乳房聚丙烯酰胺水凝胶注射物清除术的回顾性分析

Removal of polyacrylamide hydrogel injections from breast： a retrospective analysis

目的探讨乳房聚丙烯酰胺水凝胶注射物磁共振特点、术中所见和清除方法。方法对2015年1月至2016年12月上海交通大学医学院附属第九人民医院整复外科113例聚丙烯酰胺注射隆乳美容就医者的磁共振成像及临床资料进行分析，分区记录注射物性状、周围组织变化和术中所见。结果术前磁共振观察在T2加权成像抑脂序列中，注射物呈高信号表现，术中探查见注射物分布区与磁共振提示一致。113例（226侧乳房）清除的注射物包括游离态注射物和周围包囊或注射物浸润组织。全部采用乳晕切口入路，周围包囊或浸润组织采用切除方式清除。15侧乳房无明显组织浸润，211侧乳房注射物周围均有不同程度组织浸润和组织变性。有浸润组织211侧乳房中，腺体后脂肪浸润104侧、胸大肌浸润23侧、腺体后脂肪加胸大肌同时浸润83侧，腺体后脂肪和胸大肌均浸润1侧。结论聚丙烯酰胺水凝胶注射隆胸术后普遍存在注射物组织浸润。推荐使用乳晕入路手术切除浸润腺体后脂肪组织。

Objective To explore the features of magnetic resonance imaging （MRI） and removal procedures of the polyacrylamide hydrogel （PAAG） injections from the breast. Methods From January 2015 to December 2016, 113 continuous cases of breast PAAG implants were involved into this study. Features of MRI, characteristics of PAAG and tissue changes around PAAG were recorded and analyzed. Results The PAAG was demonstrated high T2 signals on MRI that was consist- ent with the surgical findings. In total of 226 breasts, the PAAG injected implants were removed with peri-areolar incision approach, and PAAG in free state was squeezed and capsular or infiltrated tissues were dissected. In 15 breasts, capsules were thin with no infiltrated tissue. In other 211 breasts, a lot of PAAG infiltrated tissues were observed and these infiltrated tissues included gland, fat tissue, pectoralis major muscle, pectoralis minor muscle or intercostal muscles. Conclusions In these cases, PAAG has been injected into breasts for 7 to 20 years. For such long period, PAAG infiltrated tissues present a lot of difficulties and more complicated to remove. Dissection is the strategy we recommend.