目的比较PDL和长脉宽1 064 nm Nd∶YAG两种激光在早期瘢痕治疗中的临床疗效和安全性。方法对早期瘢痕患者进行随机自身对照研究。将瘢痕等分为两组,两侧分别行PDL(Vbeam,Candela,595 nm,6~9 J/cm~2,脉宽0.45 ms,光斑7 mm,DCD 20/20 ms)和Nd∶YAG激光(Gentle YAG,Candela,150~180 J/cm~2,脉宽10 ms,光斑3 mm,DCD20/20/20 ms)治疗。每月1次,共治疗3次,随访2个月后进行VSS评分。结果本组共21例早期瘢痕患者,瘢痕时间平均3.4周。治疗前VSS评分为(4.57±1.29);治疗后,VSS评分PDL组为(3.62±1.11),Nd∶YAG组为(3.48±1.17)。两组VSS评分差异无统计学意义(P>0.05),但均较治疗前显著降低(P<0.05)。厚度和血流情况评分,PDL组显著优于Nd∶YAG组(P<0.05);柔软度评分Nd∶YAG组显著优于PDL组(P<0.05)。结论 PDL和Nd∶YAG两种激光均可改善早期瘢痕外观,但其优势各有不同。

Objective To evaluate and compare the effectiveness of pulsed dye laser(PDL)and the long-pulsed Nd:YAG laser in the treatment of fresh scars. Methods Patients with fresh scars were involved for a comparative randomized split-scar trial. Each scar was divided at the midline into two fields. One half received treatment by pulsed dye laser (Vbeam, Candela Corp.) with a 7 mm spot size at 0.45 ms with 6~9 J/cm2and a 20 ms spray duration with a 20 ms delay. The other half was treated by Nd:YAG (GentleYAG, Candela Corp.) with a 3 mm spot size at 10 ms with 150~180 J/cm2. Patients received 3 laser treatment sessions at one month interval. The scars were evaluated with Vancouver scar scale (VSS) 2 months after treatment. Results Twenty-one patients with average 3.4-week scars were involved. Two months after last treatment, final total VSS analysis revealed significant decline of both PDL and long-pulsed Nd:YAG laser group after treatment (P<0.05), but no statistical difference between the 2 groups (P>0.05). However, the emphasis was different. The PDL sites advantaged in the improvement of vascularity and thickness of scar, whereas Nd:YAG in pliability. Conclusion Both 2 kinds of lasers could improve the appearance of fresh scars but emphasize differently.