本文選題：咖啡斑 + 長期療效��； 參考：《復(fù)旦大學(xué)》2014年博士論文

【摘要】：背景咖啡斑是常見的表皮色素異常性皮膚病,表現(xiàn)為形狀、大小不一,表面光滑,顏色均一的淡褐色或咖啡色斑片。暴露部位的咖啡斑通常有治療需求,目前報(bào)道的咖啡斑激光療效的差異比較大,且存在觀察的病例數(shù)少以及隨訪時(shí)間過短等問題,此外,影響咖啡斑激光治療效果的相關(guān)因素目前仍不夠明確。目的研究調(diào)Q紫翠玉寶石和調(diào)Q紅寶石激光治療咖啡斑的長期療效和并發(fā)癥,并且探討影響咖啡斑激光治療效果的相關(guān)因素。方法收集2006年10月至2011年5月至我院皮膚科激光中心就診的80例咖啡斑患者,使用調(diào)Q紫翠玉,調(diào)Q紅寶石激光或兩者聯(lián)合治療,隨訪時(shí)間距末次治療半年以上。通過就診卡以及電話隨訪患者獲取患者激光治療的參數(shù)、治療次數(shù)、療效、復(fù)發(fā)情況、出現(xiàn)的并發(fā)癥,患者的年齡、家族史、發(fā)病年齡、病程,以及咖啡斑的數(shù)目、大小、部位等基本信息,并通過照片評(píng)價(jià)皮損的邊界形態(tài)。其中療效根據(jù)皮損顏色改善的情況分為無效、好轉(zhuǎn)、顯效和痊愈四個(gè)等級(jí)。評(píng)價(jià)咖啡斑激光治療的長期療效,并通過兩組獨(dú)立樣本或多組獨(dú)立樣本的秩和檢驗(yàn)分析可能影響咖啡斑療效的相關(guān)因素。采用SPSS22.0軟件進(jìn)行數(shù)據(jù)統(tǒng)計(jì)處理。結(jié)果本研究隨訪了80名咖啡斑患者,男女比例1：1.05,治療次數(shù)為1-8次,平均隨訪時(shí)間27.9±11.6月(6-53月),有效率和顯效率分別為61%和42.5%,復(fù)發(fā)率為12.2%,復(fù)發(fā)的時(shí)間多在末次治療后1-3年內(nèi),均為部分復(fù)發(fā)。調(diào)Q紫翠玉激光,調(diào)Q紅寶石激光和兩種激光聯(lián)合治療在療效上無統(tǒng)計(jì)學(xué)差異。即使治療次數(shù)增加,仍有部分咖啡斑激光治療效果不佳,提示療效與治療次數(shù)之間并非呈單純的正相關(guān)關(guān)系�？Х劝呒す獐熜c患者的性別、發(fā)病年齡、病程和咖啡斑的部位之間無明顯的相關(guān)性。面積小的咖啡斑較面積大的治療效果更好,鋸齒狀邊界的咖啡斑較邊界圓潤光滑的療效好。有3例患者(3.75%)治療后出現(xiàn)了長期并發(fā)癥,分別為局部永久性色素減退,皮膚質(zhì)地改變和繼發(fā)皮炎。結(jié)論1.調(diào)Q紫翠玉激光和紅寶石激光可以較安全、有效地治療咖啡斑,長期的復(fù)發(fā)率在12%左右,多為部分復(fù)發(fā)。2.咖啡斑調(diào)Q紫翠玉激光和紅寶石激光療效的個(gè)體差異較大。3.咖啡斑的激光療效和咖啡斑的大小和邊界有關(guān),其具體的機(jī)制尚有待進(jìn)一步研究。4.調(diào)Q紫翠玉和紅寶石激光治療咖啡斑長期并發(fā)癥的發(fā)生率較低。
[Abstract]:Background Coffee spot is a common skin disease of epidermal pigmentation, which is characterized by a variety of shapes, sizes, smooth surfaces and uniform brown or brown patches. There is usually a need for treatment of coffee spots at exposed sites. There is a large difference in the efficacy of coffee spots reported at present, and there are problems such as the small number of cases observed and the short follow-up time, etc., in addition, The related factors affecting the effect of laser treatment of coffee spot are still not clear. Objective to study the long-term efficacy and complications of Q-switched emerald and Q-switched ruby laser in the treatment of coffee-spot, and to explore the related factors affecting the efficacy of Q-switched ruby laser in the treatment of coffee-spot. Methods from October 2006 to May 2011, 80 patients with coffee spots were treated with Q-switched purple emerald jade, Q-switched ruby laser or a combination of the two. The follow-up time was more than half a year after the last treatment. The parameters, times of treatment, curative effect, recurrence, complications, age, family history, onset age, course of disease, number and size of coffee spots were obtained by means of card and telephone follow-up. The basic information, such as location, was used to evaluate the boundary shape of skin lesions. According to the improvement of skin color, the curative effect can be divided into four grades: ineffective, improved, effective and cured. To evaluate the long-term efficacy of coffee-spot laser therapy, and to analyze the related factors that may affect the efficacy of coffee-spot by rank sum test of two groups of independent samples or groups of independent samples. SPSS22.0 software is used to process the data. Results 80 patients with coffee-spot were followed up. The ratio of male to female was 1: 1.05, the times of treatment was 1-8, the average follow-up time was 27.9 鹵11.6 months from June to 53 months. The effective rate and effective rate were 61% and 42.5%, respectively. The recurrence rate was 12.2 and the time of recurrence was mostly within 1-3 years after the last treatment. All were partial recurrence. Q-switched purple jade laser, Q-switched ruby laser and two kinds of laser combined treatment have no statistical difference in curative effect. Even if the frequency of treatment increased, there were still some coffee spot laser treatment effect is not good, suggesting that there is not a simple positive correlation between the efficacy and the number of treatment. There was no significant correlation between the laser effect of coffee spot and sex, age, course of disease and site of coffee spot. Coffee spots with small area were better than those with large area, and coffee spots with serrated edges were better than those with smooth edges. There were long-term complications after treatment, including local permanent hypopigmentation, skin texture change and secondary dermatitis. Conclusion 1. Q-switched purple jade laser and ruby laser can be more safe, effective treatment of coffee spots, long-term recurrence rate of about 12%, mostly partial recurrence. 2. The individual difference between coffee spot Q-switched purple jade laser and ruby laser was significant. 3. The laser effect of coffee-spot is related to the size and boundary of coffee-spot, and its specific mechanism needs to be further studied. Q-switched purple jade and ruby laser treatment of coffee spot long-term complications were lower.
【學(xué)位授予單位】：復(fù)旦大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2014
【分類號(hào)】：R758.4

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