肿胀法外超声吸脂术的组织学研究

目的 观察外超声能量作用于活体组织后的组织学变化，以探索其作用机制。方法 对3只家猪腹部两侧进行外超声与非超声比较，作用不同时间后在光镜和电镜下观察其皮肤组织全层的变化。结果 在外超声作用18min内，随着作用时间的延长，猪的皮下脂肪组织和生物大分子结构的破坏程度不断加重，脂肪组织中产生的空泡不断增大而皮肤组织及血管无明显变化。结论 外超声吸脂术可通过稳定的空泡效应选择性地使脂肪细胞结构发生不可逆的坏死性改变，这一改变与作用时间成正比。     

Effects of fat mass reduction by dieting and by lipectomy on carbohydrate metabolism in obese patients

Summary The interrelation of enlarged body fat mass (BFM) with reduced carbohydrate tolerance and hyperinsulinemia was studied in obese subjects with chemical diabetes. These patients were subjected to lipectomy following weight loss induced by a low-calorie, low-carbohydrate diet. An improvement in glucose tolerance and in insulin sensitivity and a reduction in insulin release during OGTT was observed after a diet-induced BFM loss of 9.9 ± 1.2 kg. Subsequent surgical reduction of BFM by 6.0 ± 0.5 kg had no further effect upon carbohydrate tolerance, insulin release or insulin sensitivity though a marked decrease in basal plasma FFA values was observed. These findings suggest that fat mass enlargementper se has no effect on blood glucose homeostasis after oral or i.v. loading. The improvement in carbohydrate tolerance and in insulin resistance usually observed following diet-induced loss of BFM seems to be due to the reduction in calorie and carbohydrate intake rather than to decrease of BFM. Preliminary results of this study were presented at the 9th Congress of the International Diabetes Federation, held in New Delhi in 1976 (abstract ≠ 333).     

Experience with More Than 5,000 Cases in Which Monitored Anesthesia Care Was Used for Liposuction Surgery

Background Conscious sedation using monitored anesthesia care can provide a clinical spectrum from relaxation to moderate anesthesia. This middle ground between general anesthesia and pure tumescent liposuction can help facilitate patient comfort and surgical proficiency during the procedure.Objective To describe a method of liposuction surgery with monitored anesthesia care in which a designated licensed and qualified individual is responsible for administration of supplemental intravenous conscious sedation as well as continuous monitoring of the patient.Methods Conscious sedation is induced with midazolam, and the patient is titrated to level II-V on the Ramsey sedation scale with propofol. The basic surgical technique is that of tumescent liposuction. However, the supplemental conscious sedation allows the tumescent fluid to be infiltrated at higher rates and fat extraction to be completed in a shorter period with minimal or no discomfort.Results In the authors experience with more than 5,000 cases of liposuction surgery using this method, safety and efficacy have been proved. No patients have experienced significant adverse effects.Conclusion Tumescent liposuction surgery with monitored anesthesia care provides a middle ground between general anesthesia and purely tumescent liposuction.     

Functional applications of suction-assisted lipectomy: A new treatment for old disorders

Ever since the introduction of suction-assisted lipectomy in the United States in 1981, the technique has been applied to an increasing number of disorders of the subcutaneous tissues. Indeed, suction-assisted lipectomy has evolved into the method of choice in the treatment of certain pathological entities. While the extraction of lipomas is the most common functional application, suction-assisted lipectomy has also been used successfully to treat such conditions as gynecomastia, axillary hyperhidrosis, benign symmetric lipomatosis (Madelung's disease), congenital body asymmetry, congenital or acquired lymphedema, flap defatting, traumatic or postoperative hematomas, and fat necrosis. We have successfully treated patients presenting with the above disorders. No morbidities or mortalities were encountered in our series of 18 patients. The final results were considered favorable by the majority of patients. Acceptance by the patients of this treatment modality was extremely high because of the smaller incisions required, the exactness in contouring, the simple and minimal postoperative care needed, and the ease with which the procedure can be repeated to refine the results. A comprehensive review of the literature is presented along with our own patient management and long-term results.     

