葡萄酒色斑的Waner分型与治疗

目的探讨葡萄酒色斑(PWS)的Waner分型、治疗选择及临床疗效。方法137例PWS按Waner分型,其中Ⅰ~Ⅲ型129例,采用Vbeam染料激光治疗;Ⅳ型8例,采用病灶切除全厚皮片移植或扩张皮瓣移位术。结果Ⅰ、Ⅱ型PWS103例,治愈率24.27%(25/103),有效率51.45%(53/103);Ⅲ型PWS26例,治愈率3.84%(1/26),有效率11.53%(3/26)。并发症:水泡17例,浅表瘢痕7例,铁锈样色斑13例。Ⅳ型PWS8例,手术后外形明显改善。结论Vbeam染料激光对Ⅰ、Ⅱ型PWS疗效较好,Ⅲ型疗效较差;Ⅳ型手术是最佳的选择。     

葡萄酒色斑的Waner分型与治疗

目的探讨葡萄酒色斑（PWS）的Waner分型、治疗选择及临床疗效。方法137例PWS按wane，分型，其中Ⅰ～Ⅲ型129例，采用Vbeam染料激光治疗；Ⅳ型8例，采用病灶切除全厚皮片移植或扩张皮瓣移位术。结果Ⅰ、Ⅱ型PWS103例，治愈率24．27％（25／103），有效率51．45％（53／103）；Ⅲ型PWS26例，治愈率3．84％（1／26），有效率11．53％（3／26）。并发症：水泡17例，浅表瘢痕7例，铁锈样色斑13例。Ⅳ型PWS8例，手术后外形明显改善。结论Vbeam染料激光对Ⅰ、Ⅱ型PWS疗效较好，Ⅲ型疗效较差；Ⅳ型手术是最佳的选择。     

长脉冲激光治疗下睑静脉性黑眼圈的临床研究

目的 探讨长脉冲激光治疗下睑静脉性黑眼圈的临床疗效和安全性.方法 采用长脉冲1064nm Nd:YAG激光,光斑直径6mm,双脉宽6～10ms,脉冲间隔20ms,能量130～140J/cm2,接触式冷却治疗,治疗间隔1个月;治疗后6个月时随访,并评价病灶的清除率,共分为五级:Ⅰ级(0～24%),Ⅱ级(25%～49%),Ⅲ级(50%～74%),Ⅳ级(75%～99%),Ⅴ级(100%).结果 本组30例患者,治疗1～3次,均达到下睑静脉完全清除.获随访6个月,清除率为100%,未见复发.治疗时,患者仅有中度疼痛(评分均值为3.6分),皮肤红斑均在24h内消退,治疗部位无一例发生紫癜、色素改变和瘢痕形成.结论 长脉冲1064nm Nd:YAG激光能有效、安全地治疗黑眼圈,并能选择性地清除显露的下睑静脉,对下睑皮肤无损伤,可达到理想的美容效果.     

高频电针联合595nm脉冲染料激光治疗皮肤囊肿的疗效观察

目的:观察高频电针联合595nm脉冲染料激光治疗皮肤囊肿的疗效。方法:选择皮肤囊肿患者68例,先以高频电针打孔引流,取出囊壁,再用595nm脉冲染料激光治疗。脉冲染料激光参数选择:波长595nm,脉宽0.45ms,能量6.0～8.0J/cm~2。结果:痊愈率98.5%(67/68),美容效果好占73.5%(50/68),患者满意率97.0%(66/68)。结论:高频电针联合595nm脉冲染料激光治疗皮肤囊肿安全有效,美容效果好。     

595nm脉冲染料激光治疗皮肤良性血管异常性疾病疗效分析

目的:探讨595nm脉冲染料激光治疗皮肤良性血管异常性疾病的临床疗效和安全性。方法:使用595nm脉冲染料激光(Vbeam血管激光治疗仪)治疗479例皮肤良性血管异常性疾病,其中血管瘤267例,微静脉畸形132例,毛细血管扩张症24例、蜘蛛痣45例,血管角皮瘤11例,根据不同的病变选择相应的参数进行治疗。结果:595nm脉冲染料激光治疗皮肤良性血管异常性疾病的有效率分别为血管瘤92.1%、微静脉畸形79.5%、毛细血管扩张症95.8%、蜘蛛痣100%、血管性角皮瘤90.9%。12例(2.5%)患者出现暂时性色素沉着,无1例发生瘢痕。结论:595nm脉冲染料激光治疗皮肤良性血管异常性疾病安全、有效。     

