Liposuction under local anesthesia: a retrospective analysis of 100 patients

Liposuction was used for the purpose of body contouring in 100 patients. Among these patients, three had lipoma, and one had gynaecomastia. The 100 consecutive patients had liposuction surgery performed on an outpatient basis, using local anesthesia. Ninety-one patients were women, and 9 were men. Seventy-one had bilateral procedures and 29 had liposuctions in one region of the body. The most common areas treated were lateral thighs, followed by the neck for treatment of "double chin." The youngest patient was 19 years of age and the oldest 73. There were no significant complications. The most common postoperative complaints were pain, ecchymosis, edema, and temporary hyperethesia. Four patients required "touch-up" procedures.     

Liposuction surgery under local anesthesia: limited blood loss and minimal lidocaine absorption

A large volume of lidocaine with epinephrine can be administered in dilute concentrations into the subcutaneous space, resulting in minimal blood lidocaine levels. This allows large-volume, multiple-area liposuction to be done painlessly under local anesthesia with only oral and intramuscular sedation and analgesia. Other advantages include minimal blood loss, decreased patient morbidity and expense, and elimination of the risks of general anesthesia and intravenous anesthesia/sedation.     

Liposuction for lipomas

Six cases of giant lipomas were treated by liposuction surgical removal. The method involves only a 1-cm incision and insertion of a liposuction cannula. The fibrous stroma of the lipoma may be more difficult to remove. Liposuction is a safe and easy method of removing giant lipomas.     

Liposuction surgery of the lateral thigh

We report our experience in 50 patients who underwent liposuction surgery of the lateral thighs with or without concomitant liposuction surgery of the hip and buttock areas. This procedure has proven to be a remarkably safe and effective method for removal of fat in properly selected individuals. The operation avoids the problems of blood loss and scarring associated with other operations used to remove fat and makes for extremely satisfied patients.     

吸脂法乳腺癌腋窝淋巴结清扫术的临床应用

目的 探讨抽脂法乳腺癌腋窝淋巴清扫的手术技术。方法 分析采用抽脂法进行乳腺癌腋窝淋巴结清扫手术的42例患者的临床资料,并与34例采用传统腋窝淋巴结清扫术患者进行比较。结果 术中岀血量两组比较差异无统计学意义（P>0.05),清扫淋巴结总数及阳性淋巴结数其差异无统计学意义（P>0.05）,损伤淋巴结数差异无统计学意义（P>0.05）。抽脂组可以明显提高肋间神经保护的成功率（P<0.05）,两组随访6~24月,均未见复发与转移。结论 抽脂法腋窝淋巴结清扫术有利于显露肋间臂神经,淋巴结清扫可以达到传统手术的清扫范围,是安全可行的。     

Liposuction gives complete reduction of chronic large arm lymphedema after breast cancer

About one-third of all women treated for breast cancer develop arm lymphedema. In addition to the worry of the cancer itself, the swollen and heavy arm is both a physical and a psychosocial handicap for the patients. Previous surgical and conservative treatments have not always given satisfactory and permanent results, conceivably because lymphedema causes hypertrophy of the subcutaneous adipose tissue. From this point of view, liposuction (LS) combined with Controlled Compression Therapy (CCT) is an interesting approach, as the hypertrophied adipose tissue is effectively removed and the outcome sustained by wearing a compression garment. Pre- and postoperative arm edema volumes were measured using the water displacement technique. Skin blood flow was recorded using Laser Doppler imaging. Lymph transport in the arm was assessed by indirect lymphoscintigraphy. LS + CCT reduced the arm edema volume completely, compared with a 50% decrease following CCT alone. The use of a compression garment after liposuction is necessary in order to maintain the normalized arm volume. LS + CCT did not affect the already impaired lymph transport; it merely increased skin microcirculation. A reduced incidence of cellulitis was noted.     

改良根治术联合抽脂术对乳腺癌的疗效研究

目的探讨改良根治术联合抽脂术治疗乳腺癌的临床疗效。方法选取乳腺癌患者64例,以随机数字表法分为观察组和对照组各32例;对照组行常规改良根治术,观察组行改良根治和抽脂联合术。结果两组复发率、转移率及生存率比较,无统计学差异(P>0.05);观察组总并发症发生率显著低于对照组(25.0%vs 53.1%,P<0.05);观察组患者躯体、心理、社会、精神评分分别为(61.2±7.83)、(111±9.66)、(59.4±6.84)、(46.3±5.86)分,对照组分别为(53.5±6.54)、(106±8.31)、(54.3±6.61)、(43.2±5.54)分,观察组各项评分均显著高于对照组(P<0.05或P<0.001)。结论改良根治术联合抽脂术治疗Ⅰ、Ⅱ、Ⅲ期乳腺癌,能够较完整清除病灶,且能够保护肋间臂神经,可提高患者的预后生存质量。     

Clinical Application of Endoscopic Inguinal Lymph Node Resection after Lipolysis and Liposuction for Vulvar Cancer

