行面部注射物取出术患者临床诊疗分析

Retrospective analysis of the diagnosis and treatment of patients receiving facial injected filler removal surgery

目的探讨面部注射物取出术处理方式,优化其诊疗流程。方法回顾性分析2005年1月至2019年11月北京协和医院整形美容外科收治的138例面部注射物取出术病例,均为女性,年龄25~67岁,病程6个月至19年,平均6.07年。138例患者的注射材料主要为聚丙烯酰胺水凝胶、生长因子和羟基磷灰石。常合并多个部位注射,主要集中在下颏、颞部、鼻部与脸颊。患者多表现有不同程度的焦虑、紧张、恐惧等精神症状,局部症状以硬结、肿胀、疼痛、瘙痒、移位为主。所有患者术前均行体表肿物超声波检查进行定位及辅助诊断,选择尽可能隐蔽的切口行局部清创术,尽可能去除填充物,并反复冲洗局部组织,切除组织常规送病理及细菌检查。结果所有患者术后切口均一期缝合。24例因术后注射物残留或精神症状强烈而行多次手术。13例患者组织细菌培养显示合并金黄色葡萄球菌感染,经辅助抗生素治疗痊愈。根据本组患者治疗情况,提出简要诊疗流程,为临床实践提供参考。结论对行面部注射物取出术患者,应根据注射物的性质、种类、注射部位、辅助检查结果、患者的症状,综合制订面部注射物取出术方案,术中合理选择切口、切除方式,选择性围术期使用抗生素,并适度安排辅助心理治疗。

Objective To investigate the characteristics,production mechanism and treatment of facial injected filler removal surgery.Methods A retrospective analysis of 138 cases of facial injected filler removal surgery was conducted in Peking Union Medical College Hospital.The patient’s filler substances,injection site,adverse reaction symptoms,duration,examination result,surgical method and times,and pathological and bacterial examination result were analyzed.Results All cases were women,aged from 25 to 67 years old,with a course ranging from 6 months to 19 years.Most of the injected substances were polyacrylamide hydrogel,growth factor,and hydroxyapatite.Most of the injection sites were jaw,temporal,nose,and nasolabial fold.Regarding the clinical manifestations,patients presented different levels of anxiety,depression,or other mental symptoms,with the local symptoms of induration,swelling,pain,and itchy mainly.All patients underwent the ultrasound examination,showing subcutaneous hypoechoic without blood flow.The excision of the tissue was routinely sent for pathological and bacterial tests.Tissue culture of 13 patients showed a combined S.aureus infection.Twenty-four patients underwent excision for more than once due to residue filler or mental symptoms.We propose a brief diagnosis and treatment process to provide a reference for clinical practice.Conclusions The facial injected filler removal surgery plan should be formulated according to the material,injection site,and examination result,symptoms of the patients,to properly select the incision and the removal method,perioperative use of antibiotics and psychotherapy.