超脉冲点阵CO2激光联合自体脂肪移植治疗痤疮萎缩性瘢痕

刁立君 蔺洁 冯敏

[摘要]目的：分析超脈冲点阵CO2激光联合自体脂肪移植对痤疮萎缩性瘢痕的治疗作用。方法：按照随机数字表法将2019年10月-2020年10月笔者医院收治的86例痤疮萎缩性瘢痕患者分为对照组与观察组，每组43例。对照组采用超脉冲点阵CO2激光进行治疗，观察组采用超脉冲点阵CO2激光联合自体脂肪移植进行治疗。治疗1周后，观察两组治疗效果、结痂时间、结痂脱落时间、愈合时间、皮肤生理指标[经皮水分丢失（Transepidermal waterloss，TEWL）、红斑指数（Erythema index，EI）、角质层含水量]及不良反应情况。结果：观察组的总有效率明显高于对照组[95.35%（41/43） vs 76.74%（33/43）]，差异有统计学意义（P<0.05）。观察组结痂时间、结痂脱落时间及愈合时间均明显短于对照组，差异有统计学意义（P<0.05）。观察组的TEWL、EI明显低于对照组，角质层含水量明显高于对照组，差异有统计学意义（P<0.05）。两组均未发生严重不良反应。结论：超脉冲点阵CO2激光联合自体脂肪移植对痤疮萎缩性瘢痕具有很好的治疗作用，能够明显改善皮肤功能。

[关键词]痤疮;萎缩性瘢痕;超脉冲点阵CO2激光;自体脂肪移植

[中图分类号]R758.73+3    [文献标志码]A    [文章编号]1008-6455（2021）07-0008-03

The Therapeutic Effect of Super-pulsed Fractional CO2 Laser Combined with Autologous Fat Transplantation on Acne Atrophic Scar

DIAO Li-jun1，LIN Jie2，FENG Min3

（1.Department of Plastic Surgery，the First Central Hospital of Baoding，Baoding 071000，Hebei，China;2.Department of Medical Cosmetology，Hebei Provincial People's Hospital，Shijiazhuang 050051，Hebei，China;3 Department of Medical Cosmetology，Hebei Academy of Dermatology，Baoding 071000，Hebei，China）

Abstract： Objective  To discuss the therapeutic effect of super-pulsed fractional CO2 laser combined with autologous fat transplantation on acne atrophic scar. Methods  According to the random number table methods， 86 patients with acne atrophic scar who was divided into the control group and the observation group in our hospital from October 2019 to October 2020， with 43 patients in each group. Patients were treated with super-pulsed fractional CO2 laser in the control group， while patients were treated with super-pulsed fractional CO2 laser combined with autologous fat transplantation in the observation group. One week after treatment， the therapeutic effect， scab time， scab shedding time， healing time， skin physiological indicators[（transepidermal waterloss （TEWL）， erythema index （EI）， cuticle water content] and adverse reactions were observed in both groups. Results  The total effective ratein the observation group was significantly higher than that in the control group[95.35% （41/43） vs 76.74% （33/43）]， the difference was statistically significant （P<0.05）. The scab time， scab shedding time and healing time in the observation group were significantly shorter than those in the control group（P<0.05）. The TEWL and EI in the observation group were significantly lower than those in the control group （P<0.05）， and the cuticle water content was significantly higher than that in the control group（P<0.05）. There were no severe adverse reactions in both groups. Conclusion  The super-pulsed fractional CO2 laser combined with autologous fat transplantation had a good therapeutic effect on acne atrophic scar， and it could significantly improve the skin function.

Key words： acne; atrophic scar; super-pulsed fractional CO2 laser; autologous fat transplantation

痤疮是临床常见皮肤疾病，95%的痤疮患者会出现痤疮瘢痕[1]。临床上将痤疮瘢痕分为萎缩性瘢痕、增生性瘢痕及瘢痕疙瘩，其中以萎缩性瘢痕最为常见，对患者的健康及美观产生严重影响，进行积极有效的治疗具有重要意义。临床上，痤疮萎缩性瘢痕的治疗方法多样，主要包括化学剥脱法、激光、组织填充等[2]。超脉冲点阵CO2激光是一种微创激光治疗技术，利用激光对真皮的光生物学效应和热效应刺激或损伤真皮，启动皮肤修复机制，刺激真皮胶原的增生并加以重组，从而达到较好的治疗瘢痕的作用，但是会对皮肤的结构及功能产生一定的影响，从而影响长期治疗效果[3]。自体脂肪移植治疗瘢痕已在国内外实施多年，并取得了较好的效果[4]。……