雌激素对脂肪移植血管化的影响

发布时间：2018-08-08 16:56

【摘要】：背景:20世纪至今,自体脂肪移植逐渐被人民群众和外科医生所认可,广泛应用到美容整形的各个领域,如治疗面部凹陷,隆乳术等[1-10]。1893年,Neuber首先报道了将上臂脂肪移植填充面部的案例[11]。随着技术的提升,自体脂肪移植又逐渐用于癌症术后重建,硬皮病,重度皱纹,修复瘢痕等领域[12-17]。自体脂肪移植术,是指在人体自身脂肪较丰富的部位,用一定方法抽吸脂肪组织,然后运用一些方法处理成纯净的脂肪颗粒,将其注射植入需要改变的有缺陷的部位,通过脂肪组织的增生,从而完善受区形态的一种手术方法。许多国内学者研究表明,促进移植脂肪内部血供重建,获得有效的组织血液灌流,缩短脂肪组织的低血期,为各种细胞因子作用提供保障,可促进前脂肪细胞向脂肪细胞分化,对提高移植体存活具有重要意义[18]。早期能否及时建立血供对移植脂肪的成活至关重要[19]。因此较多学者利用各种细胞因子来促进脂肪移植体早期血运重建,然而细胞因子的流失和作用时间具有不确定性。目的:探讨更年期雌激素以及雌激素替代疗法对脂肪移植存活效果的影响。研究方法和结果:取SD大鼠40只,行背部双侧切口双侧卵巢摘除术,连续一周取其阴道分泌物,确认动情周期消失,即造模成功。将绝经大鼠按照体重排序,随机抽样分为四组。雌激素替代组A组(n=10):脂肪移植前后均进行苯甲酸雌二醇替代;雌激素替代组B组(n=10):卵巢切除后脂肪移植前未予替代,移植后行苯甲酸雌二醇替代;雌激素替代组C组(n=10):卵巢切除后脂肪移植前苯甲酸雌二醇替代,移植后停用;空白组D组(n=10):移植前后不予雌激素应用。行雌激素替代和生理盐水对照45天后,检测大鼠雌激素水平,无菌操作下抽取腹股沟脂肪组织2-3ml,经漂洗离心后,分别移植到SD大鼠背部皮下。术后按照分组处理,继续饲养45天。45天后,处死各组大鼠,完整取出移植物,通过大体观察,石蜡切片HE染色组织学观察,RT-PCR半定量检测VEGF及免疫组化检测雌激素受体α,观察移植脂肪存活的效果。结论:研究发现,脂肪移植前予以雌激素替代治疗有利于脂肪组织的存活,成活率较高;雌激素可促进雌激素受体α的表达,雌激素通过与受体结合,促进VEGF的表达,VEGF可促进移植脂肪体内微血管生成。脂肪移植术后予以雌激素替代治疗,无助于脂肪组织的再血管化;绝经大鼠行脂肪移植后,脂肪体积保留较多,但血管密度相较于雌激素替代较低,远期存活效果不如雌激素替代组;术前应用雌激素,优于术后应用雌激素。
[Abstract]:Background: since the 20th century, autogenous fat transplantation has been accepted by people and surgeons, and has been widely used in various fields of cosmetic and plastic surgery, such as the treatment of facial depression. Breast augmentation [1-10]. Neuber first reported a case of facial implants with upper arm fat graft in 1893 [11]. With the development of technology, autologous fat transplantation has been gradually used in the fields of cancer reconstruction, scleroderma, severe wrinkles, scar repair and so on [12-17]. Autologous fat transplantation refers to the use of certain methods to draw fat tissue in parts of the human body that are rich in fat, and then use some methods to treat it into pure fat granules and inject them into defective parts that need to be changed. A surgical method for improving the morphology of the recipient area through the proliferation of adipose tissue. Many domestic scholars have shown that promoting the reconstruction of blood supply in adipose tissue, obtaining effective tissue hemoperfusion, shortening the low blood phase of adipose tissue, providing protection for the action of various cytokines, and promoting the differentiation of preadipocytes into adipocytes. It is of great significance to improve the survival of grafts [18]. Early establishment of blood supply is crucial to the survival of fat grafts [19]. Therefore, many scholars use various cytokines to promote the early revascularization of fat grafts, but the loss and duration of cytokines are uncertain. Objective: to investigate the effect of menopausal estrogen and estrogen replacement therapy on the survival of fat transplantation. Methods and results: 40 Sprague-Dawley (SD) rats were treated with bilateral ovariectomies through bilateral dorsal incision. Vaginal secretions were removed for one week to confirm that the estrus cycle disappeared and the model was established successfully. The postmenopausal rats were randomly divided into four groups according to their body weight. Estradiol benzoate (estradiol benzoate) was used before and after fat transplantation in estrogen replacement group A (n = 10), and estradiol benzoate was used in estrogen replacement group B (n = 10) before and after ovariectomized fat transplantation. Estradiol benzoate (estradiol benzoate) was substituted before ovariectomy and stopped after transplantation in group C (n = 10), while group D (n = 10) did not use estrogen before and after ovariectomy. After 45 days of estradiol replacement and physiological saline control, estrogen levels were measured. The inguinal adipose tissue was extracted 2 ~ 3 ml under aseptic operation. After rinsing and centrifugation, it was transplanted to the subcutaneous part of the back of SD rats. After 45 days of feeding, the rats were killed, the grafts were removed completely, and the grafts were taken out. Paraffin sections were stained with HE staining to observe the semi-quantitative detection of VEGF by RT-PCR and estrogen receptor 伪 by immunohistochemistry to observe the survival of fat grafts. Conclusion: estrogen replacement therapy before fat transplantation is beneficial to the survival of adipose tissue and its survival rate is higher. Estrogen can promote the expression of estrogen receptor 伪 and estrogen binds to estrogen receptor. Promoting the expression of VEGF can promote microangiogenesis in adipose tissue. Estrogen replacement therapy after fat transplantation was not helpful to the vascularization of adipose tissue. After fat transplantation, the fat volume of postmenopausal rats remained more, but the vascular density was lower than that of estrogen replacement. The long-term survival effect was not as good as that in estrogen replacement group, and the application of estrogen before and after operation was better than that of estrogen after operation.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R622

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