压力治疗联合点阵CO2激光治疗增生性瘢痕的疗效观察

目的观察压力治疗联合点阵CO₂激光治疗增生性瘢痕的临床疗效。方法回顾分析2018年1月至2020年6月收治的烧伤后增生性瘢痕患者74例。其中,对照组采用压力治疗(42例);观察组采用压力联合点阵CO₂激光治疗(32例)。治疗结束6个月后采用温哥华瘢痕量表(VSS)进行瘢痕评分,以视觉模拟评分法(VAS)进行瘢痕瘙痒及疼痛评分,并记录不良反应发生情况。结果观察组VSS评分显著高于对照组(P<0.05),且瘢痕的瘙痒及疼痛较对照组明显减轻,差异有统计学意义(P<0.05)。两组不良反应发生率差异无统计学意义(P>0.05)。结论压力治疗联合点阵CO₂激光是一种安全有效的治疗增生性瘢痕的方法。     

光动力联合点阵CO2激光治疗增生性瘢痕临床效果研究

目的：探究光动力(Photodynamic therapy,PDT)联合点阵CO₂激光治疗增生性瘢痕(Hypertrophic scar,HS)临床效果。方法：选择2017年8月-2019年8月来笔者医院就诊的HS患者124例,随机分成观察组和对照组,各62例。对照组采用点阵CO₂激光治疗,观察组在对照组基础上联合光动力治疗,两组均治疗4个月,并随访1年。比较两组患者的临床疗效及复发率,比较治疗前、后,两组患者的瘢痕状况[温哥华瘢痕量表(Vancouver scar scale,VSS)、北卡罗来纳大学(the University of North Carolina,UNC)瘢痕量表]、转化生长因子-β₁(Transforming growth factor-β₁,TGF-β₁)、骨形态发生蛋白-7(BMP-7)、表皮生长因子(Epidermis growth factors,EGF)水平、心理水平[焦虑(Self-rating anxiety scale,SAS)自评量表、...     

CO2点阵激光治疗皮肤烧伤后瘢痕修复中的疗效研究

目的探讨CO₂点阵激光治疗皮肤烧伤后瘢痕修复中的疗效。方法将2015年1月至2016年5月本院85例皮肤烧伤后瘢痕修复患者作为研究对象,随机分为观察组和对照组,观察组43例,对照组42例。观察组给予CO₂点阵激光治疗,对照组给予超脉冲CO₂激光治疗。比较两组患者瘢痕修复疗效、不同类型瘢痕修复疗效、ECCA评分、不良反应。结果观察组瘢痕修复有效率（95.35%）高于对照组（80.95%）,且观察组增生性瘢痕修复有效率（60.00%）高于凹陷萎缩性瘢痕修复有效率（37.14%）,差异具有统计学意义（P<0.05）,对照组二者之间无明显差异（P>0.05）;两组患者治疗后ECCA评分均有下降,观察组下降幅度（34.98±11.16分）大于对照组（45.12±13.24分）,比较差异明显（P<0.05）;观察组不良反应率（2.33%）低于对照组（16.67%）,比较差异有统计学意义（P<0.05）。结论 CO₂点阵激光对治疗烧伤后瘢痕修复的疗效佳、不良反应低,建议在临床上进行广泛的推广和应用。     

超脉冲点阵CO2激光联合维芎瘢痕霜治疗面部烧伤后增生性瘢痕疗效观察

目的：探讨超脉冲点阵CO₂激光联合维芎瘢痕霜治疗面部烧伤后增生性瘢痕的临床疗效。方法：选取2016年6月-2020年6月笔者科室收治的120例面部烧伤后增生性瘢痕患者为研究对象,随机分为治疗组与对照组,每组60例。对照组采用维芎瘢痕霜进行治疗,治疗组采用超脉冲点阵CO₂激光联合维芎瘢痕霜治疗。比较治疗前后两组的临床疗效、温哥华瘢痕量表(Vancouver scar scale,VSS)评分、北卡罗纳大学瘢痕量表评分、视觉模拟量表(Visual analogue scale,VAS)评分、血流灌注量及治疗期间的不良反应情况。结果：治疗后,对照组有8例复发,15例无效,总有效率为61.67%,治疗组有3例复发,6例无效,总有效率为85.00%,对照组总有效率低于治疗组,差异有统计学意义(P<0.05);两组VSS评分和北卡罗纳大学瘢痕量表评分均低于治疗前,且治疗组VSS评分和北卡罗纳大学瘢痕量表评分均低于对照组(P<0.05);治疗3、6个月后,两组VAS评分均低于治疗前,且治疗组VAS评分低于对照组(P<0.05);治疗3个月...     

