自体脂肪胶联合点阵激光治疗增生性瘢痕的临床研究

Clinical effect of autologous fat grafting combined with fractional laser therapy for treating hypertrophic scars

摘要:

目的 分析自体脂肪胶联合点阵激光在增生性瘢痕治疗中的效果。方法 选取2021年1月—2024年1月山西医科大学附属白求恩医院收治的158例增生性瘢痕患者，采用随机数字表法将患者分成对照组和观察组，各79例。对照组给予点阵激光联合生长因子外用治疗，观察组给予自体脂肪胶联合点阵激光治疗。对比两组患者的治疗效果、温哥华瘢痕量表评分（VSS）、血清指标［血管内皮生长因子（VEGF）、表皮细胞生长因子（EGF）］水平，以及治疗开始到结束后1年的不良反应情况。结果 观察组治疗总有效率高于对照组（P <0.05）。观察组患者治疗前后VSS评分（外观情况、血管情况、柔软程度和瘢痕厚度）的差值均高于对照组（P<0.05）。观察组治疗前后VEGF、EGF水平的差值均高于对照组（P <0.05）。两组不良反应总发生率比较，差异无统计学意义（P >0.05）。结论 相较于点阵激光联合生长因子外用治疗，自体脂肪胶联合点阵激光可进一步提高增生性瘢痕治疗效果，改善增生性瘢痕症状及血清相关指标表达，且不会增加患者相关不良反应发生风险。

Abstract:

Objective To analyze the effect of autologous fat grafting combined with fractional laser therapy in the treatment of hypertrophic scars.Methods The 158 patients with hypertrophic scars admitted to Norman Bethune Hospital Affiliated to Shanxi Medical University from January 2021 to January 2024 were selected. Patients were divided into the control group and the observation group using the random number table method, with 79 cases in each group. The control group received fractional laser therapy combined with the topical application of growth factors, while the observation group received combined treatment of autologous fat grafting and fractional laser therapy. The therapeutic effect, Vancouver Scar Scale (VSS) scores, levels of serum indicators [vascular endothelial growth factor (VEGF) and epidermal cell growth factor (EGF) ], and adverse reactions from the start of treatment to one year after the end of treatment were compared between the two groups.Results The overall effective rate of the observation group was higher than that of the control group (P < 0.05). The differences in sub-item scores for pigmentation, vascularity, pliability, and height on the VSS before and after treatment of the observation group were higher than those of the control group (P < 0.05). The differences in VEGF and EGF levels in the observation group were higher than those in the control group (P < 0.05). There was no significant difference in the overall incidence of adverse reactions between the two groups (P > 0.05).Conclusions Compared to fractional laser therapy alone, the addition of autologous fat grafting further enhances the treatment efficacy for hypertrophic scars, alleviates scar symptoms, improves the expression of related serum markers, and does not increase the risk of adverse reactions.