摘要:
目的 探讨利用超脉冲二氧化碳激光进行皮肤剥脱结合自体微粒皮移植治疗皮肤色素脱失的方法及临床效果.方法 首先应用超脉冲二氧化碳激光分别以0、10、20、30、40、50、60 mJ的能量参数,对2010年1月至2014年6月解放军总医院第四医学中心烧伤整形科,应用扩张皮瓣或自体皮移植治疗的10例皮肤色素脱失病例切除的色素脱失皮肤进行剥脱,其中手部标本4例,面部3例,颈部2例,背部1例.对标本行HE染色,显微镜下观察剥脱效果,选择既能完全剥脱表皮又不损伤真皮的最佳能量参数.设定最佳参数,对2011年1月至2017年12月收治的16例皮肤色素脱失患者,应用超脉冲二氧化碳激光进行表皮剥脱后,以自体微粒皮移植进行治疗,其中男12例,女4例,年龄12~47岁,平均30岁.术后1、3、6、12个月复查,留取数码照片,利用Image-ProPlus 6.0软件分析着色率.结果 不同部位表皮完整剥脱所需激光能量有所不同,背部最佳能量为50 mJ,面部和手部均为40 mJ,颈部为30 mJ.通过1年随访,16例患者均未发生因剥脱过深导致的瘢痕增生.结合微粒皮移植,15例皮肤色素脱失得到完全改善,着色率大于90%;1例患者着色率75%,着色不均匀,可能为颈部活动较大,包扎固定欠佳,导致部分微粒皮移植未成活,影响术后着色效果.结论 选择合适的超脉冲二氧化碳激光的能量参数对色素脱失皮肤进行剥脱,可以有效控制磨削深度,避免术后瘢痕增生;自体微粒皮移植可使色素脱失区重新着色,着色率高,而且均匀,效果可靠.%Objective To explore the clinical application of ultra-pulsed CO2 laser skin abrasion combined with micro-skin graft in the treatment of skin depigmentation.Methods From January 2010 to June 2014,depigmented skin specimens were used for ultra-pulsed CO2 laser skin abrasion treatment,at 0,10,20,30,40,50,60 mJ.HE stain was performed to observe the abrasion depth under the 100 times microscope view.The most appropriate parameter was set to completely remove the epidermis,and leave dermis undamaged.From January 2011 to December 2017,16 patients with skin depigmentation,12 males and 4 females,aged 12-47 years,were treated with super-pulsed carbon dioxide laser and autologous microdermis transplantation.At 1,3,6 and 12 months after the operation,patients' photos were record.The color improvement was analyzed using Image-Pro Plus 6.0 software.Results The laser energy for complete epidermis removal is different at different sites.It is 50 mJ for back skin,40 mJ for face and hand skin and 30 mJ for neck skin.After one year of follow-up,there was no hypertrophy scar caused by over-abrasion in all 16 patients.Combined with the micro-skingrafting,15 patients with skin depigmentation were completely resolved,with more than 90% color improvement rate.The improvement rate was 75% in a patient with un-uniform appearance,due to part failure of micro-skin graft.The neck movement and uncertain fixation were the reasons.Conclusions The appropriate energy parameters can control the abrasion depth to avoid the hypertrophic scar.Combined with micro-skin graft,the depigmentation area can be improved with uniform color and reliable effect.