大光斑低能量Q开关Nd：YAG激光治疗黄褐斑的CLSM及临床观察

发布时间：2018-06-18 17:58

本文选题：共聚焦激光扫描显微镜 + 黄褐斑　；参考：《安徽医科大学》2010年硕士论文

【摘要】： 背景:黄褐斑是一种临床常见的色素增加性疾病,一般好发于曝光部位,多为淡褐色或淡黑色斑,形状不规则,对称分布于额、眉、颊、鼻、上唇等颜面皮肤。由于黄褐斑的皮损多位于面部,而活检为有创检查,病人不易接受,而目前新型的皮肤影像学方法,即共聚焦激光扫描显微镜(confocal laser scanning microscopy,CLSM)可无创、原位、实时、动态对皮肤进行检查。本病的病因及发病机制至今仍未完全清楚,多数学者认为可能与内分泌、遗传、紫外线照射、妊娠、口服避孕药、内脏疾病和微生物失衡等因素有关,导致黑素细胞功能亢进或活性增加,加速黑素形成。因此,抑制黑素细胞活性和增生,阻断黑素颗粒形成以及加速其降解是治疗黄褐斑的基本原理。但是,预防紫外线、外用脱色剂和化学剥脱剂等传统治疗方法疗效欠佳,易反复。激光治疗黄褐斑疗效不一,需要进一步观察。目的: CLSM观察黄褐斑皮损及经激光治疗后的皮肤组织学特征,并观察大光斑低能量Q开关Nd:YAG1064nm激光治疗黄褐斑的疗效,以期为临床治疗黄褐斑提供一定的临床经验和理论支撑。方法:收集45例黄褐斑患者,①使用大光斑低能量调Q-Nd:YAG 1064nm激光治疗黄褐斑患者,脉宽3~7ns,光斑直径6mm或8mm,频率10Hz,能量密度2.0~3.0J/cm~2。根据患者各自情况选择适当的治疗参数。②CLSM实时动态地逐层扫描表皮和真皮乳头层细胞,观察患者正常皮肤和皮损区表皮真皮层的形态特征,特别是黑素的含量、位置、形态等特点。CLSM观察激光治疗前后正常皮肤和皮损区的改变。结果:①45例患者,治疗结束后基本治愈8例(17.78%),显效25例(55.56%),好转12例(26.67%),无效1例(2.22%),有效率为73.33%。②共聚焦激光扫描显微镜下可见黄褐斑皮损处较周围正常皮损处表皮全层黑素颗粒增多,真皮可见嗜黑素细胞或黑素颗粒,激光治疗后表皮处黑素颗粒显著减少。结论:CLSM可有效诊断黄褐斑及判断激光治疗疗效。CLSM能在一定程度上取代有创的组织病理学检查。大光斑低能量调Q 1064nm激光治疗黄褐斑疗效确切,副作用小,安全性高。
[Abstract]:Background: chloasma is a common pigmentation disease in clinic. It usually occurs in the exposed area. It is usually light brown or light black spot with irregular shape and symmetrical distribution in forehead, eyebrow, cheek, nose, upper lip and other facial skin. Because most of the lesions of chloasma are located on the face, and biopsy is invasive, it is difficult for patients to accept. However, the new skin imaging method, confocal laser scanning microscopyCLSM, is noninvasive, in situ and real-time. Check the skin dynamically. The etiology and pathogenesis of this disease are still not fully understood. Most scholars believe that it may be related to endocrine, heredity, ultraviolet radiation, pregnancy, oral contraceptive pills, visceral diseases and microbial imbalance. Causes the melanocyte function to be hyperactive or the activity increases, speeds up the melanin formation. Therefore, inhibiting the activity and proliferation of melanocytes, blocking the formation of melanin granules and accelerating their degradation are the basic principles for the treatment of chloasma. However, traditional treatments such as UV prevention, external decolorization and chemical stripping have poor efficacy and are easy to be repeated. The therapeutic effect of laser on chloasma needs further observation. Objective: to observe the histological features of the lesions of chloasma and the skin histology after laser treatment, and to observe the effect of ND: YAG1064nm laser on the treatment of chloasma, so as to provide some clinical experience and theoretical support for the treatment of chloasma. Methods: Forty-five patients with chloasma were treated with Q-Nd: YAG 1064nm laser. The pulse width was 3ns, the diameter of the spot was 6mm or 8mm, the frequency was 10Hz, and the energy density was 2.0 ~ 3.0J / cm ~ (-2). According to the patients' respective conditions, the appropriate treatment parameters. 2CLSM scanning the epidermis and dermal papilla cells layer by layer dynamically, and observing the morphologic characteristics of epidermal dermis, especially the content and location of melanin in normal skin and lesions. Morphological features. CLSM was used to observe the changes of normal skin and lesions before and after laser treatment. Results one hundred and forty-five patients, After the treatment, 8 cases were basically cured, 25 cases were treated with 55.56%, 12 cases were improved, 12 cases were improved, and 1 case was not effective. The effective rate was 73.33.2 confocal laser scanning microscope, and there were more melanin particles in the whole epidermis than in the surrounding normal lesions, and the effective rate was 73.33.2 confocal laser scanning microscope. Melanocytes or melanin granules were seen in dermis, and melanin granules in epidermis were significantly decreased after laser treatment. Conclusion.CLSM can effectively diagnose chloasma and evaluate the curative effect of laser treatment. CLSM can replace the invasive histopathology to some extent. Large spot low energy Q-switched 1064nm laser treatment of chloasma is effective, with little side effect and high safety.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R758.42

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