Optimum vacuum pressures for lipolysis

The author presents a method to test the adequacy of any suction machine pump used in lipolysis surgery, regardless of the altitude and/or sea level of the operating room physical conditions. Surgeons can, therefore, subject any vacuum pump to a vaporization test and thereby ensure its adequacy for lipolysis techniques.     

吸脂法腔镜腋窝淋巴结清扫手术的技术探讨

目的探讨吸脂法腔镜腋窝淋巴结清扫的手术技术.方法分析采用吸脂法进行完全腔镜腋窝淋巴结清扫手术的45例患者的临床资料,并与传统开放手术进行比较.结果完全腔镜腋窝淋巴结清扫手术组清扫淋巴结8～34枚,平均18枚;腔镜腋窝淋巴结清扫手术时间为60～190min,平均108 min,较传统手术时间长（P＜0.05）.腔镜手术组出血量为80～220 ml,平均152.82 ml,明显少于常规手术组280.29 ml（P＜0.01）.腔镜手术组术后腋窝引流量为60～180 ml,平均140.38ml,拔引流管时间6～15 d,平均6.91 d.术后皮下积液7例,皮肤表皮水疱5例,胸壁和上臂内侧蜂窝织炎2例.腔镜手术组在清扫腋窝淋巴结数目、术后引流量、引流时间、术后并发症等方面与常规开放性手术相比较无明显差异（P＞0.05）.结论腔镜手术组手术切口相对较小,美容效果较好,患者比较满意.吸脂法腔镜腋窝淋巴结清扫可以达到常规手术的清扫范围,但技术有待进一步规范.     

Lipectomy of Fat Rolls

A technique for lipectomy used on rolls of fat in the back is presented. It is proposed that multiplanar and aggressive liposuction in this region exaggerates the feminine waist and results in a lifting effect on the fat rolls. It is proposed that suction performed in a vertical way creates a new vertical collagen framework that supports skin in an antigravitational manner. Fat from fat rolls is aggressively suctioned in a multiplanar way to obtain a very thin adipose flap. The direction of suction is always perpendicular to the axis of the fat roll. The location of the incisions is cranial or caudal to the fat roll. This means they are vertical or longitudinal to the body axis. All the patients showed a marked improvement in both the clinical and photographic evaluations. The percentage of correction to the waist curvature was 26%. Only 11% of the patients showed minimal cutaneous irregularities (residual fat and depressions). Fat removal by multiplanar liposuction accomplished in a vertical way on the back rolls produces excellent results. The improvement results from the thin cutaneous flap needing to redrape over a longer concave waist curvature. On the other hand, the cutaneous flap readapts better in a vertical way because the new vertical collagen framework supports skin in an antigravitational manner. With this technique, postoperative edema is minimized. Lymph vessels have the same vertical direction from top to bottom, and thus are less injured.     

肿胀吸脂术在副乳腺切除中的应用

目的探讨肿胀吸脂术在副乳腺切除中的临床价值。方法对43例患者采用肿胀吸脂技术对局部隆起的副乳腺组织进行抽吸,至局部皮肤平坦,术后加压包扎。结果全部患者均I期愈合,术后切口隐蔽,局部隆起外观消失,整个胸壁及腋下曲线流畅,术后无血肿、感染等并发症发生。结论肿胀吸脂术不仅可以小切口切除副乳腺,而且很好地去除了局部增生的脂肪组织,具有更好的美学效果。     

医用电子去脂与手术整形联合治疗腹壁松垂症

目的 探讨单纯去脂术与腹壁成形术治疗腹壁脂肪堆积伴腹壁松垂症的优缺点及两者联合应用的互补效果。方法 设计耻骨联合上Ｗ形切口,在肿胀麻醉下用电子去脂机吸出腹壁多余脂肪,折叠缝合腹直肌前鞘,切除多余皮瓣,分层缝合,置负压引流,弹力绷带加压包扎塑形。结果 ２５例随访３～６个月,腹壁平坦,腹围缩小５～１５ｃｍ。结论 电子去脂术对血管神经损伤小,故吸脂后的皮瓣做腹壁成形术,成活有保障。两者结合,使腹壁松垂的