细胞辅助的脂肪移植法隆乳术：18例报告

Cell-assissted lipotransfer for breast augmentation： a report of 18 patients

目的 评估应用细胞辅助的脂肪移植技术（ cell-assissted lipotransfer,CAL）隆乳的临床疗效.方法 应用韩国Lipokit脂肪移植机自患者大腿、侧腰和下腹部抽取脂肪,将静置后的上层脂肪250 ml及抽吸液500 ml分别按文献中所示步骤经消化、离心和洗涤等处理,获取基质血管成分（stromal vascular fraction,SVF）.流式细胞仪检测术中提纯的SVF中脂肪来源干细胞（adipose derived stem cells,ADSCs）的比例.收集体外培养的第3代ADSCs,进行ADSCs的功能检测.MRI测量术前及术后3、6个月的乳房体积,分别记为V0、V3、V6,计算移植脂肪组织的吸收率,记为R3、R6.所有数据采用t检验进行分析.评价术前和术后乳房MRI影像的变化,观察有无结节、囊肿或钙化形成.结果 2009年6月至2010年11月,于临床共进行CAL隆乳18例,其中10例患者随访达6个月.新鲜分离的SVF细胞群中ADSCs平均占41.67％；培养的ADSCs细胞生长良好,经诱导后具有成脂、成骨、成软骨的能力；MRI测量结果显示V0=（416.19 ±40.43） ml、V3=（551.72±59.86） ml、V6=（538.81±68.35） ml；R3=（51.20±11.96）％、R6=（54.22±12.73）％.统计结果显示,V3和V6分别与V0比较,差异有统计学意义（P ＜0.05）；V3与V6比较,R3与R6比较,差异均无统计学意义（P＞0.05）.所有患者MRI影像未见囊肿或钙化表现.结论 CAL隆乳术中提纯的SVF细胞群中具有纯度较高的ADSCs,并具有成脂、成骨、成软骨的功能特征.术后3个月内,乳房体积缩小明显,之后乳房体积基本稳定,并较术前明显增大,形态明显改善,CAL隆乳术安全有效.

Objective To evaluate the clinical effect of cell-assissted lipotransfer（CAL） for breast augmentation.Methods 18 patients accepted breast augmentation using CAL. 10 patients completed 6-month follow-up and were involved in the study.The adipose tissue was harvested from patients＇ thighs,flanks and lower abdomen with Lipokit. After standing,250 ml fatty portion and 500 ml fluid portion of suction aspirates were processed according to the procedures reported in referece.Flow-cytometry was used to detect the percentage of adipose-derived stem cells（ADSCs） in distilled stromal vascular fraction（SVF）.The differentiation function of cultured cells also was assessed. The breast volume and images were evaluated by using MRI before operation,3 and 6 months after operation.The breast volume was marked as V0,V3 and V6 respectively. The resorption rate of transplanted adipose tissue for each breast was calculated and marked as R3 and R6.Results Averagely,the percentage of ADSCs in freshly distilled SVF was 41.67%.The in-vitro cultured cell grew well and could differentiate into fat,bone and cartilage.Statistics showed that V0,V3 and V6 was （416.19 ±40.43） ml,（551.72 ±59.86） ml and （538.81 ±68.35） ml respectively. R3 and R6 was （51.20 ± 11.96）% and （54.22 ± 12.73）%. There was significant difference between V3 and V0 （P 〈 0.05）,V6 and V0.However,no significant difference was showed between V3 and V6 or R3 and R6. In addition,no cyst or calcification was seen in all MRI images.Conclusions In process of breast augmentaion using CAL,the distilled SVF contains 41.67%ADSCs which have adipogenic,osteogenic and chondrogenic function.Within 3-month post-operation,the breast volume decreases obviously but the volume sustains after that. Compared with the preoperative volume,the 6-month postoperative volume is significantly increased and the breasts＇ contour is improved greatly.This study indicates that CAL is a safe and effective way for breast augmentation.