脉冲染料激光治疗婴幼儿体表血管瘤150例疗效分析

目的：研究595nm可调脉宽染料激光治疗体表婴幼儿血管瘤的疗效和适应证。方法：150例婴幼儿体表血管瘤接受595nm脉冲染料激光治疗,采用参数：能量7～14J/cm2,光斑直径7mm,脉宽0.5～10ms,治疗间隔15～30天,随访6个月以上。随机选择130例患儿不做任何治疗,跟踪观察瘤体变化1年,作为对照。结果：激光治疗组133例（88.7%）瘤体获得75%以上的消退,治疗后仅10例（6.7%）出现水疱,另1例（0.6%）破溃后遗留瘢痕;对照组130例仅13例（10%）获得75%以上的瘤体消退,增大109例（83.8%）,破溃后遗留瘢痕16例（12.5%）。结论：595nm脉冲染料激光治疗早期体表婴幼儿血管瘤,创伤小、疗效高,瘢痕形成等不良反应低,可达到理想的美容治疗效果,适宜在临床推广使用。     

595 nm脉冲染料激光联合曲安奈德注射治疗增生期混合型婴幼儿血管瘤疗效分析

目的探讨595 nm脉冲染料激光联合曲安奈德注射治疗在增生期混合型婴幼儿血管瘤的疗效的分析。方法选择60例增生期混合型婴幼儿血管瘤患者,首先应用595 nm脉冲染料治疗,采用参数:能量7～14 J/cm2,光斑直径7 mm,脉宽0.5～1.0 ms。冷敷30 min后,再行曲安奈德注射治疗,治疗间隔15～30 d,随访6个月以上,并观察疗效。结果 60例患者中,治疗23次以内者22例,治疗3次及以上者38例。治愈38例(63.33%),显效16例(26.67%),有效3例(5.0%),无效3例(5.0%),总有效率90%。结论 595 nm脉冲染料激光联合曲安奈德注射治疗增生期混合型婴幼儿血管瘤,疗效确切、安全,可在临床推广应用。     

595nm可调脉宽染料激光与强脉冲光治疗毛细血管扩张

目的：评价595nm可调脉宽染料激光与强脉冲光（IPL）治疗毛细血管扩张的疗效和不良反应。方法：用595nm可调脉宽脉冲染料激光仪与强脉冲光分组治疗毛细血管扩张共326例,按照就诊时间随机单盲将患者分为两组,A组：164例,应用595nm可调脉宽染料激光治疗;B组：162例,应用强脉冲光治疗。根据血管的粗细适当选择脉宽及能量密度,照射病变部位,观察局部治疗皮肤反应,即以照射部位皮肤变为紫灰色,扩张血管消失为适度。每月治疗1次,共治疗1～3次,分析两组患者的疗效和不良反应。结果：164例毛细血管扩张患者,经过595nm可调脉宽V-beam激光1～3次治疗后,85例痊愈,63例显效,总有效率90.2%;IPL组的总有效率在第1、2、3次治疗后分别为3.1%、21.6%和43.2%。与IPL组比较,595nm可调脉宽V-beam激光组的疗效要明显优于IPL组,两者的差异性有明显统计学差异（P〈0.01）。同一类型皮肤与IPL组比较,595nm可调脉宽V-beam激光组的疗效要明显优于IPL组,两者的差异性有明显统计学差异（P〈0.05）。两组治疗后皮肤反应轻微,595nm激光组治疗后会暂时出现局部水肿和紫癜,两组术后色素改变发生率无显著性差异（P〈0.05）。结论：595nm可调脉宽脉冲染料激光治疗毛细血管扩张疗效明显优于强脉冲光,且皮肤反应轻微,疗效确切,临床效果满意。     

长脉宽595nm脉冲染料激光治疗鲜红斑痣的疗效分析

目的 探讨长脉宽595nm脉冲染料激光治疗鲜红斑痣的疗效.方法 回顾性分析552例接受长脉宽595nm脉冲染料激光治疗的鲜红斑痣患者,观察治疗后的疗效及并发症.结果 552例完成治疗的患者中,疗效极好者265例,疗效好者148例,疗效欠佳(中、差)者139例.35例患者出现色素改变,3例患者在治疗后瘢痕形成.结论 长脉宽595nm脉冲染料激光是一种安全有效的鲜红斑痣治疗手段,但是对紫型鲜红斑痣治疗效果较差.     

