CAJ | 학술논문

目的：对聚丙烯酰胺水凝胶注射隆鼻术后取出，同期假体隆鼻的血肿并发症的发生进行分析，探讨聚丙烯酰胺水凝胶注射隆鼻后再次假体隆鼻的最佳手术时机。方法74例聚丙烯酰胺水凝胶注射隆鼻患者，随机分成两组，一组为I期手术组：取出聚丙烯酰胺水凝胶的同时假体植入隆鼻；另一组为分次手术，即取出注射物后6月后再次硅胶假体隆鼻。对所有受试对象保存影像资料，并留取部分术区组织进行病理切片及CD68免疫组化分析。结果74例受术者注射物绝大部分被取出，分次手术组切口均 I 期愈合，无感染或血肿发生，鼻外形良好，切口瘢痕不明显； I期手术组有8例受术者在术后24小时至一月内出现皮下血肿，其中2例血肿将切口撑开，导致假体外露。两组切片水凝胶周围组织有不同程度的纤维组织增生，并出现炎性细胞及异物巨噬细胞浸润；CD68阳性细胞的数目增多，但分次手术组在炎性细胞、异物巨噬细胞、CD68阳性细胞数目低于I期手术组，2组比较差异具有明显统计学意义(P<0.01)。I期手术组切片中小血管扩张，管壁变薄，血管内皮细胞变性，血管通透性增大，发生血肿者管腔破裂；分次手术组中血管内皮细胞变性程度及血管扩张程度有所降低，大量成纤维细胞增生，胶原纤维增多。结论聚丙烯酰胺水凝胶注入组织内引起机体免疫应答反应，组织变性，局部血管变性，脆性增大，血管内皮细胞间隙增大，血管通透性增大，取出水凝胶的同期植入硅胶假体加重组织损伤，加剧免疫应答反应，使扩张的血管易破裂出血。分次隆鼻手术，可使局部组织的免疫反应减低，机体进行自体修复，即取出注射物后6月后再次硅胶假体隆鼻可有效降低血肿并发症的发生。
목적：대취병희선알수응효주사륭비술후취출，동기가체륭비적혈종병발증적발생진행분석，탐토취병희선알수응효주사륭비후재차가체륭비적최가수술시궤。방법74례취병희선알수응효주사륭비환자，수궤분성량조，일조위I기수술조：취출취병희선알수응효적동시가체식입륭비；령일조위분차수술，즉취출주사물후6월후재차규효가체륭비。대소유수시대상보존영상자료，병류취부분술구조직진행병리절편급CD68면역조화분석。결과74례수술자주사물절대부분피취출，분차수술조절구균 I 기유합，무감염혹혈종발생，비외형량호，절구반흔불명현； I기수술조유8례수술자재술후24소시지일월내출현피하혈종，기중2례혈종장절구탱개，도치가체외로。량조절편수응효주위조직유불동정도적섬유조직증생，병출현염성세포급이물거서세포침윤；CD68양성세포적수목증다，단분차수술조재염성세포、이물거서세포、CD68양성세포수목저우I기수술조，2조비교차이구유명현통계학의의(P<0.01)。I기수술조절편중소혈관확장，관벽변박，혈관내피세포변성，혈관통투성증대，발생혈종자관강파렬；분차수술조중혈관내피세포변성정도급혈관확장정도유소강저，대량성섬유세포증생，효원섬유증다。결론취병희선알수응효주입조직내인기궤체면역응답반응，조직변성，국부혈관변성，취성증대，혈관내피세포간극증대，혈관통투성증대，취출수응효적동기식입규효가체가중조직손상，가극면역응답반응，사확장적혈관역파렬출혈。분차륭비수술，가사국부조직적면역반응감저，궤체진행자체수복，즉취출주사물후6월후재차규효가체륭비가유효강저혈종병발증적발생。
ObjectiveTo discuss the complication of hematoma of nasal augmentation with prothesis , removing the injected polyacrylamide hydrogel ( PAHG) at the same time, and to find the best time to implant prothesis for rhinoplasty after removing PAHG.Methods 74 female patients from 22 till 46 years old who suffered complications from PAHG injection for nasal augmentation were analyzed. They were separated into two groups randomly: the operation group over the same period and sub-second operation group. The operation group over the same period were removed polyacrylamide hydrogel from the nose, then silicon prothesis were implanted for rhinoplasty. The sub-second operation group were implanted the same silicon prothesis with the same operation method after removed PAHG six months later. All the patients were taken photos preoperation and postoperation, the specimen of the tissue was removed for pathologic examination in two groups, and the expression of CD68 in tissues were tested by immunohistochemistry.Results Almost all injected augmentation material was removed by operation.The sub-second operation group healed without any complications: infection, hematoma, etc. The incision scars were not very obvious.8 patients of the operation group over the same period got hematoma from 24 hours to one month after operation. 2 incison of them ruptured for the high pressure of hematoma, then the prothesis were supplanted from the nose. Pathologic examination indicated: Hyperplasia of fibrous tissue and infiltration of inflammatory cells and macrophages were found in the tissues in two groups. Positive cells of CD68 existed in the tissues, but the tissues around the polyacrylamide hydrogel had many positive cells of CD68 especially in cases with the operation group over the same period; there were significant differences between the 2 groups (P<0.01); and the numbers of inflammatory cells were not similar between the 2 groups. Small vessels dilated severely, even ruptured.Conclusion Long-term implantation of polyacrylamide hydrogel can cause immunological reaction ,vessels dilate severely, even rupture and cell proliferation in the local adjacent tissues . Re-operation six months later after removing PAHG will be the best opptunity for the tissues to recovery from the damage causing by PAHG .It’s the safe and reliable way to treat the complications of nasal augmentation with injection.