四种激光疗法治疗斑痣的疗效和安全性比较

发布时间：2018-02-12 04:28

本文关键词： 斑痣二氧化碳激光二氧化碳点阵激光 Q开关Nd:YAG激光疗效　出处：《安徽医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：研究背景:色素痣是人类最常见的皮肤良性肿瘤,可分为先天性和获得性两种类型。不同类型的色素痣所在的皮肤层次各不相同。可分为交界痣、皮内痣和混合痣。色素痣传统的治疗方法有冷冻治疗、皮肤磨削术、化学剥脱术、微波电离子治疗和手术等。这些治疗方法通常效果不是很好,而且创伤很大,甚至会留下疤痕和色素异常。随着选择性光热作用理论的提出和Q开关技术的应用,激光可以选择性的作用于黑色素细胞而对周围的组织损伤很小。激光已经成为治疗色素痣的主要方法。如今,有很多激光都可用来治疗色素痣,包括:二氧化碳激光、Q开关掺钕钇铝石榴石激光(QS Nd:YAG)、Q开关掺铒钇铝石榴石激光、Q开关红宝石激光(QSRL)、Q开关翠绿宝石激光(QSAL)以及点阵激光等。目的:观察Q开关Nd:YAG激光(Medlite C6激光)、超脉冲二氧化碳点阵激光、二氧化碳激光以及超脉冲二氧化碳点阵激光联合Medlite C6激光治疗面部色素性斑痣的疗效和安全性。方法:将40例门诊诊断为色素性斑痣患者随机分成四组,A组:Q开关Nd:YAG激光(Medlite C6激光)治疗组;B组:超脉冲二氧化碳点阵激光;C组:二氧化碳激光治疗组和D组:超脉冲二氧化碳点阵激光联合Medlite C6激光治疗组。A组先用1064nm波长治疗,再用532nm激光治疗;B组用超脉冲二氧化碳点阵激光微剥脱模式治疗;C组直接用二氧化碳激光碳化和气化,逐层磨削;D组先用点阵激光微剥脱模式扫描后,用盐水棉签擦除被剥脱的色素痣组织,再用Medlite C6激光的1064nm和532nm分别扫描皮损处。术后三个月判定疗效,分为六级标准:0:无效;1:1-24%改善;2:25-49%改善;3:50-74%改善;4=75-89%改善;5=90-100%改善。结果:A组患者经过1-3次(平均1.7次)的治疗,其中1例患者皮损颜色改善50-74%,2例改善25-49%,4例改善1-24%,3例无效,未见疤痕形成,总有效率为10%;B组患者经过1-3次(平均2.1次)的治疗,其中2例患者皮损颜色改善75-89%,5例改善50-74%,3例改善25-49%,增生性疤痕2例,凹陷性疤痕1例,总有效率为40%;C组经过1-2次(平均1.7次)的治疗,其中1例患者皮损颜色改善90-100%,5例改善75-89%,3例改善50-74%,1例改善1-24%,增生性疤痕和凹陷性疤痕各3例,总有效率为30%;D组经过1-5次(平均2.4次)的治疗,其中6例患者皮损颜色改善90-100%,2例改善75-89%,2例改善50-74%,增生性疤痕一例,总有效率为90%。A组、B组、C组分别与D组比较差异显著(P0.05)。结论:相比于其他三种治疗方案,超脉冲二氧化碳点阵激光联合Medlite C6激光治疗色素性斑痣的皮损清除率最高、术后疤痕和色素改变的发生率最低,值得临床应用。
[Abstract]:Background: pigmented nevus is one of the most common benign skin tumors in humans. It can be divided into congenital and acquired types. Different types of pigmented nevus have different skin layers and can be divided into borderline nevus. Intradermal nevus and mixed nevus. Traditional treatments for pigmented nevus include cryotherapy, skin abrasions, chemical exfoliation, microwave electroion therapy and surgery. With the development of the theory of selective photothermal action and the application of Q-switch technology, Lasers can selectively act on melanocytes and do little damage to surrounding tissues. Lasers have become the main treatment for nevus. Nowadays, many lasers can be used to treat nevus pigmentosa. It includes: QS ND: yttrium aluminum garnet laser, QS ND: YAGG Q switch, er doped yttrium aluminum garnet laser switch, ruby laser, ruby laser, emerald laser and lattice laser, etc. Objective: to observe Q switch Nd:YAG. Light Medlite C6 laser, super pulse carbon dioxide lattice laser, The efficacy and safety of carbon dioxide laser and superpulse carbon dioxide lattice laser combined with Medlite C6 laser in the treatment of facial pigmented nevus were studied. Methods: forty outpatients diagnosed as pigmented nevus were randomly divided into four groups: group A: Q. Nd:YAG laser Medlite C6 laser) treatment group B: ultra pulse carbon dioxide lattice laser group C: carbon dioxide laser treatment group and group D: ultra pulse carbon dioxide lattice laser combined with Medlite C6 laser treatment group. Group A was treated with 1064nm wavelength. Then treated with 532nm laser, group B was treated with ultra-pulse carbon dioxide laser microstripping mode. Group C was treated directly with carbon dioxide laser carbonization and gasification, and group D was first scanned by dot array laser stripping mode after layer by layer grinding. The exfoliated nevus tissue was erased with a brine swab, and the lesions were scanned with Medlite C6 laser at 1064 nm and 532 nm respectively. The curative effect was evaluated three months after operation. Divided into six levels: 1: 1: 1: 24% improvement 1: 25-49% improvement 3: 50-74% improvement 75-89% improvement 590-100% improvement. Results the patients in group A were treated 1-3 times (1.7 times on average), of which 1 case was treated with improved skin color, 50%-7442 cases improved 25-4949%, 4 cases improved 1-2424% and 3 cases had no scar formation, 4 cases had no effect, no scar formation, no scar formation, no scar formation, no scar formation, no scar formation, no scar formation, no scar formation, no scar formation, no scar formation, no scar formation, no scar formation, no scar formation. The total effective rate was 1 to 3 times (average 2.1 times) in group B, of which 2 cases had improved skin color 75-89 and 5 cases had improved 50-7410%, 3 cases had improved 25-49%, 2 cases had proliferative scar, 1 case had sunken scar. The total effective rate was one or two times (1.7 times on average) in group C, in which 1 case had skin color improvement 90-100 and 5 cases had improved 75-893.One case had improved 50-74 and 1 case had improved 1-24g, 3 cases had proliferative scar and 3 cases had sunken scar, respectively, there were 3 cases of hyperplastic scar and 3 cases of sunken scar, respectively. The total effective rate was 1 to 5 times (average 2.4 times) in group D, in which 6 cases had skin color improvement 90-100 and 2 cases had improved 75-89 and 2 cases had improved 50-74 and hypertrophic scar in one case. The total effective rate was 90%. The difference between group C and group D was significant (P 0.05). Conclusion: compared with the other three treatments, the removal rate of skin lesions in group B and C is the highest, compared with the other three treatments, and the treatment of pigmented nevus with Medlite C6 laser is the highest in the treatment of pigmented nevus. The incidence of postoperative scar and pigment changes is the lowest, which is worthy of clinical application.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R758.51

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