面部注射充填引起脑血管意外一例报告及文献回顾

Cerebrovascular infarction after cosmetic facial injections： a case report and literature review

目的结合我们报道的1例面部注射透明质酸继发脑出血死亡的案例，对面部注射充填引起脑血管意外的病例进行文献回顾。方法以“filler injection、autologous fat、hyaluronic acid、stroke、cerebrovascular disease、cerebral embolism”等为关键词，在PubMed等国内外数据库搜索，时限为1990年1月至2016年7月，统计内容包括研究者信息、患者状况、注射信息、治疗信息、并发症状况、治疗和预后情况。结果共纳入18篇文献（20例患者），报道最多来自韩国；注射材料为脂肪17例（81％），透明质酸4例（19％）；注射部位最多为眉间（9例）。合并脑血管意外的『庙床表现以偏瘫（15例）、意识障碍（7例）、失语（5例）多见；8例（47％）于术中及术后立刻出现，81％合并失明。梗塞灶多为大脑中动脉（14例）、大脑前动脉（6例）、额叶（6例）、顶叶（5例），包含本例患者共3例合并脑出血。失明患者预后差，不可恢复，神经系统症状则大多可有改善。结论脑血管意外为面部注射充填少见的严重并发症，须引起高度注意。

Objective To report a case who had cerebral hemorrhage after facial injection with hyaluronic acid and to present the literature review about cerebrovascular infarction after cosmetic facial injection. Methods Articles were collected from domestic and overseas database, with the key word of ＂filler injection, autologous fat, hyaluronic acid, stroke, cerebrovascular disease, cerebral embolism＂ from 1990 January to 2016 July. Information about researchers, patients, injection, complication, therapy and prognosis was collected. Results The analysis shows cases are mostly reported by South Korea among the 18 articles in total （20 cases）. 81% of injection material is autologous fat and the rest is hyaluronic acid. Glabella is mostly injected（ n = 9）. Symptoms of cerebrovascular infarction are paralysis （n = 15 ）, disturbance of consciousness （ n = 7 ） and aphasia （ n = 5 ） , whose onset were mostly within the operation （47% , n = 8）. 81% cases were combined with blindness. Infarction positions mostly were middle cerebral artery （ n = 14 ） , anterior cerebral artery （ n = 6 ） , frontal lobe （ n = 6 ） and parietal lobe （ n = 5 ）. Meanwhile, there were three cases combined with cerebral hemorrhage including the case we reported in this article. Blind patients had poor prognosis while the other neurologic symptoms mostly could be improved. Conclusions Cerebrovascular infarction is a rarely severe complication of cosmetic facial injection, which we should pay close attention to.