超声在聚丙烯酰胺水凝胶填充术后取出治疗中的应用

Application of ultrasound in guiding suction of polyacrylamide hydrogel

目的探讨高频彩色多普勒血流显像（CDFI）超声及超声扩展成像技术在颌面部及乳房聚丙稀酰胺水凝胶注射填充术后并发症治疗前后的应用价值。方法应用高频CDFI超声及超声扩展成像技术对15例颌面部及乳房注射填充术后患者行抽吸前检查，观察填充物的不同超声表现，根据超声结果确定手术方式，并将超声检查结果与手术结果相对照，抽吸术后定期随访。9例隆乳者中，注射位置正常但要求取出者4例，注射位置异常（填充物出现于乳房皮下层、腺体层、胸肌层）者5例；6例颌面部填充者中，填充物异位（填充物出现于预注射部位以外）形成硬结者5例，感染者1例。结果术后经6～18个月的跟踪随访，超声显示，9例隆乳者中，有4例患者无注射材料残留，切口瘢痕细小，乳房无明显变形；5例患者乳房不同程度的萎缩变形，超声显示有凝胶残留。6例颌面部填充者中，超声均显示有不同程度的凝胶残留。结论高频CDFI超声检查及超声扩展成像技术能清晰显示填充物的层次、位置及不同表现，为注射填充术后并发症抽吸治疗方案的选择提供良好的影像学依据，并可无创、动态、跟踪监测抽吸术后的变化，有一定的临床应用价值。

Objective To discuss the application value of high frequency ultrasound and free style extended image in diagnosis and guiding the suction after augmentation mammoplasty or maxillofacial filling with polyacrylamide hydrogel （PAHG） injection. Methods To determine the position of the graft and guide the direction of suction, examinations with high frequency CDFI and free style extended image were performed on 15 cases who undergone the augmentation mammoplasty or maxillofacial filling with PAHG injection, and the results were used to guide the doctors to decide the operative ways. The results of preoperative examinations and postoperative effects were compared and the follow-up was carried out. Of 15 cases, 9 cases with augmentation mammoplasty, these fillers of PAHG were taken out from 4 with right position and 5 with malposition; Of 6 cases with maxillofacial filling, formation of sclero- sis from PAHG malposition was in 5 cases and infection in 1 case. Results Postoperative following up were performed for 6 to 18 months, 4 of 9 cases with augmentation mammoplasty showed slight scar, non remaining of filler and unobvious deformation of breast; 5 cases appeared deformation of atrophy on different degrees and remaining of PAHG; all 6 cases of maxillofacial filling were with remaining of PAHG. Conclusion High frequency ultrasound and free style extended image can clearly display the echo of graft in space of injected breast augmentation, locate the position of abnormal graft accurately, which can help the doctors choose the best method of suction performing, with no-trauma, dynamic state, repeated detection. It can also show the changes of the performation.