点阵CO2激光治疗烧伤后瘢痕挛缩的临床应用及研究进展

瘢痕挛缩是烧伤后瘢痕常见并发症,导致功能障碍和生活质量低下,给患者带来了巨大的痛苦。瘢痕挛缩的传统治疗方式有外科手术、加压疗法和物理疗法等。虽取得了一定效果,但仍然有局限性。随着激光技术的迅速发展,点阵CO₂激光在瘢痕治疗方面得到广泛应用,近年来其治疗瘢痕挛缩的疗效逐渐显现。本篇综述总结了点阵CO₂激光治疗瘢痕挛缩的临床应用和相关机制,以及点阵CO₂激光干预瘢痕挛缩时机的相关研究进展。     

重组牛碱性成纤维细胞生长因子对面部凹陷性瘢痕超脉冲点阵CO2激光治疗后皮损的修复作用分析

目的：观察外用重组牛碱性成纤维细胞生长因子(Recombinant?bovine?basic?fibroblast?growth?factor,rbbFGF)对面部凹陷性瘢痕超脉冲点阵CO₂激光治疗后皮损的修复作用。方法：采用随机数字表法将2018年9月-2020年9月笔者医院收治的136例面部凹陷性瘢痕患者分为观察组和对照组,每组68例。两组患者均给予超脉冲点阵CO₂激光治疗,对照组患者术后给予外用金霉素软膏,观察组患者术后外用rb-bFGF。比较两组患者临床疗效、治疗后相关指标(红斑持续时间、结痂时间、疼痛持续时间),观察治疗前、治疗3个疗程后两组患者皮损情况(Echelle?d’evaluation?clinique?des?cicatrices?d’acne,ECCA)、皮肤生理指标(毛孔、面部红色区、紫质、棕色斑)、血清炎性因子肿瘤坏死因子、白细胞介素-6、白细胞介素-8、白细胞介素-1β变化情况。结果：观察组患者临床总有效率明显高于对照组,观察组患者红斑持续时间、结痂时间、疼痛持续时间均短于对照组,差异均有统计学意义(P<0...     

CO2点阵激光结合丝素蛋白载积雪草苷水凝胶治疗兔耳增生性瘢痕的实验研究

目的 评估丝素蛋白水凝胶作为一种药物载体的可行性,以及CO2点阵激光协同丝素蛋白载积雪草苷水凝胶（SNF-AC）对兔耳增生性瘢痕的治疗效果。方法 制备SNF-AC并表征;构建兔耳增生性瘢痕模型,按治疗方法不同进行分组：(1) L+SNF-AC组,CO2点阵激光+涂抹SNF-AC;(2)L组,CO2点阵激光;(3)SNF-AC组,涂抹SNF-AC;(4)空白对照组（Control组）。治疗后第7、14天,测量增生性瘢痕厚度,评价血管分布,HE染色观察组织学形态,Masson染色观察胶原纤维排列。结果 SNF-AC与丝素蛋白的表面形貌和流变学行为相似,拉曼光谱特征峰显示丝素蛋白可成功加载积雪草苷。治疗后第7天,瘢痕相对厚度变化值L+SNF-AC组>L组>SNF-AC组>Control组,且L+SNF-AC组、L组和Control组差异有统计学意义。治疗后第14天,L+SNF-AC组瘢痕相对厚度变化值高于其他3组,但各组之间无统计学差异。治疗后第7、14天,L+SNF-AC组血管分布评分显著优于其余3组（P<0.05）。治疗后第14天,HE染色显示L+SNF-AC组增...     

重组人表皮生长因子外用联合超脉冲点阵CO2激光治疗面部痤疮凹陷性瘢痕疗效分析

目的：探究重组人表皮生长因子(Recombinant human epidermal growth factor,rhEGF)外用联合超脉冲点阵CO₂激光(Ultrapulse fractional CO₂ laser,UFCL)治疗面部痤疮凹陷性瘢痕的疗效。方法：选择2020年1月-10月来笔者医院就诊的80例面部痤疮凹陷性瘢痕患者为研究对象,按随机数表法分为观察组和对照组,每组40例。对照组采用UFCL治疗,观察组在对照组基础上外用rhEGF,比较两组临床疗效、瘢痕改善情况(ECCA评分)及生活质量(DLQI评分),记录两组结痂时间、红斑持续时间、疼痛持续时间、痂皮完全脱落时间以及不良反应发生情况。结果：治疗后,观察组总有效率为92.50%,高于对照组的75.00%,差异有统计学意义(P<0.05);治疗后,两组ECCA评分低于治疗前,且观察组均低于对照组,差异有统计学意义(P<0.05);治疗后,观察组的红斑持续时间、疼痛持续时间、痂皮完全脱落时间均短于对照组,差异有统计学意义(P<0.05),两组结痂时间比较,差异无...     

