非剥脱铒玻璃点阵激光治疗妊娠纹疗效观察及患者满意度分析
2019-11-23邵燕磊张俭陆维
邵燕磊 张俭 陆维
[摘要]目的:觀察1 540nm非剥脱铒玻璃点阵激光治疗妊娠纹的疗效及患者满意度。方法:选取笔者医院2018年1月-2018年12月收治的62例妊娠纹患者,按随机数表法分为观察组与对照组,每组31例。观察组采用1 540nm铒玻璃点阵激光治疗,对照组采用10 600nm CO2点阵激光治疗。比较两组治疗后的有效率、治疗前和末次治疗3个月后的灰度差值、患者满意度、创面红斑水肿消退时间、痂皮脱落时间及色素沉着发生率。结果:观察组有效率83.87%,高于对照组的61.29%,差异有统计学意义(P<0.05)。两组治疗前腹部照片灰度差值的差异无统计学意义(P>0.05),末次治疗后3个月,两组腹部照片的灰度差值均较治疗前显著下降(P<0.05),且观察组末次治疗后3个月腹部照片的灰度差值显著低于对照组(P<0.05)。观察组患者满意度为93.55%,高于对照组74.19%,两组比较差异具有统计学意义(P<0.05)。两组治疗后即刻均出现创面红斑水肿与痂皮脱落,红斑水肿消退时间与痂皮脱落时间比较,差异无统计学意义(P>0.05);观察组与对照组色素沉着发生率分别为6.45%与19.35%,差异无统计学意义(P>0.05)。结论:1 540nm铒玻璃点阵激光对妊娠纹的改善作用优于10 600nm CO2点阵激光,且不良反应少,是妊娠纹的理想治疗方案。
[关键词]非剥脱性;铒玻璃点阵激光;妊娠纹;局灶性光热作用;美观性
[中图分类号]R616.4 [文献标志码]A [文章编号]1008-6455(2019)11-0060-03
Abstract: Objective To observe the aesthetics and patient satisfaction of 1 540 nm non-exfoliated Er glass lattice laser treatment of stretch marks. Methods A total of 62 patients with stretch marks admitted to our hospital from January 2018 to December 2018 were enrolled in the observation group and the control group, 31 cases each. The observation group was treated with a 1 540 nm Er glass dot matrix laser, and the control group was treated with a 10 600 nm CO2 dot matrix laser. Compare the efficiency of the two groups, the gray level difference after treatment and the last treatment for 3 months, the patient satisfaction, the time of erythematous edema, the time of molting and the incidence of pigmentation. Results The effective rate of the observation group was 83.87%, which was higher than 61.29% in the control group, the difference was statistically significant (P<0.05). There was no significant difference in the gray-scale difference between the two groups before treatment (P>0.05). At 3 months after the last treatment, the gray-scale differences in the abdominal photographs of the two groups were significantly lower than those before the treatment (P<0.05). The gradation difference of the abdominal photographs of the observation group at 3 months after the last treatment was significantly lower than that of the control group (P<0.05). The patient satisfaction of the observation group was 93.55%, which was higher than 74.19% in the control group (P<0.05). The wound erythema edema and ecdysis of both groups immediately after treatment, and there was no significant difference between the time of erythematous edema and the time of ecdysis (P>0.05). The incidence of pigmentation in the observation group and the control group were 6.45% and 19.35%, respectively, and the difference was not statistically significant (P>0.05). Conclusion The 1 540nm non-exfoliated Er glass lattice laser is better than the 10 600 nm CO2 dot matrix laser in improving the stretch marks, and has fewer adverse reactions. It is an ideal treatment for stretch marks.
2.5 典型病例:患者,42岁,脐部周围妊娠纹。纹路处皮肤较正常肤色白、亮,且触之皮肤明显松弛,弹性差;治疗4周后,妊娠纹大幅减轻,仅见轻微纹路,触之皮肤松弛改善、弹性增大。见图1。
3 讨论
近年来,有学者[7]提出妊娠纹也属于真皮瘢痕,使得点阵激光逐渐应用于妊娠纹的治疗。点阵激光以水为作用靶,被含水的结构皮肤组织吸收后产生局灶光热作用对真皮形成刺激,促进新的胶原纤维生成与胶原重塑,从而改善妊娠纹[8]。以往认为[9-10]铒玻璃点阵激光由于水的吸收相对较少,所产生的局灶性光热作用相对较弱,利于保持皮肤表皮完整,故皮肤组织受损相对较轻,同时激光作用也弱于剥脱性点阵激光。
本研究结果显示1 540nm非剥脱铒玻璃点阵激光治疗妊娠纹的改善作用明显,治疗后美观度高,患者满意,效果优于CO2点阵激光,这一结果与以往结论不符。笔者考虑可能与非剥脱性点阵激光能量足够大时,其穿透深度可大幅增加,从而有效刺激真皮层合成胶原纤维并加强胶原重塑,达到与剥脱性点阵激光相当甚至更强的作用[11]。范娅琦[12]的动物实验证实,对于非剥脱点阵激光,不同能量对增生性瘢痕的疗效也不同。按照以往观念,1 540nm非剥脱铒玻璃点阵激光的皮肤损伤更轻,理论上治疗后引起的创面红斑水肿可更快消退,痂皮也可更快脱落。而本研究中两组创面红斑水肿消退时间与痂皮脱落时间的差异虽无统计学意义,但观察组仍相对更长,提示1 540nm非剥脱铒玻璃点阵激光并未因局灶光热作用相对较弱而减轻皮肤组织损伤,也进一步验证了1 540nm非剥脱铒玻璃点阵激光的作用更强这一事实。
色素沉着是点阵激光治疗的常见不良反应,本研究中两组色素沉着发生率比较差异无统计学意义,可能与样本量较少有关。目前认为[13],色素沉着的发生与能量、微热损伤区密度、回合数等有关,对照组色素沉着发生率相对较高,可能与CO2点阵激光的微热损伤区密度较大有关,可局部加强外用保湿乳剂,改善色素沉着。有研究[14]将1 550nm非剥脱铒玻璃点阵激光治疗妊娠纹与CO2点阵激光进行对比,两者疗效并无显著性差异,推测与每次治疗间隔时间相对较短,真皮胶原重塑未完全以及治疗时能量偏低等有關。本研究结果表明,点阵激光的治疗间隔时间稍长,可使皮肤有足够产生并重塑胶原的时间,对妊娠纹的改善作用更明显。
综上,1 540nm铒玻璃点阵激光与10 600nm CO2点阵激光均可有效改善妊娠纹,其中1 540nm铒玻璃点阵激光在能量足够大时对妊娠纹的改善作用优于10 600nm CO2点阵激光,且无永久性不良反应,可为妊娠纹的治疗提供参考。
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[收稿日期]2019-01-28
本文引用格式:邵燕磊,张俭,陆维.非剥脱铒玻璃点阵激光治疗妊娠纹疗效观察及患者满意度分析[J].中国美容医学,2019,28(11):60-62.