受区肿胀预扩张技术在自体脂肪面部移植中的临床应用

发布时间：2018-02-20 19:52

  本文关键词： 受区肿胀预扩张技术 自体脂肪移植 脂肪存活率 安全性　出处：《山东大学》2017年硕士论文　论文类型：学位论文

【摘要】：研究背景:面部美学注重五官立体、脸颊饱满,填充物的出现满足了我们对美丽的追求。自体脂肪颗粒来源丰富、取材简单且无排斥反应,作为一种天然的填充物近年来受到临床医生的重视。自体脂肪移植术(autologous fat grafting,AFG)可运用于美容及重建修复整形,包括面部形态不良、凹陷性疤痕畸形、先天性及后天性颌面部畸形、乳房整形等。然而,伴随着脂肪移植手术越来越广泛的使用,临床上的并发症时有发生困扰着求美者及整形医师。AFG术后并发症如瘀斑、血肿、硬结形成、受区感染、脂肪液化、皮肤凹凸不平、上睑下垂及皮肤麻木等,严重时脂肪造成的血管栓塞甚至会使受术者出现眼睛失明、急性中风及皮肤坏死等危急情况。因此,安全问题始终是放在脂肪移植手术最关键的位置,如何降低甚至杜绝手术并发症的发生成为整形外科领域研究的热点。肿胀麻醉技术作为一种安全、无痛、经济、实施方便同时又利于手术操作的麻醉方法在脂肪获取中首先被应用后,临床上积累了大量经验。本课题的创新之处在于受区采用肿胀预扩张技术发挥肿胀液的优势以便移植脂肪更安全有效地进行。本研究针对移植受区的肿胀扩张预处理,进行了临床病例分析研究。通过肿胀预扩张自体脂肪面部移植术后临床病例的收集,验证受区肿胀预扩张自体脂肪移植的临床应用价值。研究目的:观察肿胀预扩张自体脂肪面部移植术后的临床疗效,评估肿胀预扩张技术在脂肪移植术中的临床应用价值。研究方法:自2015年5月到2016年12月,对由不同原因所致面部凹陷的14例求美者采用受区肿胀预扩张技术行自体脂肪面部移植术治疗,受术者年龄为16到44岁,根据面部凹陷组织的缺损部位、范围、程度不同一次移植脂肪量为3.9～44ml,应用高频超声测定求美者手术前后各时间定点软组织的厚度及血流信号,保存求美者影像学资料并进行术后随访问卷调查。利用Kruskal-WallisH检验各时间点脂肪移植物存留情况,应用方差分析对比各时间点血流信号面积,观察术后恢复情况,追踪求美者术后满意度及并发症发生情况。研究结果:14例求美者术后凹陷部位改善明显,与术前相比脂肪移植区定点软组织厚度变化率术后1个月、术后3个月及术后6个月的中位数及四分位数间距分别为 70.1%(53.85%)、56.4%(51.95%)、16.7%(35.8%),三组数据的差异具有统计学意义(H=1.4×108,P0.05)。高频超声示术区行肿胀预扩张自体脂肪填充术后脂肪排布均匀,具有局部组织粘连的部位经预扩张后组织松解良好;移植区定点软组织厚度的变化呈先快后慢逐步稳定的状态。受术者术前、术后24小时、术后7天、术后1月、术后3月及术后6月定点软组织血流信号面积分别为(3.97±0.84)‰;(2.21±0.55)‰;(6.89±2.39)‰;(14.61±4.66)‰;(9.39±3.94)‰;(15.87±3.02)‰,六组数据的差异具有统计学意义(F=3.471,P0.05),移植术后血流信号面积显著增加。随访期间脂肪移植区无一例出现红肿、硬结、囊肿等并发症;求美者满意度高;术后12小时疼痛评估(数字分级评分法NRS)平均为:0.8分,即为术后止痛效果满意。研究结论:受区肿胀预扩张脂肪移植术在临床上的应用是安全及有效的。受区肿胀预扩张易于进行解剖间隙分离、增强麻醉效果、减少术后并发症的发生率,受术者接受度及满意度高。
[Abstract]:Research background: the aesthetic focus on three-dimensional facial features, full cheeks, appear filling we meet the pursuit of beauty. The source of autologous fat granules were rich, simple and no rejection, as a natural filler by the clinician's attention in recent years. Autologous fat transplantation (autologous fat grafting, AFG) can be used for the beauty and reconstruction of facial plastic, including bad shape, atrophic scar deformity, congenital and acquired maxillofacial deformity, breast plastic surgery. However, accompanied by fat transplantation is more and more widely used, the clinical complications that occurred in the troubled beauty and plastic surgeon.AFG postoperative complications such as ecchymosis, hematoma, induration formation, by infection, fat liquefaction, uneven skin, ptosis and numbness of skin, fat embolism caused serious when even the recipient eyes Blind, acute stroke and skin necrosis and other emergency situations. Therefore, the security problem is always put in the position of fat transplantation is the key, how to reduce or even eliminate the occurrence of complications has become the hot research field of plastic surgery. Tumescent technique is a safe, painless, economic, convenient and conducive to the implementation of anesthesia operation was first applied to obtain fat after clinical has accumulated considerable experience. The innovation of this paper is that by using swelling pre expansion technology play advantage for transplantation of adipose swelling fluid more safely and effectively. The research on swelling expansion pretreatment transplantation area, analyzed clinical cases. The swelling of pre expanded autologous fat transplantation face the collection of clinical cases, the clinical application value of verification by swelling pre expanded autologous fat transplantation. Study The observation of clinical curative effect of autologous fat swelling pre expansion facial transplantation, clinical application value of swelling pre expansion technique in fat transplantation. Methods: from May 2015 to December 2016, by the different causes of facial depression in 14 cases for the United States by swelling pre expansion by autologous fat transplantation technique after treatment, patients aged 16 to 44 years old, according to the defect position, facial tissue, a different amount of fat transplantation is 3.9 ~ 44ML, the application of high frequency ultrasound in the determination of the thickness and blood flow before and after surgery for the United States at each time point of soft tissue, save for the United States imaging data and investigation the postoperative follow-up questionnaire. Using Kruskal-WallisH test at different time points of fat graft retention, application of variance analysis compared each time point of blood flow signal area, to observe postoperative recovery and tracking for the United States 鑰呮湳鍚庢弧鎰忓害鍙婂苟鍙戠棁鍙戠敓鎯呭喌.鐮旂┒缁撴灉:14渚嬫眰缇庤，

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