调Q激光与手术切除治疗口腔黏膜黑斑后的复发率比较：一项回顾性队列研究

Recurrence rate of oral melanotic macule treated with Q-switched alexandrite laser versus surgical excision: a retrospective cohort study

摘要

目的 比较755 nm调Q激光与手术切除治疗口腔黏膜黑斑后的复发率。方法 本研究已通过单位伦理委员会审查批准，并获得患者知情同意。采用回顾性队列研究设计，纳入2019年1月—2021年8月在上海交通大学医学院附属第九人民医院口腔黏膜病科门诊接受调Q激光或手术切除治疗的口腔黏膜黑斑患者，收集患者的一般资料、临床特征和随访病史。将治疗后1年复发率作为主要结局指标，长期不良反应发生率作为安全性评价指标，采用Kaplan-Meier法分析两组间的1年无复发率。结果 本研究共纳入了57例患者，其中16例患者接受了手术切除治疗，41例患者接受了调Q激光治疗，两组人口统计学和临床特征基线无显著差异。手术切除组所有患者均未观察到口腔黏膜黑斑的复发（0%），而调Q激光组有12例（29.27%）患者出现复发，平均复发时间为治疗后6.08个月，复发与吸烟（P = 1.000）、胃肠道息肉（P = 1.000）、纵型黑甲（P = 0.187）、家族史（P = 0.552）、治疗次数（P = 0.567）或是否多发（P = 0.497）均无相关性。与手术切除相比，调Q激光治疗口腔黏膜黑斑1年复发的比值比为4.41，95%置信区间为1.27-15.24（P = 0.020）。手术切除组中有3例患者（18.75%）报告损害切除处出现凹陷和疤痕，而调Q激光组没有患者报告长期不良反应（0%）（P = 0.019）。结论 与手术切除相比，调Q激光治疗口腔黏膜黑斑的优势在于长期不良反应率较低，但复发率相对较高，在治疗前需与患者沟通两种方法的优劣，以助临床决策。

Abstract

Objective To compare the recurrence rates between 755 nm Q-switched alexandrite laser (QSAL) treatment and surgical excision of oral melanotic macules (OMM). Methods This study was reviewed and approved by the Ethics Committee, and informed consent was obtained from the patients. A retrospective cohort study was designed to collect demographic and clinical characteristics and follow-up data from patients with OMM. Patients who received QSAL or surgical excision in the Department of Oral Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine from January 2019 to August 2021 were included. The one-year recurrence rate was investigated as the primary outcome. Long-term adverse reaction rates were investigated as safety indicators. Kaplan-Meier analyses were performed to analyze the recurrence-free rates between the groups. Results A total of 57 patients were enrolled in this study. 16 patients underwent surgical excision, and 41 underwent QSAL. The baseline demographic and clinical characteristics between the groups were not significantly different. No recurrence (0%) of OMM was observed in the surgical excision group, while in the QSAL group, the macule recurred in 12 patients (29.27%). The average duration of recurrence was 6.08 months after treatment. Recurrence was not found to be associated with smoking (P = 1.000), gastrointestinal polyps (P = 1.000), longitudinal melanonychia (P = 0.187), family history (P = 0.552), treatment sessions (P = 0.567) or multiple macule lesions (P = 0.497). Compared with treatment with surgical excision, the odds ratio of recurrence for treatment with QSAL was 4.41, with a 95% confidence interval of 1.27-15.24 (P = 0.020). In the surgical excision group, 3 patients (18.75%) reported depressions and scars on the lesion, while no long-term adverse reactions (0%) were reported in the QSAL group (P = 0.019). Conclusion Compared with surgical excision, the advantage of QSAL is the low long-term adverse reaction rate, while the disadvantage is the relatively high one-year recurrence rate. It is necessary to communicate the advantages and disadvantages of the two methods with OMM patients to assist in clinical decision-making.

关键词

口腔黏膜黑斑 / 调Q激光 / 手术切除 / 随访 / 复发 / 不良反应 / 凹陷 / 疤痕

Key words

oral melanotic macule / Q-switched alexandrite laser / surgical excision / follow-up / recurrence / adverse reaction / depression / scar

Author summay

孙凯，主治医师，博士，Email：[e-mail]