内镜下超声脂肪抽吸术

目的；观察电视内镜辅助的脂肪抽吸术的可行性。方法：自1999年1月至2001年，笔者采用国产超声辅助吸脂器械，内镜设备和自行研制的“软组织内镜视野观察器”进行吸脂手术16例，吸脂部位共23处，分别为腹部，大腿，小腿和腰部。结果：通过电视内镜系统，在软组织视野观察器帮助下，能清楚的观察到超声吸脂机“溶解”脂肪的过程,经内镜可见到吸脂前后脂肪层的改变；改变了传统脂肪抽吸手术盲视的现状。全部病例手术后观察2－6个月手术，手术效果满意，未出现明显并发症。结论：内镜下手术是整形外科手术中新的技术，该技术需要手术者有传统整形外科手术的实际操作经验和短期的内镜操作训练。     

超量灌注吸脂术在减少并发症方面的研究

为了探索可以减少并发症的脂肪抽吸术，分别运用超量灌注钝性技术及锐性技术对离体脂肪组织块进行抽吸。通过组织切片观察抽吸后皮下残留结构及脂肪抽吸物的差异。认为正确的选用手术方法及手术器械能保留皮下脂肪组织中的血管，神经，纤维隔，从而可以减少或避免并发症的发生。     

超量灌注吸脂术在减少并发症方面的研究

为了探索可以减少并发症的脂肪抽吸术，分别运用超量灌注钝性技术及锐性技术对离体脂肪组织块进行抽吸。通过组织切片观察抽吸后皮下残留结构及脂肪抽吸物的差异。认为正确的选用手术方法及手术器械能保留皮下脂肪组织中的血管、神经、纤维隔，从而可以减少或避免并发症的发生     

脂肪抽吸术并发症及其防治

脂肪抽吸术是目前治疗皮下局部脂肪堆积的有效方法，肿胀技术、超声辅助技术的发展增加了手术的安全有效性，但同其他手术一样也不可避免地发生并发症，不仅影响手术效果，严重时甚至危及生命。现将目前流行的两种脂肪抽吸方法，即：传统肿胀法脂肪抽吸术与超声吸脂术可能产生的各种并发症综述如下。[第一段]     

超量灌注吸脂术在减少并发症方面的研究

为了探索可以减少并发症的脂肪抽吸术,分别运用超量灌注钝性技术及锐性技术对离体脂肪组织块进行抽吸。通过组织切片观察抽吸后皮下残留结构及脂肪抽吸物的差异。认为正确的选用手术方法及手术器械能保留皮下脂肪组织中的血管、神经、纤维隔,从而可以减少或避免并发症的发生。     

内窥镜辅助脂肪抽吸36例

脂肪抽吸手术 ,是目前消除局部脂肪堆积 ,改善及美化形体的最有效方法。我们自 2 0 0 0年 9月 12月 ,利用内窥镜辅助脂肪抽吸手术 36例 ,取得满意效果。1　临床资料　采用内窥镜辅助法进行脂肪抽吸术共 36例 ,男 1例 ,女 35例 ;年龄 2 5～ 49岁。体重 5 6～ 78ｋｇ ,平均 6 0 5ｋｇ。纯净脂肪抽吸量为 6 10～ 2 30 0ｍｌ,平均 10 70ｍｌ。抽吸部位主要是腹部 (上、下、侧部 )、臀部 (上、下、侧部 )、股内外侧部。每人抽吸部位为 1～ 5个 ,平均 1 8个。术后随访 2 1例 ,时间为术后 7ｄ～ 5个月。术后除 1例出现皮下血肿外 ,其余均未发现严…     

应用小吸管的肿胀麻醉脂肪抽吸术

采用脂肪抽吸术能有效地减少局部脂肪堆积.传统的抽吸方法,因为抽吸机的高负压和粗大的吸刮管.所以创伤大、破坏性强、出血多,对手术的要求很高,如果操作不当可引起出血,局部皮肤坏死,甚至休克、循环系统脂肪栓塞等并发症[1～2].为减少脂肪抽吸术的并发症,我院从1997年2月开始使用小吸管肿胀麻醉脂肪抽吸,效果满意,报道如下.     

