一种新型脂肪移植工具的设计和实验研究

Designing and Experimental Research in a New Instrument for Fat Transplantation

目的设计一种取脂工具,取出不同直径轴状脂肪,再移植于裸鼠后研究其存活差异,为临床中小体积量脂肪移植提供更加便捷的方式。方法以1 m L注射器为模板,设计内径为4、6、8、10 mm的4种不锈钢取脂工具。于2014年5月~2015年4月行自体脂肪移植的12例患者中,分别采用以上4种内径取脂工具抽取腹部脂肪标本。取64只3~4周龄免疫缺陷裸鼠,随机分为A、B、C、D 4组,每组16只。以裸鼠背部皮下间隙为移植受区,分别移植用内径为4、6、8、10 mm取脂工具取出的0.5 m L脂肪组织。脂肪植入后,观察各组裸鼠存活情况以及脂肪植入部位的外观。植入脂肪术后1、2、4、8周,测量移植脂肪质量;每组随机处死4只裸鼠,取出受区剩余移植脂肪进行大体观察、组织学以及免疫组织化学染色观察,计数完整脂肪细胞以及毛细血管。结果新型手术工具可以轻松取出不同直径的轴状脂肪。脂肪植入裸鼠背部皮下腔隙后,随时间延长隆起样外观均趋于平坦,但C、D组隆起程度优于A、B组;解剖动物可见C、D组脂肪保持正常形态,并有血管长入。脂肪植入后即刻及1周时,4组脂肪质量比较差异无统计学意义(P>0.05);2、4、8周时,A组明显小于其他3组(P<0.05),B组小于C、D组(P<0.05),C、D组间差异无统计学意义(P<0.05)。组织学及免疫组织化学染色观察显示,随时间延长,与其余3组比较,D组脂肪细胞形态完整性较好,坏死区域小,血管密度高。除植入后1周各组间差异无统计学意义(P>0.05)外,其余各时间点,A组完整脂肪细胞明显少于其余3组(P<0.05),B组少于C、D组(P<0.05)。各时间点随取脂内径增大,毛细血管数呈增加趋势,组间比较差异均有统计学意义(P<0.05)。结论新型脂肪移植工具的手术操作简便,减少了对组织边缘的压迫。在10 mm范围内,取脂工具内径较大,可更好的保持组织完整性,脂肪植入裸鼠体内后血管密度更高、再血管化时间更短,形态维持的时间更持久。

Objective To design an instrument for extracting equiaxed fat with different diameters and being transplanted to nude mice so as to provide more convenience and utility for little fat transplantation. Methods Based on equiaxed fat transplantation by 1ml syringe, a stainless instrument for fat extraction was modified with four different diameters： 4mm, 6 mm, 8 mm and 10mm, respectively. 12 patients undergoing autogenous fat transplantation from May 2014 to April 2015 were randomly assigned, every 3 by one kind of instrument, to take cytological exam and enzyme assay. Then 64 3 -4 - week - old nude mice were randomly divided into 4 groups, including group A , B , C and D. We transplanted 0. 5 ml fat tissue by instruments with different diameters from the dorsal subcutaneous space and observed the survivals and recipient site. After fat implantation in 1, 2, 4 and 8 weeks, fat weight was measured. 4 mice in each group were sacrificed to extract the rest transplanted fat for gross observation, histological and immunohistochemical te s t, including intact adipocytes and capillaries counting. Results New instruments could extract equiaxed fat with various diameters easily. With time passing by , the postoperative apophyses became flat, but there were less in groups A and B than in group C and D. Normal appearance and visible capillaries were found in dissected mice in groups C and D. At the time of fat implantation and 1 week afterwards, there was no significant statistical difference in fat weight among the 4 groups （P 〉0. 05） , but from 2 weeks postoperatively, the weight in group A was less than other 3 groups （ P 〈0. 05） and was less in group B than in groups C and D （ P 〈0. 05） except for groups C and D （P 〉 0. 05） . Histological and immunohistochemical research showed a better cytological integrality, less nec-rosis and higher vessel density in group D as compared with other 3 groups with time extension. The intact adipocytes in group A was less than in other 3 groups （ P 〈 0. 05 ） and was less in group B than in groups C and D （ P 〈 0. 05 ） except for the first week postoperatively （ P 〉 0. 05 ） . In every time spot, we also found a greater capillary counting in groups with the increase of diameters （P 〈0. 05）. Conclusion The newly developed instrument for fat transplantation is simple to operate, which reduces the pressure on tissue edge. Within 10mm diameters, the bigger the inner diameters of instruments, the better integrality , higher vessel density, quicker vaso - anastomoses and longer appearance maintenance are predicted.