Lim Kwang-Ryeol, Cho Jeong-Min, Yoon Chung-Min, Lee Keun-Cheol, Lee Sang-Yun, Ju Mi-Ha
Department of Plastic and Reconstructive Surgery, Dong-A University School of Medicine, Busan, Korea.
Ellium Women's Hospital, Busan, Korea.
Arch Plast Surg. 2018 Jan;45(1):14-22. doi: 10.5999/aps.2017.01347. Epub 2017 Oct 27.
Liposuction has become one of the most frequently performed procedures in the field of aesthetic surgery. Fat embolism syndrome after liposuction can easily be overlooked or underestimated; however, occasionally, fulminating fat embolism syndrome can develop and lead to a critical situation within 2-3 days after lipoplasty. Changes over time in the amount of circulating fat particles and the histology of major organs have not yet been studied.
This study was conducted using 18 male Sprague-Dawley rats aged 12 weeks and weighing 500-628 g (average, 562 g). Fifteen rats were used as the experimental group and 3 as the control group. Under general anesthesia, tumescent-technique liposuction was performed at the lateral flank areas and abdomen for 1 hour. Blood, lung, and brain tissue specimens were obtained at 1 hour, 1 day, and 2 days after the liposuction procedure.
The average number of fat particles in the blood samples was 25,960/dL at 1 hour, 111,100/dL at 24 hours, and 21,780/dL at 48 hours. The differences between study groups were statistically significant. Both intravascular and extravascular fat particles with inflammation were seen in all 15 rats, as were inflammatory cell infiltration, hemorrhage, and consolidation with shrinkage of the lung alveoli.
These results imply that there is a strong possibility of fat embolism syndrome after liposuction in real clinical practice, and the first 24-48 hours after the operation were found to be the most important period for preventing pulmonary embolism and progression to fulminating fat embolism syndrome.
抽脂术已成为美容外科领域最常施行的手术之一。抽脂术后的脂肪栓塞综合征很容易被忽视或低估;然而,偶尔会发生暴发性脂肪栓塞综合征,并在脂肪抽吸术后2至3天内导致危急情况。目前尚未研究循环脂肪颗粒数量随时间的变化以及主要器官的组织学变化。
本研究使用了18只12周龄、体重500 - 628克(平均562克)的雄性Sprague-Dawley大鼠。15只大鼠作为实验组,3只作为对照组。在全身麻醉下,对侧腹和腹部进行肿胀技术抽脂1小时。在抽脂术后1小时、1天和2天采集血液、肺和脑组织样本。
血液样本中脂肪颗粒的平均数量在1小时时为25,960/dL,24小时时为111,100/dL,48小时时为21,780/dL。研究组之间的差异具有统计学意义。在所有15只大鼠中均可见血管内和血管外伴有炎症的脂肪颗粒,以及炎症细胞浸润、出血和肺泡实变伴肺泡萎缩。
这些结果表明,在实际临床实践中抽脂术后发生脂肪栓塞综合征的可能性很大,并且发现术后最初的24 - 48小时是预防肺栓塞和发展为暴发性脂肪栓塞综合征的最重要时期。