Q开关激光治疗双侧面部获得性太田痣样斑287例疗效分析(1)
[摘要]目的:比较Q开关紫翠宝石755nm激光、Nd:YAG 1 064nm激光和倍频Nd:YAG 532nm激光对双侧获得性太田痣样斑的治疗效果和副作用。方法:运用Q开关紫翠宝石755nm激光、Nd:YAG 1064nm激光和倍频Nd:YAG 532nm激光分别对287例患者进行治疗。结果:经过1～13次治疗后,痊愈140例,显效66例,有效59例,无效22例,总有效率71.8%,总治愈率48.8%。倍频Nd:YAG 532nm激光治疗起效快而副反应明显,Q开关紫翠宝石755nm激光和Nd:YAG 1 064nm激光起效慢但副反应轻微。结论:三种Q开关激光均能有效治疗双侧获得性太田痣样斑,长程低能量的Q开关紫翠宝石755nm激光和Nd:YAG 1 064nm激光因副反应轻微更适合美容患者的需要。
[关键词]双侧获得性太田痣样斑;Q开关;紫翠宝石激光;Nd:YAG激光;倍频
[中图分类号]R616.4 [文献标识码]A[文章编号]1008-6455(2010)06-0869-02
The analysis of 287 Acquired bilateral nevus of Ota-like macules(ABNOM) treated with Q-switchedLasers
TAN Jun,WU Dong-hui, ZHONG Qian
(Department of Plastic and Laser Cosmetic Surgery, People's Hospital of Hunan Province, Changsha410005,Hunan,China )
Abstract:Objective To discuss the therapeutic effect of Acquired bilateral nevus of Ota-like macules (ABNOM) treated with Q-switched lasers. Methods 287 cases of ABNOM were treated with Q-switched alexandrite laser, Nd:YAG laser or Double-frequency Nd:YAG laser seperatedly. Results After 1～13 times of treatments, 140 cases were cured,66 cases showed marked improvement,59 cases had fare blanching and 22 cases were evaluated as uneffective. The gross effective rate were 71.8%,and the completely recovered rate were 48.8%. The patients treated with double-frequency Nd:YAG laser showed more rapid response and underwent more obvious side-effects than with the other two lasers. Conclusions the Q-switched lasers are effective for treating ABNOM. To achieve safe and satisfactory recovery of ABNOM,long term and low energy Q-switched alexandrite or Nd:YAG laser is recommended.
Key words:Acquired bilateral nevus of Ota-like macules (ABNOM); Q-switched; alexandrite laser; Nd:YAG laser; Double-frequency
双侧获得性太田痣样斑(Acquired bilateral nevus of Ota-like macules,ABNOM)为对称分布于双侧颧部、颞部、眼睑,群集而又不融合的圆形、椭圆形,粟粒至黄豆大小的褐青色斑点,好发于中青年女性。既往采用药物、磨削、冷冻、剥脱术等方法,均不能达到满意疗效,甚至出现瘢痕、色素异常等,近年来,应用调Q开关激光治疗屡有报道,并已取得不错的效果。临床上常用的调Q开关激光有紫翠宝石激光(755nm),Nd:YAG激光(1 064nm),倍频Nd:YAG激光(532nm)和红宝石激光(694nm)等,不同激光治疗的比较研究仍然少见报道。部分患者治疗后仍然出现色素沉着和色素减退等并发症,也提示我们仍然需要进一步了解激光治疗对双侧获得性太田痣样斑的影响因素,从而找到最佳治疗方案。2002年1月～2008年12月,我们分别采用调Q开关紫翠宝石755nm激光、Nd:YAG 1 064nm激光和倍频Nd:YAG 532nm激光治疗ABNOM取得了良好效果,本文回顾性研究了287例治疗病例,现将结果报道如下。
1资料和方法
1.1 一般资料:287例ABNOM患者均为我科门诊病例,其中女285例,男2例。年龄7～55岁,平均为32.6岁,病程1～27年。皮损分布于颧部、颞部、额部、面颊部、鼻部(尤其是鼻翼缘)及下睑。皮疹为圆形、椭圆形的褐青色斑点或斑片,额部皮损常融合,颧颞部、颊部等处皮损则多孤立而不融合。
1.2治疗设备及参数:采用美国科医人医疗激光公司Versapulse四合一美肤激光进行治疗,287例患者分别选择调Q开关紫翠宝石激光(109例)、Nd:YAG 1 064nm激光(114例)和倍频Nd:YAG532nm激光(64例)进行治疗。Q开关紫翠宝石激光,波长755mm,脉宽60ns,能量4.0～6.0J/cm2;Q开关Nd:YAG激光,波长1 064nm,脉宽7ns,能量3.0～5.5J/cm2;Q开关倍频Nd:YAG激光,波长532mm,脉宽8ns,能量1.6～2.2J/cm2。
1.3治疗方法
1.3.1术前准备:治疗前拍照以备疗效评估,常规2%利多卡因凝胶表面麻醉。
1.3.2治疗方法:每次治疗时病变部位用毗连但不重复的光斑,光斑直径3mm,能量强度的选择根据皮损部位、颜色及组织反应而定,Q开关紫翠宝石755nm激光和Nd:YAG 1 064nm激光治疗后皮损出现轻度水肿、潮红;倍频Nd:YAG 532nm激光治疗后皮损表皮颜色转为霜白。激光治疗的次数视色素沉着反应等情况而定,一般Q开关紫翠宝石755nm激光和Nd:YAG 1 064nm激光每次治疗间隔1～3个月,倍频Nd:YAG 532nm激光治疗间隔3～6个月。如出现明显的色素沉着,则适当延长治疗间隔。
