,P<0.05）及联合治疗组患者改良OSAS中瘢痕宽度评分（t=17.595,P<0.05）均明显低于治疗前。联合治疗组患者治疗后6个月瘢痕宽度评分明显低于单纯激光组（均数差值为-0.48分,95%CI为-0.56~-0.40分,t=12.080,P<0.05）。联合治疗组、单纯激光组患者治疗后6个月与治疗前瘢痕宽度评分差值分别为（-0.39±0.51）、（0.04±0.56）分,组间比较,差异有统计学意义（t=13.545,P<0.05）。多元线性回归分析显示,治疗方式是瘢痕宽度改善情况的独立影响因素（β=-0.426,95%CI为-0.490~-0.363,P<0.05）。联合治疗组患者治疗前和治疗后6个月瘢痕色素减退分度比较,差异有统计学意义（Z=-3.594,P<0.05）。联合治疗组患者治疗后6个月瘢痕色素减退改善率为16.23%（86/530）,显著高于单纯激光组的3.65%（22/602）,χ2=51.618,P<0.05。二元多因素logistic回归分析显示,治疗方式是患者瘢痕色素减退改善的独立影响因素（OR=5.378,95%CI为3.293~8.781,P<0.05）。治疗后6个月,联合治疗组患者或患者家属对瘢痕治疗效果的满意率明显高于单纯激光组（χ2=6.458,P<0.05）。联合治疗组患者治疗过程中不良反应发生率为17.54%（10/57）,明显高于单纯激光组的3.80%（3/79）,P<0.05。 结论 点阵二氧化碳激光联合拉坦前列素滴眼液湿敷治疗陈旧性自伤瘢痕伴色素减退具有良好的疗效,在瘢痕宽度和瘢痕色素减退改善情况及患者满意度方面均显著优于单纯点阵二氧化碳激光治疗。 Abstract:Objective To explore the clinical efficacy of fractional carbon dioxide laser combined with wet compress using latanoprost ophthalmic solution in treating old self-injury scars with hypopigmentation. Methods This study was a retrospective cohort study. From January 1, 2018 to October 31, 2025, 136 patients with old self-injury scars accompanied by hypopigmentation who met the inclusion criteria were admitted to the Department of Plastic Surgery of the First Affiliated Hospital of Air Force Medical University. There were 41 males and 95 females, aged 13 to 25 years. Based on the treatment methods, the patients were categorized into laser-only group (79 patients, 602 scars) receiving fractional carbon dioxide laser treatment alone and combined treatment group (57 patients, 530 scars) receiving fractional carbon dioxide laser combined with wet compress using latanoprost ophthalmic solution. A total of four laser treatment was performed. Before the first treatment (hereinafter referred to as before surgery) and at 6 months after the last treatment (hereinafter referred to as 6 months after treatment), the modified observer scar assessment scale (OSAS) was used to independently score each scar in four dimensions: thickness, roughness, softness, and width; the degree of scar hypopigmentation was assessed based on the color scoring principles of the Vancouver scar scale, and the improvement rate of scar hypopigmentation was calculated. At 6 months after treatment, the satisfaction degree of patients or their family members with the scar treatment efficacy was recorded, and the satisfaction rate was calculated. The adverse reaction occurred during the treatment process was documented and the incidence of aclverse reaction was calculated. Results At 6 months after treatment, the scores for scar thickness, roughness, and softness in the modified OSAS in laser-only group and combined treatment group of patients (with t values of 35.381, 29.184, 37.659 and 36.158, 29.995, 38.596, respectively, P<0.05), as well as the scar width score in the modified OSAS in combined treatment group of patients (t=17.595, P<0.05) were significantly lower than those before treatment. The scar width score at 6 months after treatment in combined treatment group of patients was significantly lower than that in laser-only group (with mean difference of -0.48, 95% CI of -0.56 to -0.40, t=12.080, P<0.05). The difference in scar width score between 6 months after treatment and before treatment in combined treatment group and laser-only group of patients was -0.39±0.51 and 0.04±0.56, respectively, and there was statistically significant difference between the two groups (t=13.545, P<0.05). Multiple linear regression analysis showed that the treatment method was an independent influencing factor for the improvement of scar width in patients (β=-0.426, with 95% CI of -0.490 to -0.363, P<0.05). There was statistically significant difference in the degree of scar hypopigmentation between before treatment and at 6 months after treatment in combined treatment group of patients (Z=-3.594, P<0.05). The improvement rate of scar hypopigmentation