目的 比较CO2激光辅助醋酸曲安奈德(TAA)注射液渗透治疗增生性瘢痕的临床疗效。方法 回顾分析2021-06至2023-03在联勤保障部队980医院采用点阵CO2激光辅助TAA注射液渗透治疗的56例增生性瘢痕患者。首次治疗前和末次治疗后2个月,采用有效率评价治疗效果,温哥华瘢痕量表(VSS)评价瘢痕的色泽、血管分布、柔软度和厚度,采用视觉模拟量表(VAS)评价疼痛和瘙痒程度,记录患者治疗满意度和不良反应发生情况。结果 56例平均治疗4.41次。末次治疗2个月后,总体有效率98.21%,VSS评分(色泽、血管分布、柔软度、厚度)和VAS评分(疼痛、瘙痒)较治疗前均明显改善(P＜0.001)。患者主观满意率达到80.36％,均未出现创面感染、水疱、瘢痕加重、色素改变等不良反应。结论 CO2激光辅助TAA注射液渗透治疗增生性瘢痕疗效确切,无不良反应,具有临床推广应用价值。
Abstract
Objective To explore the clinical efficacy of CO2 laser-assisted triamcinolone acetonide (TAA) injection for the treatment of hypertrophic scars. Methods A retrospective analysis was performed on 56 patients with hypertrophic scars who received CO2 laser-assisted injection therapy at the 980th Hospital PLA Joint Logistics Support Force from June 2021 to March 2023. Before the first treatment and 2 months after the last treatment, the effective rate was used to evaluate the treatment effect. The Vancouver Scar Scale (VSS) was used to evaluate the color, vascularity, softness, and thickness of the scar, and the Visual Analogue Scale (VAS) was used to assess the degree of pain and itching. The patient treatment satisfaction of patients and the occurrence of adverse reactions were recorded. Results The average number of treatments was 4.41 times. Two months after the last treatment, the overall effective rate was 98.21%, and the VSS scores (color, vascularity, softness, thickness) and VAS scores (pain, itching) were significantly improved compared with those before treatment (P＜0.001). The subjective satisfaction rate of patients reached 80.36%, and no adverse reactions such as wound infection, blisters, scar aggravation, and pigmentation changes occurred. Conclusions CO2 laser-assisted TAA injection for the treatment of hypertrophic scars has a definite efficacy, without adverse reactions, which has clinical application value for promotion.
关键词
CO2激光 /
增生性瘢痕 /
曲安奈德 /
渗透治疗 /
联合治疗
Key words
CO2 laser /
hypertrophic scar /
triamcinolone acetonide /
infiltration therapy /
combined therapy
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] Zhang J, He Z, Tang Y, et al. CO(2) fractional laser combined with triamcinolone acetonide injection for the hypertrophic scars: which is first?[J]. Lasers Med Sci, 2022, 38(1): 1-7.
[2] 李明鸣, 刘林嶓, 武海龙, 等. 超脉冲二氧化碳点阵激光微孔透皮导入醋酸曲安奈德治疗早期增生性瘢痕的效果观察[J]. 中华整形外科杂志, 2021, 37(6): 612-618.
[3] Yan D,Zhao H,Li C, et al. A clinical study of carbon dioxide lattice laser-assisted or microneedle-assisted 5-aminolevulinic acid-based photodynamic therapy for the treatment of hypertrophic acne scars[J]. Photodermatol Photo, 2022, 38(1): 53-59.
[4] Vrijman C,van Drooge A,Limpens J, et al. Laser and intense pulsed light therapy for the treatment of hypertrophic scars: a systematic review[J]. Br J Dermatol, 2011, 165(5): 934-942.
[5] Sullivan T, Smith J, Kermode J, et al. Rating the burn scar[J]. J Burn Care Re, 1990, 11(3): 256-260.
[6] Heller G, Manuguerra M, Chow R J. How to analyze the Visual Analogue Scale: myths, truths and clinical relevance[J]. Scand J Pain, 2016, 13: 67-75.
[7] Andrea C I-F,Jill S W,Matthias B D. Laser Modulation of Hypertrophic Scars: technique and practice[J]. Clin Plast Surg, 2017, 44(4): 757-766.