755 nm翠绿宝石激光在葡萄酒色斑中的治疗进展

脉冲染料激光(Pulsed dye laser,PDL)至今仍是葡萄酒色斑治疗的主要方法。然而,绝大多数患者在多次染料激光治疗后,仍无法完全清除病灶,这类"脉冲染料激光治疗抵抗的葡萄酒色斑(PDL-resistant PWS)"是临床需要解决的难题。研究提出,提高PWS疗效的方式,包括光动力治疗、应用组织穿透性更深的激光、联合血管生长抑制药物等。长脉冲755 nm翠绿宝石激光相比595 nm脉冲染料激光,其组织穿透性更深,黑色素吸收更少,并有更高的激光能量。我们对长脉冲755 nm翠绿宝石激光在葡萄酒色斑中的治疗进展进行综述。     

High-Energy 595 nm Pulsed Dye Laser Improves Refractory Port-Wine Stains

BACKGROUND: Port-wine stains respond quite well to 585 nm pulsed dye laser treatment, but often clearance is not complete. We investigated a prototype, a high-energy 595 nm pulsed dye laser capable of delivering up to 9.5 J/cm2 using a 10 mm circular spot, with a 1.5 ms pulse duration. OBJECTIVE: This study was undertaken to determine if the high-energy, 595 nm, variable-pulse duration pulsed dye laser could improve port-wine stains that had become refractory to conventional treatment. METHODS: Twenty patients were entered into the study and treated with the high-energy, 595 nm, variable-pulse duration pulsed dye laser using fluences ranging from 7.5 to 9.5 J/cm2, a 1.5 ms pulse duration, and a 10 mm spot size. RESULTS: Average improvement was rated as 40% prior to the initiation of the study after an average of 8.8 treatments at an average energy of 7.9 J/cm2 with the 585 nm pulsed dye laser and 76% following an average of 3.1 treatments with the high-energy 595 nm pulsed dye laser using an average fluence of 7.9 J/cm2. Dermal spectrometer erythema measurements improved from 2.2-fold that of normal skin to 1.5-fold that of unaffected skin. CONCLUSIONS: The high-energy 595 nm pulsed dye laser improves port-wine stains that have become refractory to the conventional 585 nm pulsed dye laser.     

脉冲染料激光治疗皮肤微静脉畸形疗效分析

目的：观察595nm脉冲染料激光治疗皮肤微静脉畸形的疗效和不良反应,分析疗效相关因素,初步探讨皮肤镜技术在皮肤微静脉畸形治疗和随访中的作用。方法：应用595rim脉冲染料激光治疗皮肤微静脉畸形患者226例,观察治疗效果、不良反应,比较疗效与患者性别、年龄及病变类型等因素间的相关性,运用皮肤镜技术对疗效及不良反应进行评价分析及随访。结果：脉冲染料激光治疗皮肤微静脉畸形的总体有效率为51．8％,发生副反应7例（3．09％）,其疗效与患者年龄、病灶类型等因素相关（P〈0．05）,与性别无明显相关性;皮肤镜技术可明确区分病灶残留与色素沉着,指导后续治疗。结论：595nm脉冲染料激光治疗皮肤微静脉畸形安全性高,疗效良好,副反应低,皮肤镜技术可用于皮肤微静脉畸形激光治疗疗效的客观评价及随访。     

长脉冲1064nm Gentle YAG激光联合595nm脉冲染料激光治疗增厚型微静脉畸形回顾性分析

目的：观察长脉冲1064nm Gentle YAG激光联合595nm脉冲染料激光治疗增厚型微静脉畸形的临床疗效和不良反应。方法：使用长脉冲1064nm Gentle YAG激光和595nm脉冲染料激光对14例患者进行治疗,其中长脉冲1064nm Gentle YAG激光能量密度150～240J/cm2,光斑直径3mm,脉宽20～40ms;595nm脉冲染料激光能量密度12～15J/cm2,光斑直径7mm,脉宽6～20ms;共治疗2～7次,间隔时间4～8周。结果：痊愈6例（6/14）,显效5例（5/14）,好转3例（3/14）,无效0例。治疗后出现轻度色素沉着3例（3/14）,均在数月后恢复,遗留增生性瘢痕1例（1/14）,凹陷性瘢痕1例（1/14）。结论：长脉冲1064nm Gentle YAG激光联合595nm脉冲染料激光是目前比较安全、高效的治疗增厚型微静脉畸形的方法。     

