使用飛梭雷射合併藥物導入來預防甲狀腺術後疤痕形成的效果

謝青華
Ching-Hua Hsieh

飛梭雷射可以破壞表皮屏障並增強表面塗抹的藥物於真皮層的滲透和分佈,此為作用為雷射輔助藥物導入(laser-assisted drug delivery)。我們過去的研究報告顯示說,使用二氧化碳飛梭雷射輔助局部類固醇導入可以用來減少甲狀腺切除術後之頸部肥厚性疤痕。所以,此研究在於探討術後早期使用二氧化碳雷射輔助局部類固醇導入是否可以預防甲狀腺切除術後之肥厚疤痕形成。這項前瞻性隨機兩側分邊(prospective randomized split design)之疤痕設計研究在2018年3月至2018年12月期間,共招募了十二名剛接受甲狀腺切除術的成年女性患者,於使用二氧化碳飛梭雷射後,立刻局部塗抹0.05% Colbesol 藥膏於治療側。每間隔一個月治療一次,共五次。於治療後一年使用患者和觀察者疤痕評估量表 (Patient and Observer Scar Assessment Scale, POSAS)及治療前後之照片進行評估。結果顯示於飛梭雷射後有無塗抹Colbesol 藥膏,其術後所形成的疤痕,在疤痕各方面之改善程度並不顯著。從照片中也無法有效區分治療側和控制側形成的疤痕是否明顯之差異。簡單來說就是,使用二氧化碳飛梭雷射輔助局部類固醇導入並無法有效地預防甲狀腺切除術後之肥厚疤痕形成。

原文由整形外科謝青華醫師指導下,整形外科醫師團隊發表於台灣皮膚科醫學會雜誌(Dermatologica Sinica, July-September 2021)。

甲狀腺術後疤痕
Figure 1: The photograph of the patient 6 months (left picture) and
1 year (right picture) after the first treatment course of facilitated delivery
of topical 0.05% clobetasol propionate ointment following fractional
ablative carbon dioxide laser treatment. The right side of the neck scar
was the treatment side
甲狀腺術後疤痕
Figure 2: The photograph of the patient 6 months (left picture) and
1 year (right picture) after the first treatment course. The right side of the
neck scar was the treatment side.
甲狀腺術後疤痕
Figure 3: The photograph of the patient 6 months (left picture) and
1 year (right picture) after the first treatment course. The right side of the
neck scar was the treatment side
Figure 4: The photograph of the patient 6 months (left picture) and
1 year (right picture) after the first treatment course. The left side of the
neck scar was the treatment side
Figure 5: The patient scar assessment of the postthyroidectomy scar
by the patients themselves using Patient and Observer Scar Assessment
Scale
Figure 6: The observer scar assessment of the postthyroidectomy scar
by the treating doctor using Patient and Observer Scar Assessment Scale
Figure 7: Evaluation of the esthetic improvement of the postthyroidectomy
scar between the treatment and control sides by three blinded plastic
surgeons according to the digital photographs that were taken at 1‑year
after the first treatment course. The scale of 0–10 indicates totally
identical to significantly different between both sides of the scar. In the
blinded manner, if the plastic surgeon indicated the control side to be the
treatment side, then score was converted to be negative, ranged from
0 (totally identical) to −10 (significantly different)
Figure 8: The overall esthetic opinion of the scar by three blinded plastic
surgeons in the assessment of digital photographs 6 months and 1 year
in rating the difference of the scar compared with the surrounding normal
skin. The scale of 0–10 indicate totally identical to significantly different
from the normal skin

伸閱讀 : 【環球生技】「2021台灣再生醫學學會學術研討會」 再生醫學新武器幹細胞胞外體應用突起
延伸閱讀 : 有效之醫療品質管理工具-加護病房預後評分系統
延伸閱讀 : 輸血快速加溫器教育訓練

  • 謝青華醫師
謝青華
現職
高雄長庚醫院外科部部長
高雄長庚醫院整形外科主治醫師
學歷
台大醫學院醫學系
長庚大學臨床醫學研究所博士班
經歷
台大醫院整形外科住院醫師總醫師
高雄長庚外傷科主治醫師

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