| Objective:1.To compare the effects of fractional CO2 laser combined with intralesional injection of triamcinolone acetonide、5-fluorouracil(5-Fu)and alone intralesional injection of triamcinolone acetonide、5-Fu for the treatment of pathological scars.2.To evaluate the clinical efficacy of fractional CO2 laser combined with intralesional injection of triamcinolone acetonide、5-Fu for the treatment of pathological scars.Statistical analysis the influencing factors of clinical efficacy,and comparative analysis of the recurrence rate and adverse reactions in different types of pathological scars.Methods:1.20 patients with the same type of pathological scars at the same or similar locations were selected,the lesions totaled 84,including 78 hypertrophic scars and 6 keloids.the same type of Multiple pathological scars at the same or adjacent site on the patient were randomly divided into experimental group and control group.There were 44 lesions in the experimental group and 40 lesions in the control group.The experimental group was given the treatment of fractional CO2 laser combined with intralesional drug injection at the first treatment(at the first month),and just given intralesional drug injection at the second treatment(at the second month),followed by monthly alternate treatment according to these methods;control group just given monthly regular intralesional drug injection.Data collection and statistical analysis were conducted before treatment and one month after each treatment,compare The clinical efficacy between the two groups after each treatment.2.31 patients(Including the above 20 patients in the experimental group)with 209 pathological scars(Including the above 44 lesions in the experimental group)were selected in the study,including 146 hypertrophic scars and 63 keloids.The treatment is the same as the previous experimental group.According to the number of different treatments,evaluate the efficacy of pathological scars and the effect of two different types of pathological scars(hypertrophic scars and keloids)after each treatment,and statistically analyze whether there are differences in the clinical efficacy of the two types of pathological scars.The influencing factors of clinical efficacy were evaluated after 1 and 2 treatments(there has a stastistical diference between the groups at P<0.05),Whether or not the type of pathological scars had influence on the recurrence rate and local skin depression was statistically analyzed(using chi-square test,P<0.05 was considered statistically significant).Result:1.Comparison of the efficacy between the experimental group(44 lesions)and the control group:The total effective rate of the two groups of pathological scars after the first treatment was 40.90%and 20.00%respectively,and the total effective rate after the second treatment was 50.00%and 25.00%.There was a statistically significant difference in clinical efficacy between the two groups(P<0.05).The efficacy of the experimental group was significantly better than that of the control group.2.Analysis of the efficacy of combination therapy(209 lesions):The total effective rate from 1st to 6th after treatment of pathological scar was:30.10%,43.90%,67.30%,80.60%,84.20%,86.40%,as the number of treatments increases,the effect becomes more pronounced.The total effective rates from 1st to 6th after treatment of hypertrophic scars were:35.60%,52.10%,74.50%,86.50%,92.00%,93.90%,and the total effective rate from 1st to 6th after treatment of keloids Followed by:17.50%,25.40%,51.60%,68.30%,71.10%,76.90%,There was a statistically significant difference in the efficacy of different types of pathological scars(P<0.05),the efficacy of hypertrophic scars was superior to keloids.3.Analysis of the relevant influencing factors of the curative effect:The patients’ age,disease course,the area and site of pathological scar all have an effect on the clinical effect of pathological scar.The total effective rates of patients aged 16～group、age 20～group and age 44～group after the first treatment were 48.60%,27.00%,0.00%respectively.The total effective rate after the second treatment was 65.70%、41.10%and 11.10%respectively.There was a statistically significant difference in the therapeutic effect between the age 16～group and age 20～group,and the clinical efficacy of the former was significantly better than the latter,but the aged 16～group and age 44～group、age 20～group and age 44～group was no statistically significant difference between the age groups.There was a negative correlation between the age of the patients and the efficacy,The older the age,the worse the efficacy.The total effective rates of the disease course<4 years,4-8 years,and 8 years groups after the first treatment were 43.80%,24.70%and 27.60%respectively.After the second treatment,the total effective rates were 60.80%,39.50%and 38.80%respectively.there was a statistical difference between the disease course<4 year group and the 4-8 years group,>8 years group,and the clinical efficacy of pathological scars in the disease course<4 years group were better than the latter two groups,but there was no statistically significant difference between the latter two groups.There was no positive or negative correlation between disease course and efficacy.The total effective rate of the small area group,medium area group,and large area group of pathological scars after the first treatment was 35.00%,4.00%and 0.00%,respectively,and the total effective rate after the second treatment was 49.70%,12.00%and 14.30%respectively.The efficacy of pathological scars of small area group、medium area group and large area group had a statistical difference,the small area group was significantly better than the medium group and large area group,but There was no statistical difference in the efficacy of the latter two groups.There is a negative correlation between area and efficacy,that is,the larger the area,the worse the efficacy.The total effective rate of the facial-neck,trunk,perineum,and extremities after the first treatment was 17.90%,35.00%,10.00%and 9.10%respectively.After the second treatment,the total effective rate was 22.20%,48.40%,20.00%,54.50%respectively.The clinical efficacy of pathological scars at different sites was statistically different,but there was no statistical difference between the groups.4.Relationship between the recurrence rate and different types of pathological scars:In this group of data,the recurrence rates of hypertrophic scar and keloid were 2.70%and 11.10%respectively.There was a statistically significant difference in the recurrence rate between the two groups.The recurrence rate of keloids was significantly higher than hypertrophic scars.5.The relationship between adverse reactions and the types of pathological scars:The incidence of local skin depression and atrophy during hypertrophic scars and keloids was 11.00%and 3.20%respectively.During the treatment,There was not statistically significant difference in the local skin depression and atrophy occurred between the two groups.Conclusion:1.The clinical efficacy of fractional CO2 laser combined with intralesional injection triamcinolone acetonide and 5-Fu for the treatment of pathological scar was better than single drug intralesional injection.2.The clinical efficacy of fractional CO2 laser combined with drug injection for the treatment of Pathological Scar is significant,with few side effects,and is worthy of clinical application,especially suitable for hypertrophic scars.3.The patients’ age,disease course,the area and site of pathological scar all have an effect on the clinical effect of pathological scar,Among them,there was a negative correlation between the age and area of pathological scar and efficacy.4.There was a significant difference in the recurrence rate after treatment of different types of pathological scars,the recurrence rate of keloids was significantly higher than hypertrophic scars.5.there was no statistical difference in the occurrence of local skin depression and atrophy in different types of pathological scars. |
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