大范围大容量脂肪抽吸形体雕塑术

Body contouring with extensive and large-volume liposuction procedures

目的探讨大范围和大容量脂肪抽吸术的安全性和临床效果。方法回顾性分析2011年10月至2021年6月上海交通大学医学院附属第九人民医院整复外科收治的单次抽吸范围超过15%总体表面积和(或)抽吸量达5 L及以上的脂肪抽吸塑形患者的临床资料。麻醉方式为全身麻醉联合0.025 2%低浓度利多卡因肿胀液分次注射, 手术方式为系列脂肪抽吸形体雕塑术。对肿胀液注射量、抽吸总量、抽吸脂肪量、抽吸液体量、并发症发生情况等进行统计, 并调查患者满意度。结果共纳入313例患者, 男5例, 女308例, 年龄(30.6±8.2)岁, 体质量指数(23.9±3.5) kg/m2。其中271例行1次手术, 37例行2次手术, 5例行3次手术, 共进行了360例次手术。术中肿胀液注射量为(8 741.6±1 559.8) ml;利多卡因最大注射量为3 200 mg;抽吸总量为(6 582.4± 1 515.0) ml,其中抽吸脂肪量为(3 662.1±1 230.8) ml, 抽吸液体量为(2 936.0±765.4) ml;注射量/抽吸总量比率为1.37±0.23。抽吸总量≥10.00 L者共13例次(3.61%), 7.50~9.99 L者73例次(20.28%), 5.00~7.49 L者259例次(71.94%), <5.00 L者15例次(4.17%)。1例患者(0.28%)因术后贫血需输入红细胞悬液纠正, 其余患者均无大量失血导致的贫血, 亦未见其他严重并发症。轻微并发症10例(2.78%), 主要包括术区凹凸不平(5例)、局部血清肿(2例)、切口愈合不良或瘢痕增生(2例)、射频紧肤术中烫伤导致轻度色素沉着(1例)。术后患者满意率为97.2%(350/360)。结论大容量和(或)大范围脂肪抽吸术安全而有效, 患者满意度高;使用0.025 2%低浓度利多卡因肿胀液分次注入皮下脂肪行肿胀麻醉可以有效减少利多卡因中毒风险。

Objective To explore the safety and clinical effects of extensive and large-volume liposuction.Methods From October 2011 to June 2021 in the Department of Plastic and Reconstructive Surgery,Shanghai 9th People’s Hospital,Shanghai Jiao Tong University School of Medicine,patients receiving liposuction exceeding 15%of the body surface area and/or volume of aspirate exceeding 5 liters in a single operative session were retrospectively reviewed.All patients received liposculpture procedure under general anesthesia plus sequential infiltration of 0.0252%low-concentration lidocaine tumescent solution.The total volume of tumescent solution injected,total volume of aspirates,volume of aspirated fat and fluid,complications as well as patient satisfaction were analyzed.Results A total of 313 patients,5 males and 308 females,were included in the study.The average age was 30.6±8.2 years and average body mass index was 23.9±3.5 kg/m2.A total of 360 operations were performed.Among them,271 cases underwent 1 operation,37 cases underwent 2 operations,and 5 cases underwent 3 operations.The tumescent fluid volume was(8741.6±1559.8)ml with the maximum usage of lidocaine of 3200 mg.The aspirates volume was(6582.4±1515.0)ml,of which the volume of supranatant fat and infranatant fluid were(3662.1±1230.8)ml and(2936.0±765.4)ml,respectively.The ratio of infiltrate to aspirate was 1.37±0.23.Aspirate volume exceeded 10.00 L in 13 operations(3.61%),ranged from 7.50 to 9.99 L in 73 operations(20.28%),5.00 to 7.49 L in 259 operations(71.94%)and less than 5.00 L in 15 operations(4.17%).Except for one patient(0.28%)receiving transfusion of red blood cell suspension due to postoperative anemia,no severe complications were observed.There were 10 cases(2.78%)of minor complications,including mild irregularities(5 cases),local seromas(2 cases),poor incision healing or scar hyperplasia(2 cases)and mild pigmentation caused by skin burn during radiofrequency skin tightening(1 case).The satisfaction rate of the patients was 97.2%(350/360).Conclusions The results of this study indicate that large volume and extensive liposuction are safe.The satisfaction of the patients is very high.Sequential infiltration of tumescent solution with 0.0252%low-concentration of lidocaine tumescent solution is safe in reducing the risk of lidocaine toxicity.