硅凝胶联合超脉冲CO2点阵激光术对剖宫产术后皮肤瘢痕的预防及治疗效果

目的探讨硅凝胶联合超脉冲CO₂点阵激光术对剖宫产术后皮肤瘢痕的预防及治疗效果。方法前瞻性研究纳入2018年7~8月东莞市松山湖中心医院收治的100例剖宫产术后患者作为研究对象,分为观察组和对照组,各50例。对照组不予任何干预。观察组于手术伤口拆线后立即予硅凝胶涂抹,每日3次,3个月为1个疗程;观察组完成硅凝胶疗程后,有28例患者产生瘢痕,均立即采用超脉冲CO₂点阵激光术治疗,每3个月1次,共3次。2组患者于产后3、6、9、12及18个月时采用温哥华瘢痕评分量表(VSS)对瘢痕形态进行评分,采用视觉模拟评分法(VAS)对瘢痕疼痛及瘙痒情况进行评分。记录观察组的临床疗效和治疗过程中发生的不良反应。结果产后3、6、9、12及18个月,观察组VSS评分(6.00±1.31)、(5.38±1.35)、(4.78±1.23)、(4.20±1.1)、(3.92±1.00)分]、疼痛(2.84±1.02)、(2.40±0.93)、(2.06±0.62)、(1.20±0.67)、(1.04±0.60)分]及瘙痒(3.00±1.05)、(2.50±0.86)、(2.12±0.67)、(1.34±0.59)、(1.12±0.59)分]评分均呈逐渐下降趋势,且明显低于同一时间段对照组VSS评分(6.60±1.56)、(6.44±1.25)、(6.38±1.21)、(6.46±1.51)、(6.48±1.47)分]、疼痛(3.94±0.87)、(3.82±0.83)、(3.76±0.72)、(3.72±0.81)、(3.66±0.87)分]及瘙痒(4.08±0.99)、(3.98±0.89)、(4.00±0.90)、(4.04±0.92)、(3.96±0.95)分]评分,差异均有统计学意义(P<0.05);而对照组VSS评分、疼痛及瘙痒评分均未见明显变化(P>0.05)。观察组经超脉冲CO₂点阵激光术治疗后9个月(产后18个月),治疗的总有效率达92.9%,总显效率82.1%。观察组不良反应发生率低:轻度色素沉着14.29%,持续性红斑7.14%。结论硅凝胶联合超脉冲CO₂点阵激光术对剖宫产术后皮肤瘢痕的预防及治疗效果满意,不良反应轻微,值得临床推广应用。

Prevention and treatment effect of skin scar after cesarean section by silica gel combined with super-pulse CO2 point lattice laser

Objective To explore the prevention and treatment effect of silicone gel combined with super-pulse CO₂ point lattice laser in the treatment of scar after cesarean section. Methods From July to August 2018,100 patients after cesarean section admitted to Dongguan Songshan Lake Central Hospital were included in the prospective study and used as research objects,divided into observations group and control group,50 cases each. The control group was not intervened. In the observation group,the surgical wound was smeared with silicone gel immediately after the removal of the suture,3 times a day for 3 months as 1 courses. A total of 28 patients developed scar in the observation group after completing the course of silicone gel treatment. All these patients were treated with super-pulse CO₂ point lattice laser once every 3 months for 3 times. At 3,6,9,12,and 18 months postpartum,the patients in the two groups were scored with the Vancouver Scar Score Scale(VSS) for scar morphology,and the visual analog scale(VAS) was used for scores for scar pain and itching. The clinical efficacy of the observation group and the adverse reactions that occurred during the treatment were recorded. Results At 3,6,9,12 and 18 months postpartum,the score of VSS(6. 00 ± 1. 31),(5. 38 ± 1. 35),(4. 78 ± 1. 23),(4. 20 ± 1. 1),(3. 92 ± 1. 00) points],pain(2. 84 ± 1. 02),(2. 40 ± 0. 93),(2. 06 ± 0. 62),(1. 20 ±0. 67),(1. 04 ± 0. 60) points] and pruritus (3. 00 ± 1. 05),(2. 50 ± 0. 86),(2. 12 ± 0. 67),(1. 34 ± 0. 59),(1. 12 ± 0. 59) points] of the observation group were gradually decreased,and which were significantly lower than those of the control group VSS scores (6. 60 ± 1. 56),(6. 44 ± 1. 25),(6. 38 ± 1. 21),(6. 46 ± 1. 51),(6. 48 ± 1. 47) points],pain (3. 94 ± 0. 87),(3. 82 ± 0. 83),(3. 76 ± 0. 72),(3. 72± 0. 81),(3. 66 ± 0. 87) points] and pruritus (4. 08 ± 0. 99),(3. 98 ± 0. 89),(4. 00 ± 0. 90),(4. 04 ± 0. 92),(3. 96 ± 0. 95) points],the differences were statistically significant(P < 0. 05). There was no significant change in score of VSS,pain and pruritus in the control group(P > 0. 05). In the observation group,the total effective rate was 92. 9% and the total apparent efficiency was 82. 1% in 9 months(18 months after delivery) after treatment. The incidence of adverse reactions in the observation group was low: mild pigmentation was 14. 29%,persistent erythema was 7. 14%. Conclusion Silicone gel combined with super-pulse CO₂ point lattice laser is effective in preventing and treating scar after cesarean section. At the same time,the adverse reactions were mild which worthy of clinical application.