1.3.3治疗后处理:治疗后外搽湿润烧伤膏,嘱患者禁止洗搽治疗部位,直到皮损处痂皮自然脱落,并尽量减少日光照射,痂皮自然脱落后可于患处外用防晒剂,治疗期间使用保湿霜及防晒霜,停用祛斑类化妆品和药品。, 百拇医药(谭 军,吴东辉,钟 茜)
[关键词]双侧获得性太田痣样斑;Q开关;紫翠宝石激光;Nd:YAG激光;倍频
[中图分类号]R616.4 [文献标识码]A[文章编号]1008-6455(2010)06-0869-02
The analysis of 287 Acquired bilateral nevus of Ota-like macules(ABNOM) treated with Q-switchedLasers
TAN Jun,WU Dong-hui, ZHONG Qian
(Department of Plastic and Laser Cosmetic Surgery, People's Hospital of Hunan Province, Changsha410005,Hunan,China )
Abstract:Objective To discuss the therapeutic effect of Acquired bilateral nevus of Ota-like macules (ABNOM) treated with Q-switched lasers. Methods 287 cases of ABNOM were treated with Q-switched alexandrite laser, Nd:YAG laser or Double-frequency Nd:YAG laser seperatedly. Results After 1～13 times of treatments, 140 cases were cured,66 cases showed marked improvement,59 cases had fare blanching and 22 cases were evaluated as uneffective. The gross effective rate were 71.8%,and the completely recovered rate were 48.8%. The patients treated with double-frequency Nd:YAG laser showed more rapid response and underwent more obvious side-effects than with the other two lasers. Conclusions the Q-switched lasers are effective for treating ABNOM. To achieve safe and satisfactory recovery of ABNOM,long term and low energy Q-switched alexandrite or Nd:YAG laser is recommended.
Key words:Acquired bilateral nevus of Ota-like macules (ABNOM); Q-switched; alexandrite laser; Nd:YAG laser; Double-frequency
双侧获得性太田痣样斑(Acquired bilateral nevus of Ota-like macules,ABNOM)为对称分布于双侧颧部、颞部、眼睑,群集而又不融合的圆形、椭圆形,粟粒至黄豆大小的褐青色斑点,好发于中青年女性。既往采用药物、磨削、冷冻、剥脱术等方法,均不能达到满意疗效,甚至出现瘢痕、色素异常等,近年来,应用调Q开关激光治疗屡有报道,并已取得不错的效果。临床上常用的调Q开关激光有紫翠宝石激光(755nm),Nd:YAG激光(1 064nm),倍频Nd:YAG激光(532nm)和红宝石激光(694nm)等,不同激光治疗的比较研究仍然少见报道。部分患者治疗后仍然出现色素沉着和色素减退等并发症,也提示我们仍然需要进一步了解激光治疗对双侧获得性太田痣样斑的影响因素,从而找到最佳治疗方案。2002年1月～2008年12月,我们分别采用调Q开关紫翠宝石755nm激光、Nd:YAG 1 064nm激光和倍频Nd:YAG 532nm激光治疗ABNOM取得了良好效果,本文回顾性研究了287例治疗病例,现将结果报道如下。
1资料和方法
1.1 一般资料:287例ABNOM患者均为我科门诊病例,其中女285例,男2例。年龄7～55岁,平均为32.6岁,病程1～27年。皮损分布于颧部、颞部、额部、面颊部、鼻部(尤其是鼻翼缘)及下睑。皮疹为圆形、椭圆形的褐青色斑点或斑片,额部皮损常融合,颧颞部、颊部等处皮损则多孤立而不融合。
1.2治疗设备及参数:采用美国科医人医疗激光公司Versapulse四合一美肤激光进行治疗,287例患者分别选择调Q开关紫翠宝石激光(109例)、Nd:YAG 1 064nm激光(114例)和倍频Nd:YAG532nm激光(64例)进行治疗。Q开关紫翠宝石激光,波长755mm,脉宽60ns,能量4.0～6.0J/cm2;Q开关Nd:YAG激光,波长1 064nm,脉宽7ns,能量3.0～5.5J/cm2;Q开关倍频Nd:YAG激光,波长532mm,脉宽8ns,能量1.6～2.2J/cm2。
1.3治疗方法
1.3.1术前准备:治疗前拍照以备疗效评估,常规2%利多卡因凝胶表面麻醉。
1.3.2治疗方法:每次治疗时病变部位用毗连但不重复的光斑,光斑直径3mm,能量强度的选择根据皮损部位、颜色及组织反应而定,Q开关紫翠宝石755nm激光和Nd:YAG 1 064nm激光治疗后皮损出现轻度水肿、潮红;倍频Nd:YAG 532nm激光治疗后皮损表皮颜色转为霜白。激光治疗的次数视色素沉着反应等情况而定,一般Q开关紫翠宝石755nm激光和Nd:YAG 1 064nm激光每次治疗间隔1～3个月,倍频Nd:YAG 532nm激光治疗间隔3～6个月。如出现明显的色素沉着,则适当延长治疗间隔。
1.3.3治疗后处理:治疗后外搽湿润烧伤膏,嘱患者禁止洗搽治疗部位,直到皮损处痂皮自然脱落,并尽量减少日光照射,痂皮自然脱落后可于患处外用防晒剂,治疗期间使用保湿霜及防晒霜,停用祛斑类化妆品和药品。, 百拇医药(谭 军,吴东辉,钟 茜)