本文關(guān)鍵詞： 進(jìn)行性半側(cè)顏面萎縮 自體顆粒脂肪注射 脂肪充填 脂肪存活率　出處：《南京大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:進(jìn)行性半側(cè)顏面萎縮(Progressive Hemifacial Atrophy,PHA)是一種罕見的、發(fā)病原因不明、以單側(cè)顏面部萎縮為特征的疾病,受累范圍主要包括皮下組織、脂肪、肌肉及骨結(jié)構(gòu)等。PHA患者因其面部形態(tài)及功能上的缺陷往往需要外科干預(yù)以改善萎縮畸形的外觀。根據(jù)顏面萎縮的嚴(yán)重程度,PHA的外科治療分為軟組織充填和硬組織再造,通過充填組織使面部的缺損從形態(tài)學(xué)上都得以糾正。軟組織充填的發(fā)展中出現(xiàn)了多種多樣的材料,其中使用較為廣泛的是自體脂肪。本文旨在通過回顧我們科室采用自體顆粒脂肪注射充填術(shù)進(jìn)行外科治療的PHA患者病例,從而對(duì)此方法進(jìn)行經(jīng)驗(yàn)總結(jié),并進(jìn)一步進(jìn)行一個(gè)合理的評(píng)價(jià)。方法:2015年01月至2017年04月,我們共為4名PHA患者進(jìn)行了腹部脂肪抽提及面部自體顆粒脂肪注射充填術(shù)。術(shù)前常規(guī)詢問病史,在自然光下采集患者不同角度的面部圖像,根據(jù)對(duì)稱性原則在面部進(jìn)行等高線標(biāo)記。局麻下從腹部抽取一定體積的脂肪顆粒,之后在患側(cè)面部萎縮處進(jìn)行顆粒脂肪注射充填。充填術(shù)后再次拍照采集圖像。術(shù)后半年內(nèi)患者于門診復(fù)查,或者通過電話或SNS對(duì)其進(jìn)行隨訪,了解術(shù)后面形變化及填充脂肪的吸收情況,比較術(shù)前及術(shù)后不同時(shí)間所采集的照片,以此來評(píng)估自體顆粒脂肪注射充填術(shù)的效果及有無出現(xiàn)術(shù)后并發(fā)癥�；颊弑救嗽趶�(fù)查隨訪時(shí)需要評(píng)價(jià)本次手術(shù)的滿意度,包括"滿意"、"一般"和"不滿意"。外科醫(yī)師同時(shí)也對(duì)本次手術(shù)進(jìn)行評(píng)價(jià)。結(jié)果:外科醫(yī)師通過對(duì)患者前期病史資料采集、體格檢查等后個(gè)體化設(shè)計(jì)了手術(shù)細(xì)節(jié),4例PHA患者的自體顆粒脂肪抽提及充填手術(shù)均過程順利,術(shù)后凹陷的面部變得飽滿,外觀改善明顯。術(shù)后隨訪時(shí)未見患者出現(xiàn)并發(fā)癥。全部外科醫(yī)師都對(duì)手術(shù)結(jié)果表示滿意。對(duì)患者進(jìn)行短期隨訪時(shí),不同嚴(yán)重程度的PHA患者對(duì)自體顆粒脂肪注射充填術(shù)滿意度不一樣,1例輕度萎縮患者對(duì)手術(shù)結(jié)果表示滿意,2例中度萎縮患者對(duì)脂肪充填術(shù)滿意度一般,1例重度患者對(duì)手術(shù)結(jié)果不滿意,自覺充填脂肪吸收明顯。結(jié)論:軟組織充填術(shù)是改善PHA患者顏面萎縮最主要的外科治療方法。自體顆粒脂肪是軟組織充填術(shù)中較為理想的面部凹陷填充材料,具有來源廣泛、取材方便、生物相容性好、填充形態(tài)好及創(chuàng)傷小等優(yōu)點(diǎn)。采用自體顆粒脂肪注射充填術(shù)后短期時(shí)間內(nèi)形態(tài)令人滿意,且手術(shù)時(shí)間短,創(chuàng)傷和并發(fā)癥發(fā)生率低,是面部萎縮畸形重塑的一種安全而理想的手術(shù)方法。但是這種方法也存在易吸收的缺點(diǎn),目前臨床表現(xiàn)嚴(yán)重的患者需要多次手術(shù)外觀才能獲得明顯改善。因此,如何降低脂肪移植后的吸收率、提高脂肪成活率,可為下一步獲得更好的治療效果提供發(fā)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.
【學(xué)位授予單位】：南京大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R622
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本文編號(hào)：1445901