振动脂肪抽吸技术962例报道

目的：介绍振动脂肪抽吸技术的操作要点以及962例脂肪抽吸术的临床应用体会。方法：利用肿胀麻醉技术进行手术部位浸润后，应用振动吸脂仪器进行脂肪抽吸和身体塑形。结果：962例就医者脂肪抽吸量为100～4500ml，其中4例就医者发生皮下血清肿，经局部穿刺排液，加压包扎后吸收；3例发生切口延迟愈合；无1例发生局部皮肤坏死。全部就医者均获得较明显的吸脂塑形效果，吸脂后术区皮肤均有一定程度的回缩。结论：与传统的吸脂术相比，振动脂肪抽吸术安全可靠，易于掌握，尤其适用于大范围脂肪抽吸。     

超声吸脂术的进展及并发症

超声波辅助吸脂术是在传统脂肪抽吸术的基础上发展起来的消除局部脂肪堆积而改善体形的一项新技术，通过超声波辅助下乳化脂肪，冉用抽吸管吸引液化的脂肪，从而实现体形重塑。这种形体的改善往往是永久性的，而且比较传统的脂肪抽吸术破坏性强、出血多、并发症多等缺点，超声波辅助吸脂术具有损伤血管、淋巴管、神经少，并能选择性地破坏脂肪组织加以吸出，     

体外超声辅助下的脂肪抽吸术

目的 介绍体外超声辅助下的脂肪抽吸技术的操作要点及206例患者的临床体会。方法 运用肿胀麻醉技术进行术区浸润后，应用体外超声设备对术区进行体外超声处理，能量设置为3W；作用时间为10～15min。然后，运用传统的脂肪抽吸方法进行吸脂塑形。结果 206例患者，脂肪抽吸量为200～4300ml,其中有1例患者发生局部小面积皮肤浅层坏死，3例发生血清肿，经换药1～2周后痊愈，其余患者无严重的并发症发生。206例患者均获得较明显的吸脂塑形效果，吸脂后术区皮肤均有一定程度的回缩。结论 体外超声波辅助下的脂肪抽吸术安全可靠、易于掌握。其对脂肪的乳化作用有利于脂肪的吸出，同时有利于皮肤的回缩。     

Local anesthesia for abdominoplasty,liposuction, and combined operations

This article describes a procedure to perform abdominoplasty, liposuction, and combined operations under local anesthesia. With an anesthetic solution composed of 25 cc of 2% lidocaine, 25 cc of 0.5% bupivacaine, 1 cc of epinephrine or ornipresine, and 350 cc of saline solution, a satisfactory dilution with low concentration and lasting effects was obtained. After infiltration a large amount was lost in the incision, the dissection, and the resected dermofatty tissue. A small amount of anesthetic remained in the operated area to be metabolized by the liver. Low lidocaine levels were found in venous blood samples during surgery. This type of anesthesia is advised in minor, limited, and normal abdominoplasties in normalsized patients, or major abdominoplasties in small patients. In liposuction procedures, it is possible to anesthetize the patient using the same procedure and operate in an equivalent area. As a high proportion of the infiltrated anesthesia was lost during the operation, a similar amount could be used to infiltrate and operate other areas so that an abdominoplasty might be combined with liposuction or mastoplasty. We have experience with 25 abdominoplasties and 21 liposuctions performed under local anesthesia. There were no complications related to local anesthesia and no one had unpleasant memories of intraoperative events.This paper was awarded with a special mention in the Argentinian Congress on Plastic Surgery, Mendoza, Argentina, 1990     

保留神经血管及淋巴管在腋淋巴结清扫术的临床意义

目的探讨一种腋淋巴结清扫的新技术及评价其临床疗效。方法对30例术前扪及腋淋巴结肿大的乳腺癌患者行改良根治术,腋窝注射脂肪溶解液及脂肪抽吸后进行淋巴结清扫术,术中病人均不用结扎血管,而且保留肋间臂神经、胸长神经及胸背神经。结果平均完成手术时间70min,术中出血少,平均每例取出淋巴结16.2个,全部病人病理检查均有淋巴结转移,平均转移4.3个。所有病人术后均无出现明显的并发症。术后平均随访6个月,患者均无腋肿瘤复发、肩关节活动良好、上肢无水肿及麻痹等情况。结论采用脂肪溶解液及脂肪缺吸方法在腋淋巴结清扫术具有操作简单、省时、淋巴结清扫较彻底、神经血管损伤少及术后并发症少等优点。     

