自体脂肪注射移植隆乳术后并发症的超声特征

Ultrasonographic features in complications of cosmetic augmentation with autologous fat obtained by liposuction

目的 探讨自体脂肪颗粒注射移植隆乳术后脂肪结节的超声图像特征及其演变过程,帮助临床与乳腺其他性质的肿块相鉴别.方法 对38例自体脂肪颗粒注射移植隆乳术患者进行术后超声随访,对超声发现的结节,描述结节的大小、部位、形态、边界、内部回声、钙化类型和声晕.结节每隔3～6个月随访,观察其大小及形态的变化.结果 38例中25例患者50侧乳房测及结节76个,其中实性16个（21.1%）,囊实性8个（10.5%）,囊性52个（68.4%）.注射隆乳术后脂肪坏死结节的主要超声征象是无血流76个（100%）,边界清晰66个（86.8%）,形态规整54个（71.1%）,无声晕74个（97.4%）,囊性52个（68.4%）,无钙化63个（82.9%）,蛋壳样钙化10个（13.2%）,囊实性结节中的实性成分随体位移动8个（100%）.7例患者手术,病理诊断均为脂肪坏死.结论 超声监测自体脂肪颗粒注射移植隆乳术后并发症是一种有效的诊断方法,可减少不必要的盲目穿刺.

Objective To evaluate the ultrasonographic （US） features and evolution of breast fat necrosis after cosmetic augmentation with autologous fat obtained by liposuction, to help distinguish fat necrosis from more ominous breast masses. Methods Breast sonography was performed on 38 patients underwent bilateral breast augmentation by autologous fat injection to evaluate the grafted fat tissues in interval of 3-6 month after the operation. Observations in follow up sonography included the sizes,positions, shape,echogenicity,margin features, calcifications and evolutions of the suspicious nodules in the breasts. Results Seventy-six nodules occurred in 25 of the 38 patients were detected after the fat graft. Among the 76 nodules,52 were cystic（68. 4%） ,8 were complex（10. 5%） and 16 were solid（21.1%）. The analysis of the predominant features of the nodules sonographic appearances were as follows： all the nodules had no flow signal, 66 （86. 8%） had clear margins,54（71. 1%） had regular shapes,52 were cystic（68. 4%） ,63（82. 9% ） had no calcifications, 10（13. 2%） had egg-like calcifications,74（97. 4% ） had no halo,and the positions of the solid components in 8 complex nodules move following the change of the detected body position. There were 7 nodules with fat necrosis removed surgically and confirmed by pathology. Conclusions Breast ultrasound is an accurate and simple method to follow up the temporal changes of the fat nodules after autologous fat injection. It may help to avoid unnecessary biopsies.