Aim: To examine lymph nodes obtained after lipolysis and liposuction of subcutaneous fat of the inguinalregion of female vulvar cancer patients to explore the feasibility of clinical application. Methods: The field ofoperation was on the basis of the range of the conventional resection of inguinal lymph nodes. We injected lipolysisliquid fanwise, started liposuction after 15-20 minutes; then the subcutaneous fatty tissue was sucked out clearlyby suction tube. We selected the first puncture holes located on 2-3 cm part below anterior superior spine, theothers respectively being located 3cm and 6cm below the first for puncturing into the skin, imbedding a trocarto intorduce CO₂ gas and the specular body, and excise the lymph nodes by ultrasonic scalpel. The surgicalfield chamber was set with negative pressure drainage and was pressured with a soft saline bag after surgery.Results: A lacuna emerged from subcutaneous of the inguinal region after lipolysis and liposuction, with a widefascia easily exposed at the bottom where lymph nodes could be readily excised. The number of lymph nodesof ten patients excised within the inguinal region on each side was 4-18. The excised average number of lymphnodes was 11 when we had mature technology. Conclusion: Most of adipose tissue was removed after lipolysisand liposuction of subcutaneous tissue of inguinal region, so that the included lymph nodes were exposed andeasy to excise by endoscope. This surgery avoided the large incision of regular surgery of inguinal region, theresults indicating that this approach is feasible and safe for used as an alternative technology.     

Ambulatory anesthesia

Ambulatory surgical procedures are a large and increasing fraction of all surgery in the United States. A specialized health care team must be assembled to care for these patients and meet their special needs. Ambulatory surgery patients should be selected according to medical and psychosocial criteria. Patient preparation includes a history and physical examination, limited laboratory tests, empty stomach, and appropriate monitoring. Premedication should be supportive, and verbal as well as medicinal; drugs include ataractics and analgesics. All forms of general or regional anesthesia may be used. Recovery goals must be well defined, aiming for "home readiness." Ambulatory anesthesia care is concluded with postdischarge follow-up, for quality assurance and risk management.     

Outpatient anesthesia

More complex methods of outpatient anesthesia, including I.V. sedation and general anesthesia, have become commonplace. Patient selection and preoperative evaluation are discussed, as well as the choice of who will deliver anesthesia. Appropriate outpatient facilities and monitoring are reviewed. The authors' favorite methods of anesthesia, caveats, and suggestions are presented, as well as prevention and treatment of anesthesia problems and emergencies.     

肿瘤相关性贫血对吸入和静脉麻醉效能的影响

目的 比较不同程度肿瘤相关性贫血对七氟烷吸入麻醉和丙泊酚全凭静脉麻醉效能的影响。方法 选择择期行腹腔镜手术的肿瘤相关性贫血患者120例,按照患者术前血红蛋白水平分为三组：正常血红蛋白组（A组：n=40,Hb≥120 g/L）、轻度贫血组（B组：n=40,90≤Hb<120　g/L）、中度贫血组（C组：n=40,60≤Hb<90　g/L）,各组再随机分为七氟烷吸入麻醉（S组,n=20）和丙泊酚全凭静脉麻醉（P组,n=20）两个亚组。分别于诱导前（T1）、插管前（T2）、插管即刻（T3）、气腹建立时（T4）、拔除气管导管时（T5）和术后2 h（T6）抽取静脉血,记录各时点血氧饱和度（SpO₂）、平均动脉压（MAP）、心率（HR）和脑电双频指数（BIS）;记录气腹压、气腹时间、总出血量、输血量和总输液量;比较每组患者血管活性药物使用情况、所需丙泊酚或七氟烷用量、睁眼时间、拔管时间及术后躁动和恶心呕吐的发生率;用酶联免疫吸附试验检测血清皮质醇、5-羟色胺（5-HT）的浓度。结果 S组内比较七氟烷用量差异无统计学意义（P>0.05）,而CP组患者诱导及维持期丙泊酚用量较AP组明显减少（P<0.05）。S组睁眼时间比P组短（P<0.05）,术后躁动、恶心呕吐的发生率比P组高（P<0.05）。S组和P组患者T3、T5时点较T1时点的皮质醇与5?鄄HT浓度明显升高,较T2时点明显下降,差异有统计学意义（P<0.05）,组间与组内比较差异均无统计学意义（P>0.05）。结论　肿瘤相关性贫血患者丙泊酚全凭静脉麻醉较七氟烷吸入麻醉术后苏醒慢,但躁动及呕吐发生率低。中度贫血患者较正常血红蛋白患者丙泊酚全凭静脉麻醉用药少,但血管活性药物使用率高。     