非溶脂腔镜腋窝淋巴结清扫术在乳腺癌治疗中的临床研究

目的:探讨非溶脂腔镜腋窝淋巴结清扫术治疗乳腺癌的临床疗效、安全性、优势、手术规范与技巧。方法:前瞻性纳入2016年10月至2019年10月收治的96例乳腺癌患者。根据腋窝手术方式随机分为腔镜组(n=48,行非溶脂腔镜腋窝淋巴结清扫术)与对照组(n=48,行传统开放腋窝淋巴结清扫术)。对比分析两组临床资料及治疗结果。结果:两组手术时间、淋巴结清扫数量、淋巴结阳性率差异无统计学意义(P>0.05)。腔镜组手术切口、术中出血量、术后引流量、手术并发症发生率优于对照组,住院费用高于对照组,差异有统计学意义(P<0.05)。术后6个月,腔镜组肩关节活动度、生活质量评分均优于对照组,差异有统计学意义(P<0.05)。术后随访14~50个月,中位随访37个月,两组均未出现切口种植、局部复发及远处转移。结论:非溶脂腔镜腋窝淋巴结清扫术在保证腋窝淋巴结清扫效果的同时具有美容效果好、创伤小、并发症少等优势,改善了患者的术后生活质量,值得临床推广应用,但术者需要具备一定的腔镜下乳腺手术技术与技巧。     

Application of liposuction and its clinical significance]

300 liposuction patients involving 444 anatomical areas are reported in this paper. The clinical significance of the applied anatomy and the comparison between groups are analyzed. 1. The distribution of the liposuction areas. 2. The distribution of blood vessels in the abdominal wall, buttocks and thighs and its relation to the volume of fat removed as well as blood loss. The blood vessels are so abundant in the abdominal wall that the blood loss is larger than that in the buttocks and thighs in the operation. According to the anatomical characteristics of distribution of the blood vessels, the authors pointed out a few "relatively forbidden areas". In group 2 we intentionally avoided doing liposuction in these areas. The results showed that the blood loss was less than that in group 1 and that the volume of fat removed could obviously be increased. 3. The characteristics of liposuction in severe obesity or in patients over 90kg body weight: The aspirate volume is big; the blood versus fat ratio is low. So it is possible to increase the aspirate volume. The elasticity of skin of the abdominal wall is very high. It is not necessary to remove skin in very obese patients with abdominal dermatochalasis.     

猪皮下脂肪吸脂后组织学观察

目的 观察小型猪皮下组织抽吸后的组织学变化。方法 采用注射器和直径为2mm的抽吸管行白色五指山成年小型猪背部皮下吸脂术，于术前及术后不同时间点分别取吸脂区和对照区皮下脂肪组织标本进行肉眼和（或）组织切片观察。结果 抽吸侧皮下脂肪厚度明显变薄。约为对照侧的53.5%。术区脂肪组织中只在真皮下，浅筋膜隔旁和肌膜表面等处瘢痕形成较多且消褪缓慢，术后6-8个月脂肪小叶结构清楚，抽吸后皮下脂肪细胞的大小。形态与对照部位比较无显著意义。结论 吸脂术可明显减少皮下脂肪的厚度。抽吸时避免损伤皮肤和脂肪下肌层可减少术后瘢痕形成。采用细小的抽吸管可进行浅层脂肪抽吸。     

Surgical treatment of axillary hyperhidrosis: a study comparing liposuction cannulas with a suction-curettage cannula

BACKGROUND: Suction-curettage is a minimally invasive surgical approach for the treatment of focal axillary hyperhidrosis. Studies comparing the efficacy of different surgical cannulas are missing. Therefore, we gravimetrically compared a specially designed cannula versus 2 standard liposuction cannulas. METHODS: Axillary suction-curettage was performed in 42 patients (n = 42). Fourteen patients (n = 14) were operated with a 1-hole liposuction cannula, 14 patients (n = 14) with a larger 3-hole liposuction cannula, and 14 (n = 14) with a sharp suction-curettage cannula. Sweat rates in mg/min were measured by gravimetry before and 6 months after surgery. RESULTS: Sweat rate in the 1-hole liposuction cannula group was significantly reduced from 57.65 +/- 5.85 mg/min to 32.58 +/- 4.64 mg/min (P < 0.001), corresponding to a reduction of 44.15%. Patients operated with the larger 3-hole liposuction cannula showed a significant reduction of sweat rate from 63.95 +/- 8.25 mg/min to 33.14 +/- 6.25 mg/min (P < 0.001), corresponding to a reduction of 49.19%. The largest reduction of sweat rates (63.07%) was achieved with the suction-curettage cannula (61.85 +/- 9.03 mg/min to 21.27 +/- 4.42 mg/min (P < 0.001). No severe side effects were observed. CONCLUSION: Due to the higher efficacy we recommend performing suction-curettage with a sharp suction-curettage cannula.     

