面部自体脂肪填充血管栓塞机制的计算机辅助影像分析

Computer-aided image analysis of vascular thrombosis caused by facial autologous fat injection

目的探讨面部自体脂肪注射发生动脉栓塞的原因及机制。方法在PubMed、Google Scholar等数据库中搜集面部自体脂肪注射造成动脉栓塞的病例，收集患者基本信息以及诊断、治疗和接受的影像学检查等信息。结果共纳入27例患者。其中，眼动脉阻塞13例，视网膜中央动脉阻塞6例，视网膜分支动脉阻塞3例；10例视网膜动脉阻塞伴随脑梗塞；18例行不同计算机辅助影像学检查。结论面部自体脂肪注射可能会引起血管阻塞；在注射压力下，脂肪栓子通过颈外动脉的不同分支逆流进入眼动脉及其分支导致失明；在一些情况下，逆行动脉栓塞也会导致脑梗塞；发生脑梗塞的高概率表示颈内动脉可能是栓子流动的一条路径；计算机辅助影像学检查是出现血管栓塞时最常用、最可靠的检查手段。

Objective To investigate the causes and mechanism of vascular thrombosis caused by facial autologous fat injection. Methods Cases with vascular thrombosis caused by facial autologous fat injection were searched in PubMed, Google and Scholar databases. Basic demographic information of patients, diagnosis, treatment methods and computer-aided image were also collected. Results Among 27 cases, 13 cases had ophthalmic artery occlusion （OAO） , 6 cases had central retinal artery occlusion （CRAO）, and 3 cases had branch retinal artery occlusion （BRAO）. 10 cases had retinal artery occlusion accompanied with cerebral in- farction. 18 cases received different computer-aided imaging examinations. Conclusion Facial autologous fat injections may cause vascular thrombosis. Under the pressure of injection, fat emboli pass regressively into the ophthalmic artery and its branches through the different branches of the external carotid artery. In some cases, retrograde arterial embolism also causes brain infarction. High incidence of brain infarction shows that internal carotid artery may be the pathway of embolus flow. Computer-aided imaging examination is the most common and reliable means of diagnosis when embolus occurs.