自体颗粒脂肪注射充填术在进行性半侧颜面萎缩治疗中的应用

发布时间：2018-01-19 23:18

  本文关键词： 进行性半侧颜面萎缩 自体颗粒脂肪注射 脂肪充填 脂肪存活率　出处：《南京大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:进行性半侧颜面萎缩(Progressive Hemifacial Atrophy,PHA)是一种罕见的、发病原因不明、以单侧颜面部萎缩为特征的疾病,受累范围主要包括皮下组织、脂肪、肌肉及骨结构等。PHA患者因其面部形态及功能上的缺陷往往需要外科干预以改善萎缩畸形的外观。根据颜面萎缩的严重程度,PHA的外科治疗分为软组织充填和硬组织再造,通过充填组织使面部的缺损从形态学上都得以纠正。软组织充填的发展中出现了多种多样的材料,其中使用较为广泛的是自体脂肪。本文旨在通过回顾我们科室采用自体颗粒脂肪注射充填术进行外科治疗的PHA患者病例,从而对此方法进行经验总结,并进一步进行一个合理的评价。方法:2015年01月至2017年04月,我们共为4名PHA患者进行了腹部脂肪抽提及面部自体颗粒脂肪注射充填术。术前常规询问病史,在自然光下采集患者不同角度的面部图像,根据对称性原则在面部进行等高线标记。局麻下从腹部抽取一定体积的脂肪颗粒,之后在患侧面部萎缩处进行颗粒脂肪注射充填。充填术后再次拍照采集图像。术后半年内患者于门诊复查,或者通过电话或SNS对其进行随访,了解术后面形变化及填充脂肪的吸收情况,比较术前及术后不同时间所采集的照片,以此来评估自体颗粒脂肪注射充填术的效果及有无出现术后并发症。患者本人在复查随访时需要评价本次手术的满意度,包括"满意"、"一般"和"不满意"。外科医师同时也对本次手术进行评价。结果:外科医师通过对患者前期病史资料采集、体格检查等后个体化设计了手术细节,4例PHA患者的自体颗粒脂肪抽提及充填手术均过程顺利,术后凹陷的面部变得饱满,外观改善明显。术后随访时未见患者出现并发症。全部外科医师都对手术结果表示满意。对患者进行短期随访时,不同严重程度的PHA患者对自体颗粒脂肪注射充填术满意度不一样,1例轻度萎缩患者对手术结果表示满意,2例中度萎缩患者对脂肪充填术满意度一般,1例重度患者对手术结果不满意,自觉充填脂肪吸收明显。结论:软组织充填术是改善PHA患者颜面萎缩最主要的外科治疗方法。自体颗粒脂肪是软组织充填术中较为理想的面部凹陷填充材料,具有来源广泛、取材方便、生物相容性好、填充形态好及创伤小等优点。采用自体颗粒脂肪注射充填术后短期时间内形态令人满意,且手术时间短,创伤和并发症发生率低,是面部萎缩畸形重塑的一种安全而理想的手术方法。但是这种方法也存在易吸收的缺点,目前临床表现严重的患者需要多次手术外观才能获得明显改善。因此,如何降低脂肪移植后的吸收率、提高脂肪成活率,可为下一步获得更好的治疗效果提供发展方向。
[Abstract]:Objective: progressive Hemifacial Atrophysis (PHA) is a rare and unknown cause of progressive hemifacial atrophy. Diseases characterized by unilateral facial atrophy include subcutaneous tissue and fat. Patients with PHA, such as muscle and bone structure, often need surgical intervention to improve the appearance of atrophy due to their defects in facial morphology and function, depending on the severity of facial atrophy. The surgical treatment of PHA can be divided into soft tissue filling and hard tissue reconstruction. The facial defects can be corrected morphologically by filling tissue. There are a variety of materials in the development of soft tissue filling. Among them, autologous fat is widely used. This article aims to summarize the experience of this method by reviewing the surgical treatment of PHA patients with autologous granular fat injection filling in our department. Methods: from January 2015 to April 2017. A total of 4 patients with PHA were treated with abdominal fat extraction and facial autograined fat injection filling. The patient's facial images from different angles were collected under natural light. According to the principle of symmetry, contour marking was performed on the face. A certain volume of fat particles were extracted from the abdomen under local anesthesia. After that, the patients were injected with granular fat in the atrophy area of the affected side. The images were taken again after filling. The patients were followed up by telephone or SNS within six months after the operation. To find out the shape change and fat absorption after operation and compare the pictures taken before and after operation. In order to evaluate the effect of autologous granular fat injection filling and postoperative complications, patients themselves need to evaluate the satisfaction of the operation, including "satisfaction" during follow-up. "General" and "unsatisfactory". The surgeon also evaluated the operation. Results: the surgeon designed the details of the operation by collecting the data of the patient's previous medical history, medical examination and so on. The extraction and filling of autologous granular fat in 4 patients with PHA were successful, and the depressed face became full after operation. There was no complication at the postoperative follow-up. All the surgeons were satisfied with the results of the operation, and the patients were followed up for a short period of time. Different severity of PHA patients were not satisfied with autologous granular fat injection filling. One patient with mild atrophy was satisfied with the results of the operation and 2 patients with moderate atrophy were generally satisfied with fat filling. One severe patient was not satisfied with the results of the operation. Conclusion:. Soft tissue filling is the most important surgical method to improve facial atrophy in patients with PHA. Autologous granular fat is an ideal filling material for facial depression in soft tissue filling. It has the advantages of wide source, convenient material collection, good biocompatibility, good filling morphology and little trauma. The low incidence of trauma and complications is a safe and ideal surgical method for facial atrophy remodeling, but it also has the disadvantages of easy absorption. At present, patients with severe clinical manifestations need multiple operations to improve their appearance. Therefore, how to reduce the absorption rate of fat transplantation and improve the survival rate of fat. It can provide the development direction for the next step to obtain better therapeutic effect.
【学位授予单位】：南京大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R622
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本文编号：1445901