| Objectives:1.To compare the clinical efficacy,adverse reactions and recurrence rates of 585nm pulsed dye laser combined with fractional CO2 lase,intralesional injection of triamcinolone acetonide,5-fluorouracil(5-Fu)(experimental group)and fractional CO2 laser combined with intralesional injection of triamcinolone acetonide and 5-fluorouracil(5-Fu)(control group)for the treatment of hypertrophic scars.2.To investigate the influence of age,disease course,the area and site of scar and other relevant factors on the clinical efficacy of 585nm pulsed dye laser combined with fractional CO2 laser,intralesional injection of triamcinolone acetonide and 5-fluorouracil(5-Fu)for the treatment of hypertrophic scars.Method:31 patients with the same type of hypertrophic scars at the same or adjacent sites were selected,the lesions totaled 220.The same type of multiple hypertrophic scars at the same or adjacent parts on the same patient were randomly divided into the experimental group(119)and the control group(101).The experimental group was given the treatment of fractional CO2 laser combined with intralesional drug injection at the first month,and given 585nm pulsed dye laser combined with intralesional drug injection at the seconde month,followed by monthly alternate treatment according to these methods.The control group given monthly regular treatment of fractional CO2 laser combined with intralesional drug injection.Two months as a course of treatment,the skin lesions of the two groups were photographed under the same conditions,data collection,and the Sawada clinical grading score and POSAS scoring were collected,before each course of treatment.Through the statistical analysis,compare the clinical efficacy between the experimental group and the control group before and after treatment,adverse reactions(such as local skin necrosis,local skin depression,etc.)and recurrence rates were compared between the two groups during treatment and within 6 months after treatment.After the first,second and third courses of treatment,the influence of age,disease course,the area and site of scar and other relevant factors on the clinical efficacy of the experimental group was statistically analyzed(P<0.05 was considered statistically significant).Results:1.Inter-group comparisons of POSAS and Sawada scores between the experimental group and the control group before and after treatment:the difference of total score of POSAS and Sawada between the two groups was statistically significant(P<0.001),and the efficacy of the experimental group was significantly better than that of the control group,and the efficacy increased with the course of treatment.Among them,the differences of the Sawada scores of high hardness scores between the two groups were statistically significant(P<0.05),indicating that the experimental group is better than the control group on the improvement of the hyperplastic scar high hardness,especially the experimental group on the improvement of the hyperplastic scar color significantly better than that of control group(P<0.001).However,there was no statistically significant difference in itch pain scores between the two groups(P>0.05).2.Inter-group comparisons of clinical efficacy between the experimental group and the control group:the total effective rate after the first,second and third courses of treatment in the two groups was 57.98%(n=119),42.57%(n=101);81.20%(n=117),60.00%(n=100);90.65%(n=107),81.25%(n=96).The difference of clinical efficacy between the two groups was statistically significant(P<0.05),indicating that the treatment effect of the experimental group was significantly better than the control group with the increase of treatment course.3.Analysis of relevant factors of clinical efficacy in the experimental group:age,disease course,the area and site of scar of the patients in the experimental group all had an impact on the clinical efficacy of hypertrophic scar.The total effective rate after the first,second and third courses of treatment of each age was 81.25%(n=16),58.33%(n=96),0.00%(n=7);80.00%(n=15),85.26%(n=95),28.57%(n=7);100%(n=14),90.69%(n=86),71.43%(n=7),the differences of clinical efficacy among different age groups were statistically significant(P<0.05).There was a negative correlation between age and curative effect,the older the patient,the worse the treatment effect.The total effective rate after the first,second and third courses of treatment of different course was 68.30%(n=85),43.48%(n=23),9.09%(n=11);90.36%(n=83),60.87%(n=23),54.54%(n=11);73.98%(n=73),78.27%(n=23),54.54%(n=11),and the differences of clinical efficacy among different course was statistically significant(P<0.05).The longer the course of disease,the worse the treatment effect.The total effective rate after the first,second and third courses of treatment of different area group was 63.63%(n=99),40.00%(n=15),0.00%(n=5);86.60%(n=97),40.00%(n=15),100%(n=5);90.90%(n=88),85.71%(n=14),100%(n=5).Except for the first course of treatment,the difference of clinical efficacy among different scar areas was statistically significant(P<0.05).The larger the scar area,the worse the treatment effect.The total effective rates of neck,trunk,limb and perineum in the first,second and third treatment courses were 53.20%(n=47),62.71%(n=59),60.00%(n=10),33.33%(n=3);80.85%(n=47),82.76%(n=58),88.89%(n=9),33.33%(n=3);88.09%(n=42),92.46%(n=53),100%(n=9),66.67%(n=3).There was no statistically significant difference in the efficacy of hypertrophic scar in different parts(P>0.05)4.Inter-group comparisons of adverse reactions of hypertrophic scar between the experimental group and the control group:in the data of this group,the incidence of local skin necrosis was 1.68%in the experimental group and 0.99%in the control group,and the incidence of local skin depression was 3.36%and 7.92%,respectively,with no statistical significance(P>0.05).5.Inter-group comparisons of the recurrence rate of hypertrophic scar between the experimental group and the control group:in the data of this group,the recurrence rate of hypertrophic scar between the experimental group and the control group was 2.52%and 10.89%,respectively,the difference was statistically significant(P<0.05),the recurrence rate of the control group was significantly higher than that of the experimental group,indicating that hypertrophic scar in the control group was more likely to relapse after treatment than that in the experimental groupConclusions:1.The clinical efficacy of 585nm pulsed dye laser combined with fractional CO2 laser,intralesional injection of triamcinolone acetonide and 5-fluorouracil(5-Fu)for the treatment of hypertrophic scars was obviously better than the fractional CO2 laser combined with intralesional injection of triamcinolone acetonide and 5-fluorouracil(5-Fu),especially can obviously improve the color,height and hardness of hypertrophic scar and reduce the recurrence rate(P<0.05),but the difference of local skin necrosis,depression and other adverse reactions is not statistically significant(P>0.05).2.Age,disease course,the area and site of scar of patients all have an impact on the clinical efficacy of hypertrophic scar,and all of them are negatively correlated with the clinical efficacy. |
