Kenkel J M, Robinson J B, Beran S J, Tan J, Howard B K, Zocchi M L, Rohrich R J
Department of Plastic and Reconstructive Surgery at the University of Texas Southwestern Medical Center, Dallas 75235-9132, USA.
Plast Reconstr Surg. 1998 Jul;102(1):213-20. doi: 10.1097/00006534-199807000-00035.
The objective of our study was to investigate the effects of ultrasonic energy on tissues, using a porcine model, performed under various instrumental and procedural parameters. Domestic pigs were anesthetized and prepared for surgery. An incision was made on the side of the hip randomly assigned to the right or left side. Tumescence solution was infiltrated via a blunt tip, small diameter cannula, followed by performance of standard liposuction. On the contralateral side, a similar incision was made. For ultrasonic liposuction experiments without the sheath, a percutaneous introducer was inserted into the incision, which was protected at the entry site from contact with the cannula. Tumescence solution was infiltrated via a blunt tip, small diameter cannula, and then the site was treated with ultrasonic energy at maximum output from the machine with liposuction concurrent through the hollow cannula. The experiments with the sheath did not require a pretreatment with tumescence solution but consisted of tumescence solution pumped through the sheath at a low infusion rate, with concurrent treatment utilizing ultrasonically assisted liposuction through the central lumen of the cannula. In all cases, the lipoaspirate was preserved for biochemical analysis. After treatment, the pigs were euthanized, and samples for histopathology were taken. The pigs were then perfused with a radio-opaque solution through the left ventricle following preperfusion with saline. The groups were ultrasound-assisted liposuction with sheath (n = 3), ultrasound-assisted without sheath (n = 4), and tumescence alone (n = 1), with standard liposuction performed on the contralateral side for all ultrasound-assisted liposuction animals. The lipoaspirates from the ultrasonically assisted liposuction with the sheath showed significantly less blood loss (measured as hemoglobin in the aspirate) than standard liposuction (p = 0.012) at comparable levels of fat (measured as triglycerides in the aspirate). The lipoaspirates from ultrasound-assisted liposuction without the sheath showed blood loss comparable to that experienced with standard liposuction. The ratio of hemoglobin to triglyceride was lowest in the ultrasound-assisted group with (p = 0.01) and without (p = 0.06) the sheath when compared to traditional liposuction. In both of these treated groups, the radiograms of the perfused areas showed significantly less vascular disruption when compared with suction-assisted liposuction. Histopathologic examination of specimens taken from various treated areas showed substantial tissue damage comparable in ultrasound- and suction-assisted liposuction treated groups. This preliminary experimental study showed that ultrasound-assisted lipoplasty is comparable to traditional suction-assisted lipoplasty. Treatment with ultrasound provided more significant hemoglobin/triglyceride ratios, indicative of more lipid aspirated per hemoglobin lost, and better preservation of vascular tissues as demonstrated by our perfusion studies. Treatment with the sheath showed a significantly lower hemoglobin release with a diminished volume infused into the subcutaneous space during the procedure.
我们研究的目的是使用猪模型，在各种仪器和操作参数下，研究超声能量对组织的影响。将家猪麻醉并做好手术准备。在髋部一侧做切口，随机分配到右侧或左侧。通过钝头、小直径套管注入肿胀液，随后进行标准抽脂术。在对侧做类似切口。对于无鞘超声抽脂实验，将经皮导入器插入切口，在入口处加以保护，防止其与套管接触。通过钝头、小直径套管注入肿胀液，然后使用机器最大输出功率的超声能量处理该部位，同时通过中空套管进行抽脂。有鞘实验无需预先注入肿胀液，而是以低输注速率通过鞘泵入肿胀液，同时通过套管中心腔利用超声辅助抽脂进行处理。在所有情况下，将吸出物保存用于生化分析。处理后，对猪实施安乐死，并采集组织病理学样本。在用盐水预灌注后，通过左心室向猪灌注不透射线的溶液。分组情况为有鞘超声辅助抽脂组（n = 3）、无鞘超声辅助抽脂组（n = 4）和单纯肿胀液组（n = 1），所有超声辅助抽脂动物的对侧均进行标准抽脂术。在可比的脂肪水平（以吸出物中的甘油三酯衡量）下，有鞘超声辅助抽脂吸出物中的失血量（以吸出物中的血红蛋白衡量）明显少于标准抽脂术（p = 0.012）。无鞘超声辅助抽脂吸出物中的失血量与标准抽脂术相当。与传统抽脂术相比，有鞘（p = 0.01）和无鞘（p = 0.06）超声辅助组的血红蛋白与甘油三酯之比最低。在这两个处理组中，灌注区域的X线片显示，与抽吸辅助抽脂相比，血管破坏明显减少。对取自不同处理区域的标本进行组织病理学检查发现，超声辅助和抽吸辅助抽脂处理组的组织损伤程度相当。这项初步实验研究表明，超声辅助脂肪抽吸术与传统抽吸辅助脂肪抽吸术相当。超声处理可提供更显著的血红蛋白/甘油三酯比值，表明每损失单位血红蛋白所吸出的脂质更多，并且如我们的灌注研究所示，能更好地保存血管组织。有鞘处理在术中皮下空间注入量减少的情况下，血红蛋白释放明显更低。