超脉冲CO2点阵激光辅助中药苦参油膏治疗增生性瘢痕的临床疗效观察

目的探讨超脉冲CO₂点阵激光辅助中药苦参油膏治疗增生性瘢痕的临床疗效。方法选取增生性瘢痕患者72例,随机分为对照组和研究组,每组各36例。对照组采用CO₂点阵激光治疗,冷敷冷疗后直接包扎,研究组在此基础上配合中药苦参油膏外敷,观察疗效和不良反应情况,比较两组患者疼痛指数、创面愈合时间、温哥华瘢痕量表(VSS)评分以及治疗后色沉发生率。结果每次治疗后研究组疼痛指数评分及创面愈合时间均低于对照组(P<0.05)。治疗前两组患者VSS评分无统计学差异(P>0.05);治疗后2个月和6个月时,研究组VSS评分均明显小于对照组(P<0.05)。研究组色沉发生率38.88%,明显低于对照组的72.22%,差异有统计学意义(P<0.05)。结论超脉冲CO₂点阵激光辅助中药苦参油膏治疗增生性瘢痕,可明显降低疼痛指数和VSS评分,缩短创面愈合时间,且不良反应较少,值得临床推广应用。     

超脉冲CO_2激光联合点阵铒激光治疗面部凹陷性瘢痕与增生性瘢痕的疗效比较

目的：比较超脉冲CO2激光联合点阵铒激光治疗面部凹陷性瘢痕与增生性瘢痕的临床效果。方法：2007年3月～2010年1月,我们应用超脉冲CO2激光联合点阵铒激光治疗面部瘢痕患者71例,其中凹陷性瘢痕33例和增生性瘢痕38例,分析两组病例疗效差别及可能的原因。结果：所有患者总有效率为77.5%,凹陷性瘢痕组有效率为87.9%,而增生性瘢痕组为68.4%,两组间有效率差别有统计学意义（P〈0.05）。结论：超脉冲CO2激光联合点阵铒激光是治疗面部瘢痕的方法之一,面部凹陷性瘢痕的疗效优于增生性瘢痕。     

Vascular patterns in mature hypertrophic burn scars treated with fractional CO2 laser

Background and Objective

Fractional CO₂ laser has recently emerged as a promising therapeutic modality to improve the texture and appearance of burn scars. An issue in many burn scars is persistent erythema, which traditionally has been treated with vascular lasers. Interestingly, fractional CO₂ lasers have been shown to improve the appearance of burn scars, including erythema, but no mechanism has been proposed for this change. Our objective is to evaluate the histopathologic changes in vasculature in burn scars treated with fractionated CO₂ laser, and to attempt to describe the mechanism behind reduced erythema following treatment.

Study Design/Materials and Methods

Uncontrolled, prospective study of ten patients with mature burn scars, from a clinical and histological perspective. Biopsy specimens were obtained before and 2 months after 3 treatment sessions. Anti‐CD31 immunostaining was performed to highlight vascular patterns in biopsy specimens.

Results

In histological analysis, an increase in vascular density, particularly of small caliber vessels, was seen following treatment, with an 82.6% average increase in vasculature (P = 0.028). This increase in vascularity correlated with a decrease in clinical erythema and vascularity scores, measured using the Vancouver Scar Scale.

Conclusion

Mature hypertrophic burn scars treated with a fractional CO₂ laser showed a statistically significant increase in vascular density in the superficial dermis. A non‐statistical decrease in clinically perceived erythema and improvement of overall appearance was seen. To our knowledge, this is the first report of increased vascular density in burn scars treated with fractional CO₂ laser and suggests our prior assumptions on causes of erythema in mature hypertrophic scars may need to be challenged. Lasers Surg. Med. 46:597–600, 2014. © 2014 Wiley Periodicals, Inc.     

