任盼 马富鑫 喇雨萌 郑加伟 余震

[摘要]增生性瘢痕是临床上最常见的瘢痕，其发病率高、治疗方法多、个体差异大、极易复发且无法完全去除，其临床治疗是整形美容外科的难点及热点问题。近年来，激光治疗技术凭借其操作安全便捷、疗效确切的优点在瘢痕治疗策略中扮演着愈发重要的角色。但目前激光种类繁多，不同激光的临床适应证差距较大，如何在增生性瘢痕的不同病理阶段合理选择激光还需进一步探索研究。本文旨在对国内外激光治疗增生性瘢痕不同阶段的经验及效果进行总结讨论，以期在今后的临床工作中给予一定程度的理论指导。

[关键词]增生性瘢痕;激光;点阵激光;脉冲染料激光;治疗;病理

[中图分类号]R619+.6    [文献标志码]A    [文章编号]1008-6455（2021）01-0180-04

Research Progress of Laser Treatment in Different Pathological Stages

of Hypertrophic Scars

REN Pan1， MA Fu-xin1， LA Yu-meng2， ZHENG Jia-wei3， YU Zhen1

（1.Department of Burn and Plastic Surgery， Tangdu Hospital，Air Force Military Medical University，Xian 710038，Shaanxi，China;2. Department of Dermatology，Huashan Hospital，Shanghai 200040，China;3.Department of Cardidogy， the Second Affiliated Hospital of Xian Jiaotong University， Xian 710004，Shaanxi，China）

Abstract： Hypertrophic scars are the most common clinical scars. High incidence， various treatment methods，large individual differences， easily relapsing and difficult to remove are their typical features. Their clinical treatment becomes a difficult but hot issue in plastic and cosmetic surgery. Recently， laser treatment technology has played an increasingly important role in scar treatment strategies due to its advantages of safe and convenient operation as well as precise curative effect.However，there are many types of lasers， and the clinical indications of them are quite different. How to properly select lasers towards different stages of hypertrophic scars is worth exploring and researching for ourselves. This article aims to summarize and discuss the experience and effects of laser treatment for hypertrophic scars in different stages at home and abroad， with a view to providing a certain degree of theoretical guidance in future clinical work.

Key words：hypertrophic scar; laser;dot matrix laser; pulsed dye laser; treatment; pathology

增生性瘢痕由各類意外事故及医源性的创伤导致，表现为高出皮肤平面的病损，其质地较正常组织偏硬，常伴有炎性色素沉积、局部瘙痒、灼痛，患者多有外观受损，甚至部分组织功能的受限以及不同程度的心理负担[1]。增生性瘢痕的治疗方法多样，但以脉冲染料激光、剥脱性激光及非剥脱性激光等为代表的激光技术凭借微创疗效确切、并发症少等优点已成为众多医生和患者的优先选择[2-3]。

激光因其选择性光热作用而对瘢痕组织产生光化学及光物理作用，不同病理阶段的增生性瘢痕，其病理生理学区别显著，激光作用的靶组织特点也不相同，因此，需要针对性地选择不同类型激光治疗。……