in combined treatment group of patients at 6 months after treatment was 16.23% (86/530), which was significantly higher than 3.65% (22/602) in laser-only group (χ²=51.618, P<0.05). Binary multivariate logistic regression analysis showed that the treatment method was an independent influencing factor for the improvement of scar hypopigmentation in patients (OR=5.378, with 95% CI of 3.293 to 8.781, P<0.05). At 6 months after treatment, the satisfaction rate of patients or their family members in combined treatment group regarding the treatment efficacy of scar was significantly higher than that in laser-only group (χ²=6.458, P<0.05). The incidence of adverse reaction in combined treatment group of patients during treatment process was 17.54% (10/57), which was significantly higher than 3.80% (3/79) in laser-only group (P<0.05). Conclusions Fractional carbon dioxide laser combined with wet compress using latanoprost ophthalmic solution for the treatment of old self-injury scars with hypopigmentation demonstrates significant efficacy. It is significantly superior to fractional carbon dioxide laser alone regarding improvement of scar width and hypopigmentation grading and the satisfaction of patients. -
参考文献
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图 1 单纯点阵二氧化碳激光治疗例1患者右前臂陈旧性自伤瘢痕伴色素减退的效果。1A.首次治疗前,社交距离下的瘢痕外观,可见数条边界清晰的线性陈旧性自伤瘢痕；1B.末次治疗后6个月,瘢痕厚度、粗糙度等得到改善,色素减退无明显改善,瘢痕仍清晰可见
图 2 点阵二氧化碳激光联合拉坦前列素滴眼液湿敷治疗例2患者左前臂陈旧性瘢痕伴色素减退的效果。2A.首次治疗前,社交距离下的瘢痕外观,可见数个边界清晰的线性陈旧性自伤瘢痕；2B.末次治疗后6个月,社交距离下瘢痕几乎不可见
Table 1. 2组前臂陈旧性自伤瘢痕伴色素减退患者的基本资料比较
组别 例数 瘢痕数（个） 性别（例） 吸烟史（例） 年龄（岁, 体重指数（kg/m2, 男 女 有 无 单纯激光组 79 602 22 57 31 48 18.5±2.7 20.4±2.2 联合治疗组 57 530 19 38 24 33 19.1±3.2 20.8±2.4 统计量值 χ2=0.473 χ2=0.113 t=1.079 t=1.101 P值 0.492 0.737 0.283 0.273 注：单纯激光组患者行点阵二氧化碳激光治疗,联合治疗组患者行点阵二氧化碳激光联合拉坦前列素滴眼液湿敷治疗 
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Table 2. 2组患者治疗前后前臂陈旧性自伤瘢痕的改良OSAS评分比较（分,
组别与时间点 瘢痕数（个） 厚度 粗糙度 柔软度 宽度 单纯激光组 602 首次治疗前 2.66±0.64 2.84±0.64 3.11±0.69 1.82±0.71 末次治疗后6个月 1.84±0.49 2.07±0.45 2.02±0.64 1.86±0.75 联合治疗组 530 首次治疗前 2.69±0.68 2.79±0.66 3.18±0.65 1.77±0.74 末次治疗后6个月 1.79±0.54 2.04±0.41 2.07±0.59 1.38±0.55 均数差值（95%CI）1 0.03（-0.05~0.11） -0.05（-0.13~0.02） 0.07（-0.01~0.15） -0.05（-0.13~0.04） t1值 0.800 1.387 1.774 1.107 P1值 0.424 0.166 0.076 0.269 均数差值（95%CI）2 -0.04（-0.11~0.01） -0.03（-0.09~0.02） 0.06（-0.01~0.13） -0.48（-0.56~-0.40） t2值 1.562 1.378 1.590 12.080 P2值 0.119 0.168 0.112 <0.001 t3值 35.381 29.184 37.659 1.832 P3值 <0.001 <0.001 <0.001 0.068 t4值 36.158 29.995 38.596 17.595 P4值 <0.001 <0.001 <0.001 <0.001 注：OSAS为观察者瘢痕评估量表；单纯激光组患者仅接受点阵二氧化碳激光治疗,联合治疗组患者接受点阵二氧化碳激光治疗+拉坦前列素滴眼液湿敷；均数差值（95%CI）1、t1值、P1值为2组治疗前各指标比较所得,均数差值（95%CI）2、t2值、P2值为2组治疗后各指标比较所得,t3值、P3值为单纯激光组治疗前后各指标比较所得,t4值、P4值为联合治疗组治疗前后各指标比较所得
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Table 3. 影响136例患者1 132个前臂陈旧性自伤瘢痕宽度改善情况的多元线性回归分析
因素 β值 标准误 t值 P值 95%CI 方差膨胀因子 治疗方式（以单纯激光治疗为参照） -0.426 0.032 -13.142 <0.001 -0.490~-0.363 1.033 性别（以男性为参照） 0.025 0.037 0.665 0.506 -0.048~0.098 1.109 吸烟史（以无吸烟史为参照） -0.007 0.036 -0.206 0.837 -0.011~0.013 1.266 年龄（岁） 0.001 0.006 0.158 0.875 -0.079~0.064 1.158 体重指数（kg/m2） -0.008 0.008 -0.995 0.320 -0.024~0.008 1.209
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Table 4. 2组患者治疗前后前臂陈旧性自伤瘢痕色素减退分度比较
组别 瘢痕数（个） 首次治疗前 末次治疗后6个月 0度 1度 2度 3度 0度 1度 2度 3度 单纯激光组 602 21 235 313 33 15 217 330 40 联合治疗组 530 9 220 271 30 32 247 229 22 Z值 -0.079 -5.073 P值 0.937 <0.001 注：单纯激光组患者仅接受点阵二氧化碳激光治疗,联合治疗组患者接受点阵二氧化碳激光治疗+拉坦前列素滴眼液湿敷
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Table 5. 影响136例患者1 132个前臂陈旧性自伤瘢痕色素减退改善情况的二元多因素logistic回归分析
影响因素 β值 标准误 OR 95%CI P值 治疗方式（以单纯激光治疗为参照） -1.682 0.250 5.378 3.293~8.781 <0.001 性别（以男性为参照） 0.027 0.237 0.973 0.645~1.636 0.910 吸烟史（以无吸烟史为参照） 0.116 0.235 0.890 0.709~1.779 0.621 年龄（岁） -0.018 0.039 0.642 0.910~1.060 0.642 体重指数（kg/m2） -0.043 0.053 0.958 0.863~1.063 0.417
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