Combination treatment utilizing fractional ablative and continuous wave CO2 lasers for hypertrophic burn scars

BackgroundHypertrophic scars are devastating outcomes of severe burn injuries, producing physical and mental burdens. Adequate treatment is of benefit to relieve these burdens. Laser therapy has shown scar reducing effects. In this study, we compared outcomes after combination of two different lasers or single laser treatment to treat severe hypertrophic burn scars.MethodsForty patients with hypertrophic burn scars were included in one of two therapeutic groups: continuous wave CO₂ laser and fractional ablative CO₂ laser group (group 1, n = 20) or fractional ablative CO₂ laser alone group (group 2, n = 20). Hypertrophic scars were evaluated by the observer-rated Vancouver Scar Scale (VSS) before and after treatment and by patient-completed questionnaires after treatment. Comparative analyses were performed before and after treatment, and time-dependent improvement was also analyzed.ResultsForty patients (54 hypertrophic scars) completed the laser treatment protocols. Group 1 exhibited significantly more improvement in VSS vascularity, pliability, and height indices than group 2 (p < 0.05). Time-dependent analysis of total VSS scores suggested that group 1 experienced more improvement during a shorter treatment period (p < 0.05). For patient-reported outcomes, group 1 noted better grades than group 2 in four indices, namely scar appearance, scar thickness, pain, and pruritus (p < 0.05).ConclusionEffective scar reduction was achieved using combination laser treatment, with significant improvement in multiple observer- and patient-reported outcomes. The shorter treatment period of the combination method can be a merit, as prolonged hypertrophic scars may increase morbidity. Nonetheless, cautious treatment protocols are necessary to avoid undesirable sequelae related to laser application.     

Early intervention by Z-plasty combined with fractional CO2 laser therapy as a potential treatment for hypertrophic burn scars

The aim of this study is to determine whether Z-plasty combined with fractional CO₂ laser therapy can be a potential management option for hypertrophic burn scars in the proliferation stage. A total of 105 patients (46 male and 59 female patients) diagnosed with hypertrophic scars under tension but without any functional limitations were enrolled in this study. The Vancouver Scar Scale (VSS) score and scar height were analyzed and compared. The VSS scores for all scars were improved in all groups after treatment. The scar height was also significantly decreased in each group after treatment (P < 0.05). In the C group, the scar height decreased significantly to 2.62 ± 0.21 mm, which was the maximum extent at the ≦ 6 month time point compared to the decrease in the other groups. Compared to the > 12 month time point for the C group, there was a significant difference between the ≦ 6 month time point for the L group and the > 12 month time point for the Z group. The proportion of satisfied patients was highest at 89.47% at the ≦6 month time point in the C group and lowest at 65.52% at the > 12 month time point in the L group. Six representative cases are presented. Z-plasty can decrease the thickness of a hypertrophic burn scar, which not only reduces the scar tension but also makes it easy to treat the scar with a fractional CO₂ laser. Subsequent treatment with a fractional CO₂ laser can better improve the color and texture of the scar.     

增生性瘢痕的激光治疗进展

<正>瘢痕是机体组织受到创伤后异常修复的结果,在愈合过程中组织过度增生,就会形成增生性瘢痕(hypertrophic scar,HS)[1]。增生性瘢痕发生率高,常发生于手术、外伤、烧伤及炎症后,即使技术很熟练的手术和伤口护理也很难避免其发生。在瘢痕成熟和治疗的漫长时间里,数以百万的患者承受着持续的症状和功能障碍,对患者的心理、生理危害很大。既往的治疗方法有瘢痕内注射、压迫疗法、抗肿瘤药物治疗、细胞因子相关治疗、硅树脂凝胶覆盖、     

The efficacy and safety of fractional CO2 laser therapy in the treatment of burn scars: A meta-analysis

Although we have numerous publications about the effect of fractional CO₂ laser therapy for burn scars, quantitative data about its efficacy and safety are sparse. The purpose of this meta-analysis was to assess the efficacy and safety of fractional CO₂ laser therapy for the treatment of burn scars. Pertinent studies were identified by a search of PubMed, Embase and Web of Science up to 20 September 2020. Weighted mean difference (WMD) was conducted to combine the results, and a random-effect model was used to pool the results. Publication bias was estimated using Begg and Egger’s regression asymmetry test. Twenty articles were included. Our pooled results suggested that fractional CO₂ laser therapy significantly improved the Vancouver Scar Scale (VSS) score (WMD = −3.24, 95%CI: −4.30, −2.18; P < 0.001). Moreover, the Patient and Observer Scar Assessment Scale (POSAS)-patient (WMD = −14.05, 95%CI: −22.44, −5.65; P = 0.001) and Observer (WMD = −6.31, 95%CI: −8.48, −4.15; P < 0.001) also showed significant improvements with the treatment of fractional CO₂ laser therapy. Fractional CO₂ laser significantly reduced scar thickness measured with ultrasonography (WMD = −0.54, 95%CI: −0.97, −0.10; P < 0.001). For other outcomes, including pigmentation, vascularity, pliability, and height of scar, vascularity and relief, laser therapy was associated with significant improvements. However, only the cutometer measure R2 (scar elasticity) (WMD = −0.06, 95%CI: −0.10, −0.01; P = 0.023) was significantly improved with the laser therapy, but cutometer measures R0 (scar firmness) (WMD = 0.03, 95%CI: −0.04, 0.09; P = 0.482) was not. Side effects and complications induced by fractional CO₂ laser were mild and tolerable. Fractional CO₂ laser therapy significantly improved both the signs and symptoms of burn scars. Considering potential limitations, more large-scale, well-designed RCTs are needed to verify our findings.     

