大光斑低能量模式Q-开关1064nmNd:YAG激光治疗雀斑的临床研究

发布时间：2018-05-05 10:24

本文选题：雀斑 + Q开关1064nm　；参考：《济南大学》2017年硕士论文

【摘要】：研究背景:雀斑是一种常见的皮肤色素沉着性疾病,在遗传背景基础上,受日光照射的影响,一般发病年龄在4-5岁,也可在青春期早期发病,密集或散在分布于面部等曝光部位,影响患者的社交活动和整体形象。雀斑的组织病理学特征是表皮黑素增多而黑色素细胞数量没有明显的增加。传统的冷冻、532nm Q开关KTP激光或强脉冲光都可以治疗雀斑,但治疗后患者皮损会出现结痂或是紫癜瘀斑,恢复时间较长以及色素沉着等风险的存在降低了患者的依从性,临床上需求能有效治疗雀斑而不影响患者日常工作或学习的治疗方法。2008年韩国学者首先提出了大光斑低能量Q开关1064nm Nd:YAG(QSNY)激光模式治疗黄褐斑,淡化黄褐斑的同时,治疗后仅有一过性红斑反应,不影响患者日常工作或学习,受到临床医生和患者的青睐,得以迅速普及。雀斑和黄褐斑类似,也是表皮色素沉着性皮肤病,理论上这种大光斑低能量激光治疗模式也有效,因而,我们做了前瞻性的研究设计,设计了减少雀斑患者停工时间的治疗方案。目的:本研究旨在探讨大光斑低能量模式QSNY激光治疗雀斑的安全性和有效性,以期为临床提供安全有效,不影响日常工作或学习的雀斑新型治疗方法。方法:将2013年2月至2016年4月来我院门诊的15名成年雀斑患者作为本次研究的对象。患者愿意接受我们提供的治疗方案,并签署知情同意书,治疗参数为:波长1064nm,光斑7mm,脉宽10ns,能量密度1.5-2.5J/cm2;治疗频率为2-3周一次,治疗次数3-5次,每次治疗前拍照,末次治疗结束后随访6个月。由2名临床医生根据患者治疗前后照片评价疗效,患者自我评价也纳入结果分析。结果:所有患者中8名患者取得了极好的效果(76-100%),4名患者有较好改善(51-75%),3名患者效果一般(26-50%)。在患者的自我评估中,9名患者觉得有非常明显的改善(76 100%),6名患者自觉色斑适度改善(51-75%)。其中两名患者治疗半年后有复发倾向,所有患者治疗后仅有轻微红斑,数小时内消退,不影响第二天工作,治疗后未报告色沉发生。结论:大光斑低能量模式QSNY激光治疗雀斑安全有效。
[Abstract]:Background: freckles are a common skin pigmentation disease. Based on genetic background and affected by sunlight, freckles usually occur at the age of 4-5 years and can also occur in the early puberty. Dense or scattered in the face and other exposure areas, affecting the patient's social activities and overall image. Histopathological features of freckles were increased in epidermal melanin but no significant increase in the number of melanocytes. The traditional cryopreservation Q-switched KTP laser or intense pulse light can treat freckles, but after treatment, scab or purpura ecchymosis will appear in the lesions of the patients. The long recovery time and the presence of the risk of pigmentation have reduced the compliance of the patients. In 2008, Korean scholars first proposed the 1064nm ND: YAGQSNY laser mode for the treatment of chloasma, while desalinating chloasma. Only a transient erythema response after treatment does not affect patients' daily work or study, and is popular with clinicians and patients. Freckles are similar to chloasma and are also epidermal pigmentation dermatoses. Theoretically, this kind of low-energy laser treatment mode for large spot is also effective. Therefore, we have made a prospective research design. A treatment scheme was designed to reduce the stop time of patients with freckles. Objective: to investigate the safety and efficacy of low energy mode QSNY laser in the treatment of freckles in order to provide a safe and effective method for the treatment of freckles without affecting daily work or study. Methods: from February 2013 to April 2016, 15 adult patients with freckles were enrolled in this study. The patients were willing to accept the treatment plan we provided, and signed the informed consent letter. The parameters of the treatment were: wavelength 1064nm, spot 7mm, pulse width 10ns, energy density 1.5-2.5J / cm 2, treatment frequency 2-3 weeks, treatment times 3-5 times, before treatment. All patients were followed up for 6 months after the last treatment. The therapeutic effect was evaluated by two clinicians according to the photos of the patients before and after treatment, and the self-evaluation of the patients was also included in the analysis of the results. Results: among all the patients, 8 patients achieved excellent results. In the self-assessment of the patients, 9 patients felt that there was a very significant improvement. Two of the patients had a tendency to recur after six months of treatment, all of them had only mild erythema after treatment, subsided within a few hours, did not affect the work of the next day, and did not report the occurrence of chroma after treatment. Conclusion: large spot low energy mode QSNY laser is safe and effective in the treatment of freckles.
【学位授予单位】：济南大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R758.43

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