聚丙烯酰胺（PAHG）注射隆乳术后的回顾性分析

发布时间：2018-12-29 17:43

【摘要】：目的：聚丙烯酰胺水凝胶（PAHG）是一种无色透明的聚合物，作为一种软组织填充剂，曾被认为是一种良好的填充物质，然而在实践中，很大比例的求美者在注射后，局部会出现不同程度的并发症。本文通过对聚丙烯酰胺水凝胶注射隆乳术后患者的治疗过程进行总结，分析其发生并发症的可能原因，探讨其最佳的临床治疗方案，期望对后续此类患者的治疗给予临床经验。方法：收集2012年01月至2015年03月于我科就诊的院外接受聚丙烯酰胺（PAHG）注射填充术后的临床资料，共89例患者，均为女性，年龄25-52岁，注射时间为5-20年不等，其中聚丙烯酰胺水凝胶注射填充术后出现的并发症为疼痛50例、硬结28例、乳房外形欠佳22例、移位12例、破溃感染10例、血肿（或血清肿）6例、皮肤破溃及窦道6例，其中无任何症状但由于心理因素要求手术取出的患者12例。所有患者均行手术直视下取出注射物及包膜切除，其中另外有10例患者行胸大肌部分切除，术后随访时间为6个月-24个月，通过聚丙烯酰胺水凝胶取出术后并发症的统计及术后患者满意度的调查，其中聚丙烯酰胺水凝胶取出术后出现乳房外形欠佳56例、瘢痕增生10例、乳头乳晕感觉异常7例、疼痛7例、血肿3例、包裹性积液2例、伤口延迟英语和2例。结果：聚丙烯酰胺水凝胶取出术后患者对乳房外形不满意的为32例，行二次修复手术的为5例。瘢痕增生10例，二次修复加核医学治疗症状缓解。乳头乳晕感觉异常7例。疼痛7例。血肿3例，经二次手术清除血肿。包裹性积液2例，经穿刺抽吸后症状缓解。伤口延迟愈合2例，经换药处置后二期愈合。患者对手术的满意度为非常满意的占82%，基本满意的占5.2%，但患者对外形的满意度较差，其中对外形不满意的为36%，但仅有15.6%的患者进行二次修复手术，通过假体置入及自体脂肪填充得到改善。结论：奥美定填充隆乳术后的患者，一旦出现并发症或心理负担较重，均应尽早行手术治疗。我科对注射物的取出均实施开放式手术，直视下行注射物取出术及包膜切除术，，尽量彻底的取出注射物及包膜或变性组织。但因上述手术会出现继发畸形，经个体化的治疗方案继发畸形可以得到改善，患者术后满意。
[Abstract]:Objective: polyacrylamide hydrogel (PAHG) is a colorless and transparent polymer. As a soft tissue filler, it was once considered as a good filling material. Local complications can occur to varying degrees. In this paper, we summarize the treatment process of the patients after polyacrylamide hydrogel injection augmentation mammoplasty, analyze the possible causes of complications, discuss the best clinical treatment scheme, and expect to give clinical experience to the subsequent treatment of this kind of patients. Methods: from January 2012 to March 2015, 89 patients (25-52 years old) received polyacrylamide (PAHG) injection and filling with polyacrylamide (PAHG) outside our hospital were collected. The injection time ranged from 5 to 20 years. The complications after polyacrylamide hydrogel injection and filling were pain in 50 cases, hard knot in 28 cases, poor breast appearance in 22 cases, displacement in 12 cases, rupture infection in 10 cases, hematoma (or serum swelling) in 6 cases, skin rupture and sinus tract in 6 cases. There were 12 patients who had no symptoms but required surgery because of psychological factors. All the patients underwent direct surgery to remove the injection and the capsule, and 10 of them underwent partial pectoralis major muscle resection. The follow-up period was 6 months to 24 months. The complications of polyacrylamide hydrogel extraction and the satisfaction of the patients were investigated. There were 56 cases with poor breast appearance, 10 cases with scar hyperplasia and 7 cases with abnormal nipple areola sensation after polyacrylamide hydrogel removal. There were 7 cases of pain, 3 cases of hematoma, 2 cases of enclosing effusion, 2 cases of delayed English and 2 cases of wound delay. Results: 32 cases were dissatisfied with breast appearance after polyacrylamide hydrogel extraction, and 5 cases received secondary repair operation. 10 cases of scar hyperplasia, secondary repair plus nuclear medicine treatment symptoms relief. Nipple areola was abnormal in 7 cases. There were 7 cases of pain. 3 cases of hematoma were removed by secondary operation. 2 cases of encapsulated effusion were relieved after aspiration. Delayed wound healing in 2 cases, after dressing change treatment, secondary healing. The patients' satisfaction with the operation accounted for 82 percent, and the basic satisfaction was 5.2 percent, but the patients' satisfaction with the appearance was poor. Among them, 36 patients were not satisfied with the shape, but only 15.6 percent of the patients had secondary repair surgery. Improved through prosthesis implantation and self-fat filling. Conclusion: the patients after augmentation mammoplasty with omedine should be treated as soon as possible if they have complications or heavy psychological burden. In our department, open operation was performed on the removal of the injection. The injection and the capsule or denatured tissue were removed thoroughly under the direct vision. But the secondary malformation can be improved by individualized treatment, and the patients are satisfied after operation.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R655.8

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