Evaluating the Efficacy of Treatment of Resistant Port-Wine Stains With Variable-Pulse 595-nm Pulsed Dye and 532-nm Nd:YAG Lasers

Background. Some port wine stains (PWSs), despite multiple treatments with the 585-nm 0.45-ms pulsed dye laser (PDL), fail to improve substantially.
Objective. To determine the efficacy and tolerability of variable pulse width 595-nm PDL and 532-nm Nd:YAG laser in the treatment of resistant PWS.
Methods. Twenty-two patients whose PWS failed to achieve more than 75% lightening after more than 15 treatments with the 585-nm 0.45-ms PDL were recruited. A homogenous patch of PWS was divided into five areas. Area 1 (control area) was treated with 585-nm, 0.45-ms PDL (fluence 7.5 J/cm²). Areas 2 and 3 were treated with 595-nm PDL at fluence 15 J/cm² (with cryogen spray cooling) and pulse durations of 1.5 and 10 ms, respectively. Areas 4 and 5 were treated with a 532-nm Nd:YAG laser at 2 ms, 7 J/cm² and 10 ms, 16 J/cm², respectively (with a contact cooling tip). The response was assessed by photographic evaluation.
Results. Three patients had further lightening in area 2, and two patients had further lightening in area 3. Each of three patients had further lightening in areas 4 and 5, respectively. One patient had further lightening in the control area.
Conclusion. In individual patients, it may be effective to treat resistant PWS with the variable-pulse width 595-nm PDL and the 532-nm Nd:YAG laser.     

New approaches to the treatment of vascular lesions

BACKGROUND AND OBJECTIVE: The pulsed dye laser was developed based on the concept of selective photothermolysis. By using a wavelength of light well absorbed by the target and pulse duration short enough to spatially confine thermal injury, specific vascular injury could be produced. STUDY DESIGN/MATERIALS AND METHODS: Although the pulsed dye laser revolutionized the treatment of port wine stains (PWS) and a variety of other vascular lesions, the ideal thermal relaxation time for the vessels in PWS is actually 1-10 ms, not 450 micros of the original pulsed dye laser machines. These original theoretical calculations recently have been proven correct in a study that used both an animal vessel model and in human PWS. RESULTS: Longer wavelengths of light, within the visible spectrum, penetrate more deeply into the skin and are more suitable for deeper vessels, whereas longer pulse durations are required for larger caliber vessels. CONCLUSION: A variety of lasers recently have been developed for the treatment of vascular lesions which incorporate these concepts into their design, including pulsed dye lasers at 1.5 ms, a filtered flash-lamp pulsed light source with pulse durations of 1-20 ms, several 532-nm pulsed lasers with pulse durations of 1 ms to as high as 100 ms, long pulsed alexandrite lasers at 755 nm with pulse durations up to 20 ms, pulsed diode lasers in the 800 to 900 nm range, and long pulsed 1064 Nd:YAG sources.     

Treatment of resistant port wine stains (PWS) with pulsed dye laser and non-contact vacuum: a pilot study

The blanching of resistant port wine stains (PWS) with a pulsed dye laser (PDL) requires a large number of treatments, resulting in substantial discomfort to patients, many of them children. Pneumatic skin flattening (PSF - Serenity Pro) is a new technology that generates a vacuum over the skin and reduces pain in laser-based treatments of the skin, while creating contact between the skin and an upper window. The same technology can be utilized to increase skin blood fraction while operated in a non-contact mode. The objective of this study was to test the enhancement in the efficacy of PWS treatment with PDL and Serenity Pro while vacuum is being utilized in the non-contact, blood-enrichment mode. Fifteen patients with resistant PWS underwent 1–4 treatments (interval of 5–20 weeks) under general anesthesia with a 595-nm PDL at 10–14 J/cm², 1.5–3 ms pulse duration, and 7-mm spot size. Lesion blanching with DCD chilling and with vacuum were photographed and compared. Better blanching of various degrees was observed on resistant PWS with the blood-enrichment technique in seven out of 11 patients who returned for follow-up. There were no cases of decrease in efficacy. Blood enrichment with the Serenity Pro non-contact vacuum technology has the potential of enhancing the capability of treating resistant port wine stains in over 50% of cases. Further studies will better quantify the number of treatments necessary for better lesion clearance. The vacuum-assisted technique may be of particular importance in view of the fact that achieving complete lesion clearance remains a challenge in PWS treatments.     

