自体脂肪移植隆乳的安全性及影像学改变的系统回顾

发布时间：2019-04-09 06:36

【摘要】：背景与目的为了改善由于各种原因所产生的软组织缺失导致女性乳房体积、形态过小,影响体态美观及心理上缺乏自信的情况,隆胸手术作为整形外科中最为常见的手术之一早已广泛被采用。其中自体脂肪颗粒移植术,由于其与皮瓣移植及假体植入术相比,具有来源丰富、获取方便、操作简单、创伤性小、重塑性好、无异反应生物相容性好等优势等优点,更易被患者接受。但是自体脂肪颗粒移植后并发症的出现,术后影像学改变影响乳房其他疾病,尤其是肿瘤疾病的诊断,仍是限制其广泛应用的主要因素。本文的目标意在通过系统性回顾总结,对已经发表的文献进行筛选、分析、比较及总结,对接受自体脂肪移植隆胸患者的平均并发症比率及术后影像学检查改变的情况进行汇总评价,并探讨、寻找有效降低并发症及影像学改变的可能手段及方法。方法计算机检索PUBMED(1938年至20l4年)文献数据库,收集所有相关自体脂肪隆胸术的临床报告。根据所得文题和摘要进行进一步筛查、提取数据,以进行系统回顾评价。结果1938年至2014年间共纳入15个研究共计3037例病例,所纳入的各研究中并发症率间存在统计学异质性(P0.1,I^2=93.1%),故采用随机效应模型进行分析。自体脂肪隆胸术后临床并发症发生率为12.05%[95%CI(7.47%;19.51%)],其中可触及肿块145例(56.0%),移植区脂肪坏死液化69例(26.6%),术区感染造成的蜂窝织炎等17例(6.6%),术区皮肤感觉迟钝14例(5.4%),血肿12例(4.6%),气胸2例(0.8%),术后恶性肿瘤发生率为0.16%,术后影像学检查改变率为13.17%,其中以液化性囊肿、结节为主。结论根据本次研究可以发现,自体脂肪移植隆胸术后仍存在一定比例的并发症及影像学改变,其中脂肪液化坏死相关性的并发症及术后影像学检查改变为自体脂肪移植隆胸术后最为常见的问题,所以,对单纯隆胸患者或肿瘤切除术后的乳房重建再造患者,自体脂肪移植的安全性,脂肪移植后的近期及远期并发症以及影像学的改变率与脂肪移植后脂肪存活率有着直接关系。故提高移植脂肪的成活率,被认为可以降低术后并发症及影像学改变比例。而术后原发及复发乳房肿瘤发生率与未行自体脂肪移植隆胸术的患者相比无增高。
[Abstract]:Background and objective in order to improve the size and shape of women's breasts caused by soft tissue loss due to all kinds of reasons, it affects the beauty of body and the lack of psychological self-confidence. Breast augmentation has been widely used as one of the most common operations in plastic surgery. Compared with skin flap transplantation and prosthesis implantation, autogenous fat particle transplantation has many advantages, such as rich source, easy access, simple operation, small trauma, good plasticity, good biocompatibility without any reaction, and so on, which has the advantages of rich source, easy access, simple operation, small trauma, good plasticity and good biocompatibility. More easily accepted by patients. However, the appearance of complications after autologous fat particle transplantation and the imaging changes after transplantation affect the diagnosis of other diseases of the breast, especially tumor diseases, which are still the main factors limiting its wide application. The aim of this paper is to screen, analyze, compare and summarize the published literature through a systematic review. The average rate of complications and the changes of imaging examination in patients with breast augmentation after autologous fat transplantation were summarized and evaluated, and the possible means and methods to effectively reduce the complications and imaging changes were discussed in order to find out the possible means and methods for reducing the complications and imaging changes effectively. Methods the PUBMED (1938-2014) literature database was searched by computer to collect all clinical reports of autogenous fat breast augmentation. According to the papers and abstracts obtained, further screening was carried out and the data were extracted for systematic review and evaluation. Results from 1938 to 2014, a total of 3037 cases were included in 15 studies. There were statistical heterogeneity among the complications in the studies (P0.1, I ^ 2 = 93.1%), so the random effect model was used to analyze the complications. The incidence of clinical complications after autologous fat augmentation was 12.05% [95%CI (7.47%); 19.51%), including 145 cases (56.0%) with palpable masses, 69 cases (26.6%) with fat necrosis and liquefaction in transplanted areas, 17 cases (6.6%) with cellulitis caused by surgical infection, etc. There were 14 cases (5.4%) of skin sensory retardation, 12 cases (4.6%) of hematoma and 2 cases (0.8%) of pneumothorax. The incidence of postoperative malignant tumor was 0.16%, and the change rate of postoperative imaging examination was 13.17%. Among them is liquid cyst, nodule is dominant. Conclusion according to this study, we can find that there are still some complications and imaging changes after breast augmentation with autologous fat transplantation. Among them, the complications associated with fat liquefaction necrosis and the changes of postoperative imaging examination are the most common problems after breast augmentation with autologous fat transplantation. Therefore, for patients with simple breast augmentation or breast reconstruction after tumor resection, The safety of autologous fat transplantation, the short-term and long-term complications after fat transplantation and the change rate of imaging are directly related to the fat survival rate after fat transplantation. Therefore, to improve the survival rate of graft fat is considered to reduce the rate of postoperative complications and imaging changes. However, the incidence of primary and recurrent breast tumors after operation was not higher than that of patients who had not undergone breast augmentation with autologous fat transplantation.
【学位授予单位】：上海交通大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R622;R655.8

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