面部自体脂肪注射引发兔血管栓塞的实验研究

Vascular embolization induced by injection of autologous fat in rabbits

目的探讨对实验兔面动脉注射不同类型脂肪引起兔失明、脑梗死等严重并发症的发生机制。方法2022年5月至2023年10月,在陕西中医药大学临床实验室选取雄性新西兰兔64只,分为8组,每组8只;分别为研磨脂肪组、脂肪颗粒组、脂肪脂质、生理盐水组,每组又分为0.2 ml组和0.4 ml组。从兔腹股沟切取脂肪,将脂肪切碎或用胶原酶Ⅰ处理,分离脂肪脂质和脂肪颗粒及其他组织。在下颌角下方沿切口暴露出兔面部动脉,将0.2 ml或0.4 ml切碎脂肪、脂肪颗粒、脂质逆行注射到各个组兔面动脉,然后在显微镜下缝合切口。术后观察和记录眼科和神经学症状,并进行视觉电生理和眼底镜检查以验证视力和眼底动脉梗阻。结果术后2周,0.2 ml组出现眼科症状的情况分别为研磨脂肪组8只、脂肪颗粒组5只、脂肪脂质组0只、生理盐水组0只;0.4 ml组出现眼科症状的情况分别为研磨脂肪组8只,脂肪颗粒组7只、脂肪脂质组1只、生理盐水组0只。0.4 ml组出现神经系统症状的情况分别为5、2、0、0只。接受注射后死亡情况,0.2 ml组分别为3、1、0、0只,0.4 ml组分别为8、4、0、0只。结论给实验兔注射未经胶原酶Ⅰ处理的研磨脂肪组织更易引起严重并发症,单纯脂质进入血管不会阻塞相关动脉,脂肪体积大小与术后并发症的发生率呈正相关。

Objective To explore the severe complications,such as blindness,brain infarction and even death caused by cosmetic autologous fat filler injection and their underlying mechanisms.Methods From May 2022 to October 2023,64 male New Zealand rabbits were selected in the clinical laboratory of Shaanxi University of Chinese Medicine and divided into 8 groups with 8 rabbits in each group.They were divided into grinding fat group,fat granule group,fat lipid group and normal saline group,and each group was further divided into 0.2 ml group and 0.4 ml group.Fat was cut from the rabbit groin,then chopped or treated with collagenase I,and centrifuged to separate fat lipids and fat particles,as well as other tissues.The rabbit facial artery was exposed along the incision below the mandibular angle,and 0.2 or 0.4 ml of chopped fat,fat particles,and lipids were retrogradely injected into the facial artery in each group,and then the incision was closed under the microscope.Ophthalmic and neurological symptoms were observed and recorded after surgery,and visual electrophysiology and fundus microscopy were performed to verify visual acuity and fundus artery obstruction.Results Two weeks after surgery,the incidence of ophthalmic symptoms in the 0.2 ml injection group was 100%in the grinding fat group,62.5%in the fat granule group,0 in the lipid group and 0 in the normal saline group.The complication rates of 0.4 ml embolic injection were 100%,87.50%,12.5%and 0,respectively.The incidence of neurological symptoms was 62.5%,25.0%,0 and 0,respectively.Mortality rates were 37.5%,12.5%,0 and 0 after injection of 0.2 ml,and 100%,50%,0 and 0 after injection of 0.4 ml,respectively.Conclusions Animal models have shown that grinding adipose tissue without collagenase I treatment is more likely to cause serious complications,simple lipid entry into blood vessels does not block relevant arteries,and fat volume is positively correlated with the incidence of postoperative complications.