本文關(guān)鍵詞： 受區(qū)腫脹預(yù)擴(kuò)張技術(shù) 自體脂肪移植 脂肪存活率 安全性　出處：《山東大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：研究背景:面部美學(xué)注重五官立體、臉頰飽滿,填充物的出現(xiàn)滿足了我們對(duì)美麗的追求。自體脂肪顆粒來(lái)源豐富、取材簡(jiǎn)單且無(wú)排斥反應(yīng),作為一種天然的填充物近年來(lái)受到臨床醫(yī)生的重視。自體脂肪移植術(shù)(autologous fat grafting,AFG)可運(yùn)用于美容及重建修復(fù)整形,包括面部形態(tài)不良、凹陷性疤痕畸形、先天性及后天性頜面部畸形、乳房整形等。然而,伴隨著脂肪移植手術(shù)越來(lái)越廣泛的使用,臨床上的并發(fā)癥時(shí)有發(fā)生困擾著求美者及整形醫(yī)師。AFG術(shù)后并發(fā)癥如瘀斑、血腫、硬結(jié)形成、受區(qū)感染、脂肪液化、皮膚凹凸不平、上瞼下垂及皮膚麻木等,嚴(yán)重時(shí)脂肪造成的血管栓塞甚至?xí)故苄g(shù)者出現(xiàn)眼睛失明、急性中風(fēng)及皮膚壞死等危急情況。因此,安全問(wèn)題始終是放在脂肪移植手術(shù)最關(guān)鍵的位置,如何降低甚至杜絕手術(shù)并發(fā)癥的發(fā)生成為整形外科領(lǐng)域研究的熱點(diǎn)。腫脹麻醉技術(shù)作為一種安全、無(wú)痛、經(jīng)濟(jì)、實(shí)施方便同時(shí)又利于手術(shù)操作的麻醉方法在脂肪獲取中首先被應(yīng)用后,臨床上積累了大量經(jīng)驗(yàn)。本課題的創(chuàng)新之處在于受區(qū)采用腫脹預(yù)擴(kuò)張技術(shù)發(fā)揮腫脹液的優(yōu)勢(shì)以便移植脂肪更安全有效地進(jìn)行。本研究針對(duì)移植受區(qū)的腫脹擴(kuò)張預(yù)處理,進(jìn)行了臨床病例分析研究。通過(guò)腫脹預(yù)擴(kuò)張自體脂肪面部移植術(shù)后臨床病例的收集,驗(yàn)證受區(qū)腫脹預(yù)擴(kuò)張自體脂肪移植的臨床應(yīng)用價(jià)值。研究目的:觀察腫脹預(yù)擴(kuò)張自體脂肪面部移植術(shù)后的臨床療效,評(píng)估腫脹預(yù)擴(kuò)張技術(shù)在脂肪移植術(shù)中的臨床應(yīng)用價(jià)值。研究方法:自2015年5月到2016年12月,對(duì)由不同原因所致面部凹陷的14例求美者采用受區(qū)腫脹預(yù)擴(kuò)張技術(shù)行自體脂肪面部移植術(shù)治療,受術(shù)者年齡為16到44歲,根據(jù)面部凹陷組織的缺損部位、范圍、程度不同一次移植脂肪量為3.9～44ml,應(yīng)用高頻超聲測(cè)定求美者手術(shù)前后各時(shí)間定點(diǎn)軟組織的厚度及血流信號(hào),保存求美者影像學(xué)資料并進(jìn)行術(shù)后隨訪問(wèn)卷調(diào)查。利用Kruskal-WallisH檢驗(yàn)各時(shí)間點(diǎn)脂肪移植物存留情況,應(yīng)用方差分析對(duì)比各時(shí)間點(diǎn)血流信號(hào)面積,觀察術(shù)后恢復(fù)情況,追蹤求美者術(shù)后滿意度及并發(fā)癥發(fā)生情況。研究結(jié)果:14例求美者術(shù)后凹陷部位改善明顯,與術(shù)前相比脂肪移植區(qū)定點(diǎn)軟組織厚度變化率術(shù)后1個(gè)月、術(shù)后3個(gè)月及術(shù)后6個(gè)月的中位數(shù)及四分位數(shù)間距分別為 70.1%(53.85%)、56.4%(51.95%)、16.7%(35.8%),三組數(shù)據(jù)的差異具有統(tǒng)計(jì)學(xué)意義(H=1.4×108,P0.05)。高頻超聲示術(shù)區(qū)行腫脹預(yù)擴(kuò)張自體脂肪填充術(shù)后脂肪排布均勻,具有局部組織粘連的部位經(jīng)預(yù)擴(kuò)張后組織松解良好;移植區(qū)定點(diǎn)軟組織厚度的變化呈先快后慢逐步穩(wěn)定的狀態(tài)。受術(shù)者術(shù)前、術(shù)后24小時(shí)、術(shù)后7天、術(shù)后1月、術(shù)后3月及術(shù)后6月定點(diǎn)軟組織血流信號(hào)面積分別為(3.97±0.84)‰;(2.21±0.55)‰;(6.89±2.39)‰;(14.61±4.66)‰;(9.39±3.94)‰;(15.87±3.02)‰,六組數(shù)據(jù)的差異具有統(tǒng)計(jì)學(xué)意義(F=3.471,P0.05),移植術(shù)后血流信號(hào)面積顯著增加。隨訪期間脂肪移植區(qū)無(wú)一例出現(xiàn)紅腫、硬結(jié)、囊腫等并發(fā)癥;求美者滿意度高;術(shù)后12小時(shí)疼痛評(píng)估(數(shù)字分級(jí)評(píng)分法NRS)平均為:0.8分,即為術(shù)后止痛效果滿意。研究結(jié)論:受區(qū)腫脹預(yù)擴(kuò)張脂肪移植術(shù)在臨床上的應(yīng)用是安全及有效的。受區(qū)腫脹預(yù)擴(kuò)張易于進(jìn)行解剖間隙分離、增強(qiáng)麻醉效果、減少術(shù)后并發(fā)癥的發(fā)生率,受術(shù)者接受度及滿意度高。
[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?qiáng)迤堝彂鐥囧彂鐢熸儏鍐?鐮旂┒緇撴灉:14渚嬫眰緹庤，

本文編號(hào)：1519886