Gold Daniel R, Annino Donald J
Department of Otolaryngology-Head and Neck Surgery, TUFTS University School of Medicine, Boston, Massachusetts, USA.
Laryngoscope. 2005 May;115(5):791-5. doi: 10.1097/01.MLG.0000161838.22766.88.
To familiarize the otolaryngologist with the evaluation and management of cervicodorsal manifestations of lipodystrophy in patients who have been treated with HIV protease inhibitor medications. In addition, to share the benefits obtainable with ultrasonic tumescent liposuction treatment.
Retrospective chart review of patients presenting to the senior author with symptomatic hypertrophic cervicodorsal fat pad attributable to HIV infection and HIV protease inhibitor use.
Eight patients presented for evaluation of hypertrophic cervicodorsal fat pads between January 1, 2002 and December 31, 2004. All patients had been on protease inhibitors in the past and had minimal resolution after discontinuing offending agent. Most common presenting problems include disfigurement, limited range of upper extremity and neck motion, neck and back discomfort, and difficulty with sleep including sleep-study-confirmed obstructive sleep apnea. Five of eight patients underwent ultrasonic tumescent liposuction. Three patients had satisfactory improvement of symptoms after the first surgery, whereas the other two required additional operative sessions. No complications of hematoma, seroma, infection, prolonged pain, or re-accumulation of fat pad were encountered. The primary obstacle in the three nonoperative patients was insurance denial on the basis of deemed lack of established necessity.
Cervicodorsal lipodystrophy is a well-recognized outcome of prolonged HIV infection and side effect of certain HIV medications. Patients may present with both esthetic and functional issues related to the excess tissue. Although cessation of associated medications may halt further progression, this alone does resolve the symptoms. Ultrasonic tumescent liposuction is shown in this study to be a well-suited modality for reduction of this fibrous adipose tissue. Multiple sessions may be necessary to achieve satisfactory results because of the tenacity of the tissue. It is important for the otolaryngologist to be familiar with the head and neck issues relevant to this disorder and its treatment.
使耳鼻喉科医生熟悉接受过HIV蛋白酶抑制剂治疗的患者颈背部脂肪代谢障碍表现的评估与管理。此外，分享超声肿胀吸脂治疗的益处。
对因HIV感染和使用HIV蛋白酶抑制剂导致有症状的颈背部肥厚性脂肪垫的患者进行回顾性病历审查。
在2002年1月1日至2004年12月31日期间，有8名患者因颈背部肥厚性脂肪垫前来评估。所有患者过去均使用过蛋白酶抑制剂，停用致病药物后症状改善甚微。最常见的问题包括外形受损、上肢和颈部活动范围受限、颈部和背部不适以及睡眠困难，包括经睡眠研究证实的阻塞性睡眠呼吸暂停。8名患者中有5名接受了超声肿胀吸脂术。3名患者在首次手术后症状得到满意改善，而另外两名患者需要额外的手术。未出现血肿、血清肿、感染、长期疼痛或脂肪垫重新积聚等并发症。3名未接受手术的患者的主要障碍是保险公司认为缺乏既定必要性而拒绝承保。
颈背部脂肪代谢障碍是长期HIV感染的公认后果以及某些HIV药物的副作用。患者可能会出现与过多组织相关的美学和功能问题。虽然停用相关药物可能会阻止病情进一步发展，但仅此一项并不能解决症状。本研究表明，超声肿胀吸脂术是减少这种纤维性脂肪组织的合适方法。由于组织坚韧，可能需要多次手术才能取得满意效果。耳鼻喉科医生熟悉与这种疾病及其治疗相关的头颈问题非常重要。
