轴状脂肪移植的实验和初步临床研究

EXPERIMENTAL AND PRIMARY CLINICAL RESEARCH OF CORE FAT GRAFT

目的通过与Coleman方法比较,探讨轴状脂肪移植方法的可行性。方法采用Coleman方法及轴状脂肪移植方法,分别于11例拟行头面部脂肪移植患者的下腹部抽取脂肪。取3～4周龄免疫缺陷裸鼠48只,雌雄不限,体重8.6～12.2 g;随机分为两组,每组24只。以背部皮下间隙为移植受区,实验组移植0.5 mL轴状脂肪移植方法获得的人体脂肪组织,对照组移植0.5 mL Coleman方法获得的人体脂肪组织。术后大体观察实验动物背部外观,于1、2、4、8周两组随机处死6只裸鼠,取出背部皮下移植脂肪进行大体、组织学及免疫组织化学染色观察,并于取出脂肪前后对裸鼠称重,计算移植脂肪重量。脂肪抽取术后即刻取脂肪组织进行葡萄糖转移实验和脂肪细胞活性测定。2010年5月-2011年10月,临床应用面部轴状脂肪移植治疗11例局部凹陷性畸形。结果术后实验组裸鼠背部隆起样外观基本维持,对照组2周时已趋于平坦。两组植入脂肪重量相似(P>0.05);除术后2周外,其余各时间点实验组残余脂肪重量均显著高于对照组(P<0.05)。组织学观察示实验组细胞形态保持良好,血管分布均匀;对照组细胞破坏再吸收显著,血管集中分布于移植组织边缘。术后实验组完整脂肪细胞计数均明显多于对照组,除术后2周外其余各时间点组间比较差异均有统计学意义(P<0.05)。实验组毛细血管计数均少于对照组,术后1、2周比较差异有统计学意义(P<0.05),但4、8周时差异无统计学意义(P>0.05)。轴状脂肪移植方法抽取的脂肪组织葡萄糖转移量为(1.462±0.080)mmol/L,显著高于Coleman方法抽取的脂肪组织(1.153±0.199)mmol/L(t=3.317,Ρ=0.021);且轴状脂肪移植方法抽取的脂肪组织细胞活性更佳。临床应用患者均获随访,随访时间2～9个月;随访期间受区未见明显萎缩及塌陷。结论与Coleman方法比较,轴状脂肪移植方法获得的脂肪组织可保持原结构和良好活性,移植术后能更早与受区建立血液循环,术后组织再吸收率低,形态维持时间长。

Objective To investigate the feasibility of core fat transfer by comparing with traditional Coleman technique. Methods The fat was obtained from 11 patients scheduled for fat transfer by 2 ways： Coleman＇s method and core fat graft. The latter was harvested by a modified 1 mL syringe. Then 48 nude mice at the age of 3-4 weeks, male or female, weighing 8.6-12.2 g, were divided into 2 groups randomly （n=24）. The dorsal subcutaneous space was recipient site. In the experimental group, 0.5 mL core fat was transplanted into dorsal subcutaneous space; in the control group, 0.5 mL fat obtained by Coleman＇s method was transplanted into the same site. The appearance of the back was observed after operation; fat specimens were procured at 1, 2, 4, and 8 weeks after ooeration for the gross, histoloeical, and immunohistochemicalobservations; and the residual weight of free fat-graft was calculated by the difference between pre- and post-operative mouse weights. The glucose transportation quantities and cell viability were measured immediately after obtaining fat. Facial augmentation procedure was performed with core fat graft in 11 patients with local depressed deformity between May 2010 and October 2011. Results The uplift of the back was maintained in the experimental group, but the back of mice became flat in the control group at 2 weeks postoperatively. There was no significant difference in the weight of fat-graft between 2 groups （P 〉 0.05）. The residual weight of fat-graft in the experimental group was significantly higher than that in the control groupat the other time （P 〈 0.05, except for 2nd week postoperatively）. The histological observation showed good cell morphology and well-distributed vessels in the experimental group, but obvious destruction of the cells and most vessels at the edge of fat- graft in the control group. The normal fat cells in the experimental group were significantly more than those in the control group after operation （P 〈 0.05）, except for 2nd week）. The capillaries in the experimental group were fewer than those in the control group, showing significant differences at 1 week and 2 weeks （P 〈 0.05） and no significant difference at 4 and 8 weeks （P 〉 0.05）. The glucose transportation quantities in the experimental group [（1.462 ± 0.080） mmol/L] was significantly higherthan that in the control group [（1.153 ± 0.199）mmol/L] （t=-3.317, P=0.021）. The higher cell viability was also proved in the experimental group. Eleven patients were followed up 2-9 months, and no obvious atrophy or collapses was observed at recipient site. Conclusion Compared with Coleman technique, core fat graft can keep the structure and viability of harvested fat tissue by avoiding certain damages of fat cell. Therefore, the earlier anastomoses between the host and core graft fat can reduce tissue loss and improve the fat survival. So it is recommended for enblock fat graft.