[8] Dieter M,G Scott H,R Kehl S, et al. Fractional photothermolysis: a new concept for cutaneous remodeling using microscopic patterns of thermal injury[J]. Lasers Surg Med, 2004, 34(5):426-438.
[9] 激光美容相关常见疾病诊疗指南编写组, 中华医学会整形外科学分会, 中国整形美容协会激光美容分会. 激光美容相关常见疾病诊疗指南(2024版)[J]. 中华整形外科杂志, 2024, 40(4): 362-442.
[10] Matteo Tretti C,Valerio P,Giovanna Z, et al. New developments for fractional Co2 resurfacing for skin rejuvenation and scar reduction[J]. Facial Plast Surg Clin North Am, 2019, 28(1): 17-28.
[11] Xu X, Liu J, Xiao Z, et al. Zeolitic imidazolate framework-90 loaded with methylprednisolone sodium succinate effectively reduces hypertrophic scar in vivo[J]. Nanoscale, 2024, 16(13): 6708-6719.
[12] 程凤娟, 孙文华, 王文娟. 曲安奈德联合超脉冲二氧化碳点阵激光治疗增生性瘢痕的临床疗效及对TGF-β1、VEGF水平的影响[J]. 中国医疗美容, 2025, 15(5): 13-17.
[13] 江峰地, 邵金平. 曲安奈德联合二氧化碳点阵激光治疗增生性瘢痕的临床观察[J]. 中国医疗美容, 2025, 15(3): 5-9.
[14] Shin J,Cho J,Park S, et al. Combination therapy using non-ablative fractional laser and intralesional triamcinolone injection for hypertrophic scars and keloids treatment[J]. Int Wound J, 2019, 16(6): 1450-1456.
[15] Zhou J,Hao F,Huang L, et al. Treatment of hypertrophic scars with ablative fractional carbon dioxide laser assisted with different topical triamcinolone delivery ways[J]. Heliyon, 2023, 9(12): e22818.
[16] 杜 鑫, 杨春俊. 点阵激光联合卤米松乳膏透皮给药治疗增生性瘢痕的疗效[J]. 中华医学美学美容杂志, 2020, 26(2): 3.
[17] Neubert R. Mechanisms of penetration and diffusion of drugs and cosmetic actives across the human tratum corneum[J]. Eur J Pharm Sci, 2024, 202(0): 114394.
[18] Emily W,R Rox A, Merete H. Fundamentals of fractional laser-assisted drug delivery: an in-depth guide to experimental methodology and data interpretation[J]. Adv Drug Deliv Rev, 2019, 153(0): 169-184.
[19] Sabry H H, Rahman S H A,Hussein M S, et al. The efficacy of combining fractional carbon dioxide laser with verapamil hydrochloride or 5-fluorouracil in the treatment of hypertrophic scars and keloids: a clinical and immunohistochemical study[J]. Dermatologic Surgery, 2019, 45(4): 536-546.
[20] 赵龙珠, 肖晶晶, 杨立强. 醋酸曲安奈德益康唑乳膏治疗外耳道炎性反应的疗效[J]. 武警医学, 2020, 31(9): 786-788.
[21] Jill S W,Adam J W,Peter R S. Treatment of hypertrophic scars using laser and laser assisted corticosteroid delivery[J]. Lasers Surg Med, 2013, 45(3): 135-140.
[22] Alegre-Sánchez A,Jiménez-Gómez N,Boixeda P. Laser-assisted drug delivery[J]. Actas dermo-sifiliograficas, 2018, 109(10): 858-867.
[23] 李世荣, 整形外科学[M]. 北京:人民卫生出版社, 2009: 312.
[24] 张 静, 黄 雷, 赵麒麟,等. 超脉冲二氧化碳点阵激光联合曲安奈德湿敷对早期增生性瘢痕的疗效[J]. 中南医学科学杂志, 2024, 52(2): 278-281.
[25] 陈白烨, 赵 帅, 王学明. 点阵CO2激光联合曲安奈德治疗儿童面部早期增生性瘢痕的美学效果评价[J]. 中国美容医学, 2024, 33(12): 15-20.
PDF(1490 KB)