气管内插管全麻在支气管肿瘤冷冻术中的麻醉效果及安全性

目的观察气管内插管全麻在支气管肿瘤冷冻术中的麻醉效果并评价其安全性。方法选择2012年6月至2013年9月收治的78例支气管肿瘤患者,随机分为气管内插管全麻组(观察组)和静脉镇静加气管内表面麻醉组(对照组),观察两组患者不同时间段平均动脉压(MAP)、心率(HR)以及氧分压(SO2)水平的变化,并评价各种方法的安全性。手术后3个月和6个月时进行随访,并采用健康测量量表(SF-36)进行生活质量评定。结果两组患者的MAP、HR水平在麻醉前(T0)比较,差异无统计学意义(P>0.05);观察组患者的MAP和HR水平在冷冻开始前(T1)、冷冻开始后30 min(T2)、冷冻结束时(T3)均低于对照组,差异有统计学意义(P<0.05);两组患者的SO2水平在各时间节点比较,差异均无统计学意义(均P>0.05)。两组患者术后的血常规及肝肾功能检测均未见异常。观察组患者无不良反应,对照组患者发生不良反应20例(51.3%),差异有统计学意义(P<0.01)。在术后3个月和6个月时,观察组患者的生活质量指标生理机能(PF)、生理职能(RP)和情感职能(RE)评分均高于对照组,差异有统计学意义(P<0.01)。结论支气管肿瘤冷冻术中应用气管内插管全麻麻醉效果更佳,且安全性高,有利于提高患者术后生活质量。     

常规全麻与联合麻醉对胃癌合并高血压患者术中血流动力学影响的研究

目的 探讨常规全麻与联合麻醉对胃癌合并高血压患者术中血流动力学的影响.方法 回顾性分析106例胃癌合并高血压患者的临床资料,依据治疗方法的不同将患者分为治疗组和对照组,每组各53例.对照组患者术前接受常规全麻,治疗组患者术前接受硬膜外麻醉联合常规全麻,比较两组患者术中平均收缩压(SBP)、舒张压(DBP)、心率(HR)、术中麻醉剂用量、自主呼吸恢复时间、拔管时间及肺部啰音、术中体动和苏醒期躁动的发生率.结果治疗组和对照组患者的SBP、DBP及HR比较,差异有统计学意义(P﹤0.05);两组患者各时间点的SBP、DBP及HR比较,差异有统计学意义(P﹤0.05).治疗组患者麻醉诱导后、手术探查时、拔管时、拔管5 min的SBP、DBP及HR均低于对照组(P﹤0.05);治疗组患者术中麻醉剂的应用剂量低于对照组(P﹤0.05);治疗组患者自主呼吸恢复时间和拔管时间均明显短于对照组(P﹤0.01);治疗组患者术中体动、苏醒期躁动及肺部啰音的发生率均低于对照组(P﹤0.05).结论 对于胃癌合并高血压的患者,联合麻醉相对于常规全麻可降低患者麻醉诱导后及术中的SBP、DBP及HR,降低麻醉剂的应用剂量,缩短自主呼吸恢复时间和拔管时间,降低患者术中体动、苏醒期躁动及肺部啰音的发生率,对术后患者肺部并发症的预防具有积极意义.     

静吸复合全麻与全凭静脉麻醉对卵巢癌患者血清相关因子的影响

目的 探讨静吸复合全麻和全凭静脉麻醉在卵巢癌患者中的使用.方法 选取2020年1月至2020年12月间上海市复旦大学附属华山医院收治50例卵巢癌患者,将患者根据不同麻醉方法分为对照组(静吸复合全麻)与观察组(全凭静脉麻醉)两组,每组25例.对比两组患者的CD3+、CD4+、一氧化氮(N0)和催乳素(PRL)影响.结果 ...     

Effect of anesthesia and surgery on immunity.

The observed phenomenon that multiple distant metastases may appear and grow rapidly after operation on the primary cancer is very distressing. Many experimental results suggest that surgical procedures may precipitate dissemination and growth of tumor in some instances, but the overwhelming evidences document that surgical reduction of tumor bulk can achieve cure for the host and restore the immunity lost in the face of growing tumors. Various anesthetics were shown to interfere with many phases of the immune response. But recent studies suggest that the inhibitory effect of anesthesia alone is minimal. Depression of lymphocyte transformation, detectable as early as 2 hours after induction, was related primarily to the extent of tissue trauma, the amount of blood loss, duration of operation, and whether thoracic or abdominal cavity was entered. Posoperative changes of lymphocyte counts and transformation responses usually returned to normal values within a week, whereas depression of specific cellular immunity to tumor-associated antigen in vitro, and delayed cutaneous hypersensitivity reactions in vivo, persisted for about a week and gradually returned to normal by 3 weeks. Presently the clinical significance of such transitory depression of host immunity is not known. It is hoped that this review may stimulate interest in further experimental and clinical research.     

Simple anesthesia for simple mastectomies

We describe our technique for simple mastectomy under local anesthesia for patients with high anesthetic risk factors, particularly the elderly. Seven patients with a mean age of 88 years (range 80–94 years) with American Society of Anesthesiologists (ASA) classes of three or four were given a simple mastectomy using local anesthesia and an intravenous sedative. Blood loss was minimal (mean = 95.7cm³), as was operating room time (mean = 62 min). Most patients were returned to nursing homes on post-operative day 2. There were no complications related to the procedure.