[摘要]目的：探討点阵CO2激光联合A型肉毒毒素治疗面颈部增生性瘢痕的美学效果。方法：选取2016年5月-2018年7月笔者医院收治的面颈部增生性瘢痕患者作为研究对象，共116例。采用随机数字表法将其分为对照组（58例）和研究组（58例），其中对照组采用点阵CO2激光进行治疗，治疗2周，研究组采用CO2激光联合A型肉毒毒素进行治疗，治疗10周。比较两组治疗前后的面颈部瘢痕厚度、温哥华瘢痕量表（Vancouver scar scale，VSS）评分、转化生长因子-β1（Transforming growth factor-β1，TGF-β1）水平;对比两组治疗后的视觉模拟评分（Visual analogue score，VAS）、完全上皮化时间以及不良反应发生率。结果：治疗后，两组瘢痕厚度、VSS评分、TGF-β1水平均显著下降，且研究组均低于对照组，差异有统计学意义（P<0.05）。研究组VAS评分低于对照组、完全上皮化时间短于对照组，差异有统计学意义（P<0.05）。研究组不良反应发生率为6.90%，低于对照组的10.34%，但组间比较差异无统计学意义（P>0.05）。结论：点阵CO2激光联合A型肉毒毒素治疗面颈部增生性瘢痕疗效显著，能够明显改善患者瘢痕情况，降低TGF-β1水平，缓解患者疼痛症状。

[关键词]增生性瘢痕;面颈部;激光;A型肉毒毒素;转化生长因子-β1;疼痛程度

[中图分类号]R619+.6    [文献标志码]A    [文章编号]1008-6455（2020）08-0081-04

Study on the Cosmetic Effect of Dot Matrix CO2 Laser Combined with Botulinum Toxin Type A of Facial and Neck Hypertrophic Scar

WANG Lu-ping

（Department of Medical Cosmetology，the Eighth People's Hospital of Shanghai，Shanghai 200233，China）

Abstract： Objective  To explore the cosmetic effect of dot matrix CO2 laser combined with botulinum toxin type A of facial and neck hypertrophic scar. Methods  A total of 116 patients with facial and neck hypertrophic scar admitted to our hospital between May 2016 and July 2018 were selected. They were divided into the control group （58 cases） and the research group （58 cases） by random number method. The control group was treated with dot-matrix CO2 laser treatment for 2 weeks. The research group was treated with CO2 laser combined with botulinum toxin type A， treatment for 10 weeks. The scar thickness after neck treatment and the score of vancouver scar scale （VSS） before treatment， the levels of transforming growth factor-β1 （TGF-β1） before and after treatment， the scores of visual analogue scale （VAS） and complete epithelialization time， and the incidence of adverse reactions after treatment in the two groups were observed and compared. Results  Compared with before treatment， after treatment， the scar thickness， the scores of VSS and the levels of TGF-β1 in the two groups obviously decreased， and the research group was obviously lower than those in the control group， the differences were statistically significant （P<0.05）. After treatment， the score of VAS were obviously lower than that in the control group， the complete epithelialization time of the face and neck keloid were obviously shorter than that in the control group （P<0.05）. The incidence of adverse reactions in the study group was 6.90%， lower than that in the control group（10.34%）， but there was no significant difference between the two groups（P>0.05）. Conclusion  The effect of dot-matrix CO2 laser combined with botulinum toxin type A on facial and neck hypertrophic scar is significant， which can significantly improve the scar symptoms， reduce the level of TGF-β1， relieve the pain.

Key words： hypertrophic scar; facial and neck; laser; botulinum toxin type A; transforming growth factor-β1; degree of pain

面颈部增生性瘢痕大多由烧烫伤、手术创伤、痤疮等造成，其临床主要表现为凹凸不平、色素不均匀等，可对患者特别是女性的生活带来严重影响[1-2]。面颈部增生性瘢痕的传统治疗方法包括手术切除、微晶消磨、砂纸、钻头磨削等，均具有一定治疗效果，但对患者创面影响较大，不利于预后恢复[3]。近年来，激光治疗瘢痕的技术迅速发展，其中点阵CO2激光具有促进胶原结构重建，使瘢痕变软，体积变小的作用，被广泛应用于治疗面颈部增生性瘢痕[4]。有研究[5]发现，A型肉毒毒素具有萎缩、软化瘢痕的作用，在美容外科领域已广泛应用。……