Courtiss E H, Choucair R J, Donelan M B
Department of Surgery, Harvard Medical School, Newton Lower Falls, Mass.
Plast Reconstr Surg. 1992 Jun;89(6):1068-79; discussion 1080-2.
Suction lipectomy was initially advocated for the treatment of localized collections of fat and for the removal of less than 1500 ml of material. However, many patients wished to have multiple areas treated or had diffuse collections of fat. In such instances, the removal of over 1500 ml of material and circumferential lipectomy are necessary to provide optimal aesthetic results. However, when over 1500 ml of material is removed, anesthetic requirements, fluid replacement, and treatment of blood loss become important if the operation is to be performed safely. We have treated 108 patients who had over 1500 ml of material removed. Eight-eight percent of the patients were female; 12 percent were male. Using the body-mass index, 3 percent of patients were underweight, 70 percent were normal weight, and 27 percent were overweight. Fifty-five patients (51 percent) had 1500 to 2499 ml of material removed, 26 patients (24 percent) had 2500 to 3499 ml removed, 16 patients (15 percent) had 3500 to 4499 ml removed, and 11 patients (10 percent) had over 4500 ml removed. All patients were treated in the hospital; 44 percent were admitted after surgery. A total of 227 units of autologous and 2 units of homologous blood were transfused. As measured by a computerized monitor, the average amount of blood in the material removed from thighs was 30 percent; from abdomens, the blood loss was 45 percent. The aesthetic results were generally excellent. No complications were encountered. A few patients developed undesired sequelae, the most common of which was seroma formation, which occurred in 19 percent of those who had suction of abdominal-wall fat. We believe that large-volume suction lipectomy is safe and efficacious, provided attention is directed to such important aspects of patient care as anesthesia, fluid replacement, and blood loss.
抽脂术最初被提倡用于治疗局部脂肪堆积以及去除少于1500毫升的物质。然而，许多患者希望对多个部位进行治疗或存在弥漫性脂肪堆积。在这种情况下，为了获得最佳美学效果，去除超过1500毫升的物质和进行环形抽脂术是必要的。然而，当去除超过1500毫升的物质时，如果要安全地进行手术，麻醉需求、液体补充和失血处理就变得很重要。我们治疗了108例去除超过1500毫升物质的患者。88%的患者为女性，12%为男性。根据体重指数，3%的患者体重过轻，70%体重正常，27%超重。55例患者（51%）去除了1500至2499毫升的物质，26例患者（24%）去除了2500至3499毫升，16例患者（15%）去除了3500至4499毫升，11例患者（10%）去除了超过4500毫升。所有患者均在医院接受治疗，44%的患者术后入院。共输注了227单位自体血和2单位异体血。通过计算机监测仪测量，从大腿吸出的物质中的平均血量为30%，从腹部吸出的失血率为45%。美学效果总体良好。未出现并发症。少数患者出现了不良后遗症，最常见的是血清肿形成，在抽吸腹壁脂肪的患者中，有19%发生了血清肿。我们认为，只要关注患者护理的重要方面，如麻醉、液体补充和失血情况，大容量抽脂术是安全有效的。
