[摘要]目的：研究点阵CO2激光联合脉冲染料激光（Pulsed dye laser，PDL）治疗瘢痕疙瘩的疗效及不良反应情况。方法：前瞻性入选2016年1月-2019年2月于笔者医院接受治疗的93例瘢痕疙瘩患者为研究对象，根据治疗方法不同，将患者分为点阵CO2激光治疗组（45例）和点陣CO2激光联合PDL治疗组（48例）。比较两组患者的一般临床资料及患者治疗前后温哥华瘢痕评定量表（Vancouver scar scale，VSS）评分、疼痛及瘙痒症状评分，比较两组患者治疗后的临床疗效和不良反应。结果：治疗前，两组患者年龄、性别、病程、皮损部位及皮肤Fitzpatrick分型等资料比较均无明显差异（P>0.05）;治疗后，瘢痕疙瘩VSS各项评分、疼痛和瘙痒症状评分以及不良反应发生率组间比较，联合治疗组均低于点阵CO2激光治疗组，且临床总有效率优于点阵CO2激光治疗组（93.75% vs.84.44%），以上差异均有统计学意义（P<0.05）。结论：10 600nm点阵CO2激光联合595nm PDL治疗瘢痕疙瘩，可充分发挥两种激光的作用机制，临床疗效更好，且不良反应发生较少，值得临床推广应用。

[关键词]点阵CO2激光;脉冲染料激光;瘢痕疙瘩;疗效;不良反应

[中图分类号]R619+.6    [文献标志码]A    [文章编号]1008-6455（2021）09-0089-03

Efficacy and Adverse Reactions of Fractional CO2 Laser combined with PDL Laser in the Treatment of Keloid

WANG Dong-ling

（Department of Dermatology，Qingdao Zhanhai Hospital，Qingdao 266071，Shandong，China）

Abstract： Objective  To study the efficacy and side effects of fractional CO2 laser combined with pulsed dye laser （PDL） in the treatment of keloid. Methods  A total of 93 patients with keloid were prospectively selected from January 2016 to February 2019 in our hospital. According to the different treatment methods， the patients were divided into fractional CO2 laser group （n=45） and fractional CO2 laser combined with PDL group （n=48）. The general clinical data of patients of two groups were compared， the scores of Vancouver scar rating scale （VSS）， pain and itching symptoms were compared between the two groups before and after treatment， and the clinical efficacy and adverse reactions of the two groups were compared. Results  After treatment， the VSS scores of keloid， the scores of pain and itching symptoms and the incidence of adverse reactions in the combined treatment group were lower than those in the fractional CO2 laser treatment group， and the clinical effect was better than that in the fractional CO2 laser treatment group （the total effective rate was 93.75% vs. 84.44%）， the above differences were statistically significant （P<0.05）. Conclusion  The combination of 10 600nm fractional CO2 laser and 595nm PDL in the treatment of keloid can make full use of the action mechanism of the two kinds of laser， the clinical effect is better， and the adverse reactions are less， so it is worthy of clinical application.

Key words：fractional CO2 laser; pulsed dye laser; keloid; efficacy; adverse reactions

瘢痕疙瘩是对角质损伤的异常反应，手术切除瘢痕疙瘩不仅复发率高，新生的瘢痕疙瘩还可超过原病灶边界，严重影响患者美观和肢体运动功能，并导致心理问题的发生[1]。点阵CO2激光通过发射激光光束可使瘢痕组织气化达到剥脱效果，但因为能量较高，部分患者易发生色素沉着、持续性红斑等不良反应[2]。有研究表明[3]，PDL激光可通过诱导缺氧、胶原纤维加热、二硫键解离和重排及选择性光热分解血管等机制分解过度增殖的胶原蛋白，对瘢痕疙瘩具有一定疗效。笔者科室自2016年起采用10 600nm点阵CO2激光联合595nm PDL治疗瘢痕疙瘩患者，取得了较好的临床疗效，且不良反应较少，现将结果报道如下。