超脉冲二氧化碳点阵激光联合脂肪干细胞胶移植治疗瘢痕  

Ultrapulse fractional carbon dioxide laser combined with stromal vascular fraction gel transplantation in the treatment of scars

作　　者：樊华 刘杜鹃 刘凤彬 张九文 Fan Hua;Liu Dujuan;Liu Fengbin;Zhang Jiuwen(Burn and Plastic Surgery Department and Plastic Surgery Cosmetology Laser Center,General Hospital of Jilin Chemical Industry Group,Jilin 132022,China)

机构地区：[1]吉化集团公司总医院烧伤整形科与整形美容激光中心,吉林132022

出　　处：《中华整形外科杂志》2023年第8期830-837,共8页Chinese Journal of Plastic Surgery

基　　金：吉林省卫生健康委科技项目(2013ZC027)。

摘　　要：目的探讨超脉冲二氧化碳点阵激光联合脂肪干细胞胶(SVF-Gel)移植治疗瘢痕的临床效果。方法回顾性分析2018年1月至2022年1月吉化集团公司总医院治疗的瘢痕患者的临床资料。应用超脉冲二氧化碳点阵激光进行治疗:增生性瘢痕采用Scaar FX模式治疗,能量80~150 mJ,频率250 Hz,密度3%;浅表性和萎缩性瘢痕采用Deep FX模式治疗,能量30~50 mJ,频率300 Hz,密度为5%;增生性瘢痕、萎缩性瘢痕存在瘢痕挛缩的位置,采用超脉冲模式进行人工点阵技术治疗,能量150~175 mJ,频率40 Hz,孔与孔间距离为4~5 mm,每孔治疗时间2~3 s。浅表性和萎缩性瘢痕上述治疗共进行2次,增生性瘢痕上述治疗共进行3次,每次间隔2个月。首次激光治疗后30 d左右移植SVF-Gel治疗瘢痕:抽取大腿脂肪组织制备成SVF-Gel,于瘢痕基底层和瘢痕内深层进行多点多隧道注射。于全部治疗结束后6个月复诊并评价治疗效果,采用温哥华瘢痕量表(VSS)进行评分,同时测定治疗后瘢痕皮肤与邻近正常皮肤经皮水分丢失(TEWL)差值,与治疗前进行对比。应用SPSS 20.0软件进行统计分析,数据以±s表示,治疗前、后VSS评分和TEWL差值比较采用配对t检验,P<0.05为差异有统计学意义。结果共纳入30例患者,男17例,女13例,年龄(32.7±11.2)岁。30例中浅表性瘢痕10例、增生性瘢痕10例、萎缩性瘢痕10例,瘢痕形成时间(17.5±4.5)个月。(1)浅表性瘢痕治疗后VSS评分为(1.8±0.7)分,低于治疗前的(4.7±0.8)分(t=9.26,P=0.001);治疗后瘢痕皮肤与正常皮肤TEWL差值为(2.48±0.61)g·m^(-2)·h^(-1),低于治疗前的(6.85±1.17)g·m^(-2)·h^(-1)(t=13.28,P<0.001)。(2)增生性瘢痕治疗后VSS评分为(3.9±1.1)分,低于治疗前的(10.6±1.7)分(t=9.37,P=0.001);治疗后瘢痕皮肤与正常皮肤TEWL差值为(4.91±0.87)g·m^(-2)·h^(-1),低于治疗前的(9.92±0.75)g·m^(-2)·h^(-1)(t=18.22,P<0.001)。(3)萎缩性瘢痕治疗后VSS评分为(3.5±1.2)分,低于治疗前�Objective To investigate the clinical effect of ultrapulse fractional carbon dioxide laser combined with stromal vascular fraction gel(SVF-Gel)transplantation in the treatment of scars.Methods Retrospective analysis of the clinical data of patients with scars treated at the General Hospital of Jilin Chemical Industry Group from January 2018 to January 2022.Application of ultrapulse fractional carbon dioxide laser for treatment:Scaar FX mode treatment for hypertrophic scars,micro FX energy:80-150 mJ,frequency:250 Hz,density:3%.Deep FX mode treatment for superficial scars and atrophic scars,micro FX energy:30-50 mJ,frequency:300 Hz,density:5%.Manual fractional technology(MFT)mode treatment for hyperplastic scars,atrophic scars with scar contracture site,energy:150-175 mJ,frequency:40 Hz,distance between holes:4-5 mm,treatment time 2-3 s.Superficial scar and atrophic scar were treated 2 times,hypertrophic scar was treated 3 times,and the time interval was 2 months.Transplantation of SVF-Gel for scar treatment around 30 days after the first laser treatment.Thigh fatty tissue was extracted to prepare SVF-Gel.The SVF-Gel was injected into the basal layer and deep layer of inside the scar by multi-point and multi-tunnel injection.All patients were followed up for 6 months to evaluate the therapeutic effect.Assess the Vancouver scar scale(VSS)score and the difference of transepidermal water loss(TEWL)between scar skin and adjacent normal skin was measured after treatment,compared with before treatment.The data were analyzed by SPSS 20.0,data in Mean±SD represents.Paired t-test was used to compare the difference between the VSS score and TEWL before and after treatment.P<0.05 indicates a statistically significant difference.Results A total of 30 patients were enrolled,including 17 males and 13 females,aged(32.7±11.2)years old.Among the 30 patients,10 patients were superficial scars,10 patients were hypertrophic scars,10 patients were atrophic scars.The scars’formation time was(17.5±4.5)months.(1)The VSS score of supe

关 键 词：瘢痕 超脉冲二氧化碳点阵激光 脂肪干细胞胶 再生 

分 类 号：R622[医药卫生—整形外科]