Treatment of Port Wine Stains with Intense Pulsed Light: A Prospective Study

BACKGROUND: Recent studies have shown that intense pulsed light can be useful in treating port wine stains that were resistant to previous pulsed dye laser therapy. Asian persons with high epidermal melanin context can be at a higher risk of complication. OBJECTIVE: The aim of this study was to conduct a prospective trial to assess the efficacy and complication of intense pulsed light in the treatment of port wine stains in Chinese patients. METHODS: Twenty-two Chinese patients with port wine stains without previous treatment were recruited to receive intense pulsed light source therapy for five to seven treatments at intervals of 3 to 4 weeks. Patient demographics, skin type, characteristics of port wine stains including color and location, treatment parameters, degree of pain caused by intense pulsed light treatment, percentage of clearing, and treatment complications were recorded and entered into a database. A questionnaire was conducted to assess the influence of treatment on daily activity and the intensity of pain experienced during treatment. RESULTS: There were 17 female and 5 male patients. Their ages ranged from 6 to 45 years with a mean age of 21.8+/-10.1 years. More than 90% of patients had more than 25% of clearing and the majority of patients (50%) had 25% to 50% of clearing. Although 40% of the patients showed more than 50% clinical clearance, 9% of the patients were able to achieve more than 75% clearing. The only 2 patients with less than 25% clearing had nodular port wine stains and no patient was able to achieve complete clearing. The procedures were well tolerated with a mean pain score of 2.1+/-0.9 and the treatment had no influence on daily activity. One patient developed blisters and 6 patients had swelling for more than 24 hr that all resolved within 1 week without leaving permanent marks. They have been followed up from 12 to 27 months and there was no long-term complication. CONCLUSION: Intense pulsed light can be effective in treating port wine stains in Asian patients. In experienced hands, complications can be low and should be considered as one of the therapeutic options.     

Reduction of pain in the treatment of vascular lesions with a pulsed dye laser and pneumatic skin flattening

The treatment of vascular lesions, including port wine stains (PWSs), with a pulsed dye laser is very painful and often requires general anaesthesia. This is particularly problematic with children. Pneumatic skin flattening (PSF) is a new technology that naturally reduces pain in laser-based aesthetic treatments. The objective of this study was to test pain reduction, as well as lesional clearance, by combining pneumatic skin flattening (PSF) technology with a pulsed dye laser in the treatment of vascular lesions. Twenty-one patients (three of them children) were treated for vascular lesions, mostly PWSs (13 patients). The patients were treated with a 595 nm pulsed dye laser operated at energies of 5.75–13.25 (median 9.25) J/cm². Acute pain was evaluated in all 21 patients. Topical anaesthetic (EMLA cream) was applied before treatment in six cases. Identical energies were applied to both sites. The pain during PSF treatment was compared to pain during regular treatment without PSF. Blanching response to treatment was evaluated in 18 patients after 6–12 weeks. Significant pain reduction was observed in 21/21 patients (100%). The average reduction in pain score was from 10 without PSF (painful) to 2.6 with PSF (comfortable). Follow-up examination of 18 patients after 6–12 weeks showed identical blanching of tissue in both the PSF-treated areas and those not treated with PSF in all patients. It was concluded that the PSF technology significantly reduced pain in the treatment of vascular lesions with a pulsed dye laser without affecting efficacy.     

Tunable dye laser (577 nm) treatment of port wine stains

Despite steady improvement in the laser treatment of port wine stains (PWS), hypertrophic scarring remains a serious side-effect in approximately 10% of patients. The tunable dye laser (577 nm) has been shown to cause selective vascular destruction in normal and PWS skin. We have treated ten patients using a tunable dye laser (577 nm, 300 mu sec) resulting in clearing of the PWS without any evidence of hypertrophic scarring. Treatment requires no anesthesia or wound care, and there were no postoperative infections.