595 nm染料激光联合CO₂点阵激光治疗甲状腺术后早期增生性瘢痕的疗效观察

Efficacy Observation of 595 nm Dye Laser Combined with CO₂ Fractional Laser in the Treatment of Early Hypertrophic Scars after Thyroid Surgery

摘要: 目的：初步探讨595 nm脉冲染料激光结合CO₂点阵激光治疗甲状腺术后早期增生性瘢痕的临床应用效果及治疗安全性。方法：收集我院甲状腺外科2023年11月至2024年4月，行传统甲状腺开放手术后，颈部瘢痕符合入选标准的患者，根据随机数字表分成3组：对照组A，对照组B，实验组C。实验组C予以CO₂点阵激光结合595 nm脉冲染料激光(复合激光)，对照组A予以CO₂点阵激光治疗，对照组B予以595 nm脉冲染料激光治疗。三组治疗皆每间隔1个月一次，共治疗3次。入组时及治疗周期结束后2个月，拍摄标准化数码照片，实验者采用温哥华瘢痕评估量表(VSS)、观察者瘢痕评估量表(OSAS)对三组瘢痕分别进行评估并记录，患者本人采用患者瘢痕评估量表(PSAS)对自身瘢痕进行评估并记录，且治疗期及随访期记录不良反应情况，并进行统计学分析。结果：1) 经过每月1次，共3次的不同方案激光治疗后，对照组A总有效率为14例(87.5%)，对照组B对照组B总有效率为14例(87.5%)，实验组C总有效率为15例(93.8%)。2) 经方差分析可知，对照组A、对照组B和实验组C三组患者治疗后VSS评分(F = 8.374, P < 0.001)、OSAS评分(F = 6.836, P = 0.003)和PSAS评分(F = 5.545, P = 0.007)有差异，经Dunnett-t法两两比较可知治疗后对照组A和对照组B的VSS评分、OSAS评分、PSAS评分均大于实验组C，有统计学意义。3) 经过对比治疗前后VSS量表各细项评分，综合来看，实验组在血管分布、色泽、柔软度方面改善更多。4) 实验组C不良反应发生率稍高，考虑因复合激光的叠加热效应对瘢痕及周围组织的刺激更强所致。结论：595 nm脉冲染料激光结合CO₂点阵激光治疗甲状腺术后早期增生性瘢痕，相较于单种激光治疗，总有效率更高，VSS评分及POSAS评分改善更多，在治疗血管分布、色泽、柔软度方面效果更佳。

Abstract: Objective: Preliminarily explore the clinical application effect and treatment safety of CO₂ fractional laser combined with 595 nm pulsed dye laser in the treatment of early hypertrophic scars after thyroid surgery. Methods: Patients who underwent traditional open thyroid surgery in the Thyroid Surgery Department of our hospital from November 2023 to April 2024 and whose neck scars met the inclusion criteria were collected. According to the random number table, they were divided into three groups: control group A, control group B, and experimental group C. Experimental group C was treated with CO₂ fractional laser combined with 595 nm pulsed dye laser (combined laser), control group A was treated with CO₂ fractional laser, and control group B was treated with 595 nm pulsed dye laser. The treatment for all three groups was carried out once every one-month interval, with a total of three treatments. Standardized digital photos were taken at the time of enrollment and 2 months after the end of the treatment cycle. The experimenters used the Vancouver Scar Scale (VSS) and the Observer Scar Assessment Scale (OSAS) to evaluate and record the scars of the three groups respectively. The patients themselves used the Patient Scar Assessment Scale (PSAS) to evaluate and record their own scars. In addition, the adverse reactions were recorded during the treatment period and the follow-up period, and statistical analysis was performed. Results: 1) In this study, 54 patients were initially enrolled. However, 6 patients failed to complete the treatment due to their own reasons. Eventually, 48 patients completed the study, with 16 patients in each of the control group A, control group B and experimental group C. After laser treatments with different regimens once a month for a total of 3 times, the following results were obtained: The total effective rate was 14 cases (87.5%) in Control Group A, 14 cases (87.5%) in Control Group B, and 15 cases (93.8%) in Experimental Group C. 2) Analysis of variance showed that there were differences in VSS scores (F = 8.374, P < 0.001), OSAS scores (F = 6.836, P = 0.003), and PSAS scores (F = 5.545, P = 0.007) among the three groups of patients in control group A, control group B, and experimental group C after treatment. Pair-wise comparisons using the Dunnett-t method indicated that the VSS scores, OSAS scores, and PSAS scores of control group A and control group B after treatment were higher than those of experimental group C, with statistical significance. 3) By comparing the scores of each sub-item of the VSS scale before and after treatment, overall, the experimental group had more improvements in terms of vascular distribution, color, and softness. 4) The incidence of adverse reactions in experimental group C was slightly higher. This is considered to be due to the stronger stimulation of the overlapping thermal effects of the combined laser on the scar and surrounding tissues. Conclusion: The combination of CO₂ fractional laser and 595 nm pulsed dye laser for treating early hypertrophic scars after thyroid surgery shows a higher total effective rate compared with single-laser treatment. It also leads to greater improvements in VSS scores and POSAS scores, and is more effective in treating aspects such as vascular distribution, color, and softness of the scars.