Laser therapy for venous leg ulcers

  • Review
  • Intervention

Authors


Abstract

Background

Around one percent of people in industrialised countries will suffer from a leg ulcer at some time. The majority of these leg ulcers are due to problems in the veins, resulting in an accumulation of blood in the legs. Leg ulcers arising from venous problems are called venous (varicose or stasis) ulcers. The main treatment is a firm compression garment (bandage or stocking) in order to help the blood return back up the leg. Compression, however, does not heal all ulcers, and other treatments, such as the local application of energy from low-level lasers, are sometimes used. It is unclear whether low-level laser therapy accelerates the healing of venous leg ulcers, and if it does, whether any particular treatment regimen is optimal.

Objectives

To assess the effectiveness of low level laser therapy in the treatment of venous leg ulcers.

Search methods

Searches of 19 databases, hand searching of journals and conference proceedings from 1948 onwards, and examination of bibliographies.

Selection criteria

Randomised controlled trials (RCTs) comparing low level laser therapy with: sham laser; no laser. There was no restriction on date or language. The main outcome measure used was complete healing of the ulcers.

Data collection and analysis

Data extraction was done by one reviewer and checked by a second. Meta analysis was used to combine the results of trials where the interventions and outcome measures were sufficiently similar.

Main results

There were four eligible trials. Two RCTs compared laser therapy with sham, one with ultraviolet therapy and one with non-coherent, unpolarised red light.

Neither of the two RCTs comparing laser with sham found a significant difference in healing rates; there was no significant benefit for laser evident when the trials were pooled (88 patients in total).

A three-arm study (45 patients) compared:
- laser therapy alone
- laser therapy plus infrared light
- non-coherent, unpolarised red light.
Significantly more ulcers completely healed in the group receiving a combination of laser and infrared light compared with non-coherent, unpolarised red light.

A fourth trial (6 patients) compared laser and ultraviolet light and found no significant difference.

Authors' conclusions

We have found no evidence of any benefit associated with low level laser therapy on venous leg ulcer healing. One small study suggests that a combination of laser and infrared light may promote the healing of venous ulcers, however more research is needed.

摘要

背景

雷射療法用於靜脈性小腿潰瘍

工業化國家中有約百分之ㄧ的人口不時被小腿潰瘍所苦。大部分的小腿潰瘍導因於靜脈方面的問題,造成血液淤積在小腿。因為靜脈問題所導致的潰瘍被稱作靜脈性潰瘍(曲張或瘀血) 。最常見的治療方式是以堅固的壓縮布料包覆(繃帶或襪子),以促進血液回流至小腿。然而壓迫法無法治療所有的潰瘍,因此其他的療法,像是利用低階雷射局部施以能量,有時也會被運用在治療潰瘍。關於低階雷射療法是否可加速治癒靜脈性小腿潰瘍尚不得而知,假設此法確實有效,那麼是否存在有最佳治療模式?

目標

評估低階雷射療法用於靜脈性小腿潰瘍的療效

搜尋策略

我們搜尋了19個資料庫,並且以人工搜尋了自1948年以來所發表的期刊和會議論文,並且檢索了相關的參考書目。

選擇標準

比較低階雷射療法,偽雷射 (sham laser) 以及無雷射間差異的隨機對照試驗 (Randomised controlled trials; RCTs) 。沒有發表日期和語言上的限制,主要用於衡量治療效果的指標是潰瘍是否治癒。

資料收集與分析

由一位作者負責資料摘錄,並由第二位作者進行確認。由於這些試驗所採用的介入與效果衡量的方法有足夠的相似度,因此使用了整合分析 (Meta Analysis) 來統整各項研究的結果。

主要結論

總共有4個試驗結果符合納入標準,其中有2個試驗比較了雷射療法與偽雷射,另1個包括了紫外線療法,最後1個則使用了非協調性、非偏振的紅光。這2個比較雷射療法和偽雷射間差異的試驗都並未發現兩者之間的治癒率存在顯著的差異。如果把2個試驗合併在一起 (總共88位病人) ,則證據顯示雷射並未呈現明顯的療效。在1項同時比較3種方式:只進行雷射、雷射療法加上紅外線、非協調且非偏振的紅光的試驗 (共45位病人) 中發現,接受雷射和紅外線合併治療的組別,病人的完治率明顯較高。第4個試驗 (總共6位病人) 比較了雷射和紫外線後發現兩者間的效果並無顯著差異。

作者結論

我們並未找到證據支持低階雷射療法對靜脈性小腿潰瘍是具有療效的。有項研究則建議合併使用雷射和紅外線可幫助治癒小腿潰瘍,不過仍需更多的研究方可證實。

翻譯人

本摘要由成功大學附設醫院邱曉萱翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

沒有強烈證據支持低階雷射療法可以有效治療靜脈性小腿潰瘍。即使使用新型傷口敷料和壓迫性繃帶也無法治療這個疾病,我們回顧了比較低階雷射治療小腿潰瘍和控制組之間療效的試驗,發現沒有證據顯示低階雷射療法可以有效治療靜脈性小腿潰瘍。1項小型研究顯示合併使用雷射和紅外線也許可以幫助治癒靜脈性潰瘍,然而仍需更多研究才能證實。

Plain language summary

Low level laser therapy for treating venous leg ulcers

Venous leg ulcers may not heal despite the use of modern wound dressings and compression bandages. We examined trials that compared treatment of leg ulcers with low level laser or a control. We have found no evidence of any benefit associated with low level laser therapy on venous leg ulcer healing. One small study suggests that a combination of laser and infrared light may promote the healing of venous ulcers, however more research is needed.

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