腔镜甲状腺手术与传统手术的临床对比研究

目的 探讨腔镜技术用于甲状腺手术的安全性,微创性及美容效果.方法 比较腔镜甲状腺手术(238例)和传统甲状腺手术(175例)两种术式的手术时间、术中失血量、切口美体评分、术后住院时间、住院费用、手术并发症等临床资料.结果 两组手术均获成功,无出血、声嘶、低血钙等并发症.腔镜组比传统手术组术中出血量少(P=0.021),切口美容满意度高(P=0.000),手术时间缩短(P=0.020)术后胸骨上窝约2 cm手术瘢痕,无皮肤色泽改变,美体效果好.结论 腔镜下小切口甲状腺手术与传统甲状腺手术相比,手术安全、恢复快,可获理想的美体效果,是治疗良性甲状腺疾病的理想手术方法.     

四种不同去脂术的临床应用及其效果评价

目的　提高去脂手术效果,减少并发症发生。方法采用手术切除、电子吸脂、注射器吸脂、器械性脂肪抽吸、４ 种不同去脂方法,治疗局限性肥胖症２２６ 例。结果　手术切除１０７ 例,并发血清肿１例,皮瓣远端坏死１ 例,切口感染１ 例,皮下瘀血５ 例,皮肤凹凸不平２ 例,切口瘢痕增生５ 例;电子吸脂８７ 例。血清肿１ 例,皮下瘀血２ 例;注射器吸脂５ 例,术后无一例出现明显并发症;器械性吸脂２７ 例,血清肿４ 例,皮下瘀血５ 例,皮肤凹凸不平２ 例。结论　任何去脂术对血管神经都可能造成损伤。都存在发生并发症的可能。正确选用不同去脂方法可提高去脂量,减少血管、神经、纤维隔的损伤。从而降低或避免并发症的发生     

Quality-of-life in patients with Dercum's disease-before and after liposuction

Abstract Dercum's disease is characterised by obesity, pronounced pain in the adipose tissue, and a number of associated symptoms. Liposuction has been suggested as a treatment. However, the effect on quality-of-life after liposuction in Dercum's disease has never been investigated. The objective of this study was to examine the quality-of-life in Dercum's disease before and after liposuction. A total of 114 women fulfilling the clinical criteria of Dercum's disease were included. Of the 114 women, 53 were operated on with liposuction and 61 were Dercum controls. In addition, 41 obese healthy women operated on with abdominoplasty were recruited as controls. Health-related quality-of-life (HRQoL) was measured with the Nottingham Health Profile (NHP) and the Psychological General Well-Being index (PGWB). The Dercum group had lower HRQoL than the abdominoplasty controls. After liposuction, a slight improvement could be seen in HRQoL in the operated patients compared with preoperatively, but it did not become as high as in the abdominoplasty patients. In conclusion, the findings could suggest that liposuction improves the quality-of-life slightly in Dercum's disease. Nonetheless, the causality is unclear and the improvement is not big enough to warrant operation.     

脂肪抽吸及术后并发脂肪栓塞的临床分析

采用真空抽吸器反复抽拉行脂肪抽吸术,使脂肪组织破碎为团状脂肪小球、破碎的脂肪细胞和中性脂肪.脂肪抽吸过程中,血管管腔产生裂隙,为脂肪酸进入血液循环系统提供途径.在肺血管脂肪栓塞中,由于脂肪球具有流动性和可变形性,其并未完全阻塞毛细血管血流,因此其栓塞是暂时的或不完全的.脂肪栓塞的初始症状可能是由于一些脂肪球的体积过大不能通过毛细血管,而机械性的阻塞多条血管造成的.肺细胞可以游离脂肪酸,以降低阻塞肺循环的中性脂肪,但游离脂肪酸可对肺实质形成损伤,造成成人呼吸窘迫综合征(ARDS).脂肪栓塞综合征(FES)表现为:急性低氧血症,呼吸窘迫,中枢神经系统功能障碍,以及头、颈、前胸或腋窝处瘀斑.对肺脂肪栓塞的诊断,主要依靠以上典型症状和体征.而治疗方式多采用支持治疗.