强脉冲光治疗兔耳增生性瘢痕

目的探讨强脉冲光（intense pulsed light,IPL）对兔耳增生性瘢痕的作用及机制。方法选取新西兰大白兔30只,在每只兔耳腹侧面制作2个增生性瘢痕模型,随机分为治疗组和对照组。治疗组瘢痕在建立模型第3、5、7周采用IPL进行治疗,对照组不进行治疗。观察各组瘢痕形态变化,并且于建立模型第3、5、7周IPL治疗前及建立模型第9周采集各组瘢痕组织标本,苏木精-伊红（HE）染色,采用免疫组织化学方法检测“平滑肌肌动蛋白（a—smooth mascle actin,a—SMA）、血管内皮细胞生长因子（vascular endothelial growth factor,VEGF）、增殖细胞核抗原（proliferating cell nuclear antigen,PCNA）的表达,并利用a—SMA的表达进行微血管密度（microvessel density,MVD）计数,观察微血管变化。建立模型9周时,切取正常喂养的2只兔子的腹侧正常皮肤组织标本进行同上的检查。结果经IPL治疗后的同期瘢痕色泽变淡、厚度降低。IPL治疗组瘢痕软化、完全平坦所需时间较对照组缩短。组织内a-SMA、VEGF和PCNA的表达均降低,差异有统计学意义（P〈0．05）。结论IPL对兔耳增生性瘢痕有明显的治疗作用。     

5-氨基酮戊酸介导的光动力疗法预防兔耳瘢痕增生的初步探讨

目的：探讨5-氨基酮戊酸介导的光动力疗法抑制兔耳瘢痕增生的效果。方法建立兔耳增生性瘢痕模型后,将108个增生性瘢痕块随机分为4组：空白对照组、单纯激光组、单纯5-氨基酮戊酸组及5-氨基酮戊酸介导的光动力治疗组。5-氨基酮戊酸介导的光动力治疗组在局部注射5-氨基酮戊酸后5 h 行半导体激光照射,波长635 nm,功率密度100 mW/cm2,照射20 min。治疗后观察3周瘢痕的生长情况,测量瘢痕厚度及红斑指数,取材后行 HE 染色,观察真皮层厚度的变化,计算各组瘢痕增生指数, Masson 染色观察胶原纤维排列情况,TUNEL 染色观察成纤维细胞凋亡情况。结果5-氨基酮戊酸介导的光动力治疗组瘢痕厚度与红斑指数较其他3组均降低(P <0.05);真皮层厚度明显变薄,瘢痕增生指数较其他3组明显降低(P <0.05);Masson 染色显示,5-氨基酮戊酸介导的光动力治疗组真皮层内胶原纤维较其他3组减少,且排列整齐有序;TUNEL 染色显示,5-氨基酮戊酸介导的光动力治疗组成纤维细胞凋亡数量较其他3组明显增多(P <0.05)。结论应用5-氨基酮戊酸介导的光动力疗法可以预防兔耳瘢痕增生。     

血管生长抑制因子对兔耳增生性瘢痕的作用及意义

目的通过观察血管生长抑制因子(内皮抑素)对兔耳增生性瘢痕的新生毛细血管及血管内皮细胞的影响,探讨内皮抑素防治病理性瘢痕的可能性。方法选取新西兰大耳兔16只,在兔耳腹侧面制作直径为6mm全层皮肤缺损创面,每耳4孔,共计128孔,建立增生性瘢痕模型,随机分为内皮抑素治疗组、生理盐水对照组;观察瘢痕变化。结果经内皮抑素局部注射治疗后的瘢痕持续时间缩短,同期瘢痕面积小于对照组(P<0.01)。治疗组病理组织切片光镜下同期微血管数少于对照组(P<0.01)。治疗组电镜下发现血管内皮细胞凋亡,细胞核核膜不完整、固缩,染色质分布不均、边聚,线粒体肿胀变性,嵴突破坏;对照组内皮细胞大多结构完整。结论内皮抑素可能通过抑制血管内皮细胞增殖及新生血管的形成,V诱发内皮细胞凋亡,起到一定防治瘢痕的作用,可能为临床治疗病理性瘢痕提供一条新的途径。