超声技术治疗腰腹部肥胖效果观察

目的:观察超声技术体外治疗腰腹部肥胖的临床疗效。方法:采用超声特定声波强度对60例腰腹部轻中度单纯性肥胖的就医者进行治疗,针对每例就医者治疗前后腰围测量及治疗前后的对比照片,进行临床疗效的评估。结果:显效3例,占5%;有效39例,占65%;无效18例,占30%。结论:使用超声波皮肤治疗仪治疗腰腹部肥胖,操作简单,安全可靠,就医者无痛苦易于接受,是目前值得推广的局部减肥的方法。     

Submental Nd:Yag laser-assisted liposuction

BACKGROUND: Liposuction of the neck is currently one of the most common cosmetic surgical procedures. In the present study, the author describes his experience with neck and jowl laser-assisted liposuction. STUDY DESIGN/MATERIALS AND METHODS: In this procedure, submental lipodystrophy is treated with an Nd:YAG laser, at a 1,064 nm wavelength. Over a 5-year-period, 82 subjects were treated using 6-W power, 40-Hz frequency, 150-mJ energy, and 100-microsecond pulse width parameters. Histology was performed on fatty tissue samples. RESULTS: Submental laser-assisted liposuction resulted in significant cosmetic improvement. Histology revealed a rupture of the adipocyte membrane as well as collagen coagulation and channels along the fatty tissue. Additionally, small blood vessels were coagulated. An adequate skin contraction was observed with an improvement of the cervicofacial region. CONCLUSIONS: The Nd:YAG laser is a useful tool for the treatment of local lipodistrophy. The laser proved to be effective for cellular lysis and collagen neoformation.     

超声辅助脂肪抽吸结合腹壁整形术的体形塑造

目的探讨采用超声辅助脂肪抽吸结合手术去脂行腹壁整形术的临床效果。方法术前站立位，以腹、腰部脂肪明显堆积处为中心用等高线标记脂肪抽吸区；仰卧位采用“夹捏法”确定腹壁整形术的皮肤脂肪切除区。术中先采用超声波体内导入结合肿胀技术吸除非切脂区脂肪，再进行腹壁整形术的皮肤、脂肪切除、腱膜折叠术及脐移位。结果16例术后随访6个月至2年，无感染、皮肤坏死、伤口裂开等并发症发生；并发症较少；术后皮肤回缩明显，术区平坦，感觉恢复快。结论采用体外超声波辅助吸脂结合切脂的腹壁整形术进行腹部体形塑造的临床疗效较佳。     

Circumferential “Intermediate” lipoplasty of the legs

Circumferential intermediate lipoplasty of the thighs and lower legs is an expansion of the traditional lipoplasty technique. Rather than limiting the correction to defined bulges, the goal is to thin the thigh or the calves and ankles circumferentially. This procedure is not indicated for all patients. In selected patients with extremely heavy thighs, medial and lateral bulges, full anterior thighs, and a full posterior thigh in the upper third, circumferential liposuction improves the results and produces a slimmer thigh. In the calves and ankles, circumferential lipoplasty reduces the entire lower leg giving a more attractive result rather than just reducing the medial and lateral ankle bulges. The concept of intermediate lipoplasty is introduced. This technique has advantages over the superficial technique and the traditional deep lipoplasty. No special equipment, incisions, drains, or change in technique is needed. Using circumferential intermediate lipoplasty to contour the entire lower leg results in a slimmer looking leg. There has been no increase in complications. The author reviews his experience with this technique.     

Low‐level laser therapy for fat layer reduction: A comprehensive review

Background and Objective

Low‐level laser (light) therapy (LLLT) is a noninvasive, nonthermal approach to disorders requiring reduction of pain and inflammation and stimulation of healing and tissue regeneration. Within the last decade, LLLT started being investigated as an adjuvant to liposuction, for noninvasive body contouring, reduction of cellulite, and improvement of blood lipid profile. LLLT may also aid autologous fat transfer procedures by enhancing the viability of adipocytes. However the underlying mechanism of actions for such effects still seems to be unclear. It is important, therefore, to understand the potential efficacy and proposed mechanism of actions of this new procedure for fat reduction.

Materials and Methods

A review of the literature associated with applications of LLLT related to fat layer reduction was performed to evaluate the findings from pre‐clinical and clinical studies with respect to the mechanism of action, efficacy, and safety.

Results

The studies as of today suggest that LLLT has a potential to be used in fat and cellulite reduction as well as in improvement of blood lipid profile without any significant side effects. One of the main proposed mechanism of actions is based upon production of transient pores in adipocytes, allowing lipids to leak out. Another is through activation of the complement cascade which could cause induction of adipocyte apoptosis and subsequent release of lipids.

Conclusion

Although the present studies have demonstrated safety and efficacy of LLLT in fat layer reduction, studies demonstrating the efficacy of LLLT as a stand‐alone procedure are still inadequate. Moreover, further studies are necessary to identify the mechanism of action. Lasers Surg. Med. 45:349–357, 2013. © 2013 Wiley Periodicals, Inc.     

Ultrasound-assisted lipoplasty

Background : Ultrasound‐assisted lipoplasty (UAL) has been associated with particular types of complications and uncertain long‐term effects arising from interactions between ultrasonic energy and living tissue. The present review seeks to address these issues. Methods : Search strategy Three search strategies were devised to retrieve literature from Medline, Current Contents, Embase and Cochrane Library databases up until April 2000. Study selection Inclusion of papers was largely determined using a predetermined protocol. English language papers were selected. Acceptable study designs included randomized controlled trials, controlled clinical trials, case series or case reports. Data collection and analysis Thirty‐six papers met the inclusion criteria. They were tabulated and critically appraised in terms of methodology and design, outcomes, and the possible influence of bias, confounding and chance. Other papers were also included to provide background material. Results : There was little high‐level evidence available comparing UAL and suction‐assisted lipoplasty (SAL), with no conclusive evidence that UAL has a safety benefit, although low‐quality evidence suggests that UAL is associated with reduced surgeon fatigue as well as increased operating times, slower aspiration rates and an increased learning curve. There is inadequate evidence to determine whether the theoretical potential for DNA damage from ultrasound is realized in the clinical setting. Conclusions : The evidence base for UAL is inadequate to determine the procedure’s safety and efficacy. The potential for DNA damage must be investigated with appropriate in vivo animal models. Recommendations for the safe use of UAL are discussed.     

Medial thighplasty,prevention of scar migration,and labial flattening

As more people seek body contour surgery spurred on by the media's great interest in suction lipectomy and the seemingly increasing numbers of satisfied patients, we should re-examine an area where results of body contour surgery have been less satisfying, the inner thigh. In those patients whose problem remains skin flabbiness rather than excessive fat, either alone or after successful or partially successful suction lipectomy, an inner-thigh procedure is indicated.     

The Psychiatric View of Patients of Aesthetic Surgery: Self-Esteem,Body Image,and Eating Attitude

The patient who presents for aesthetic surgery possesses various demands depending on the characteristic properties of the individual. Evaluation of self-esteem, body image and eating habits in patients of aesthetic surgery could help in understanding patients and their demands. We performed Rosenberg Scale Test for evaluation of self-esteem on 98 patients who presented for any kind of aesthetic surgery. Seventy-five patients who required no operation for body fat tissue were give body imaging scale and eating attitude scale tests. The results of the tests revealed an increase in the self-esteem of the patients, but it was not statistically significant. There was a minor disturbance in the body imaging scale without any statistical significance (p > 0.05).The eating attitude of the patients indicated a disturbance with a ratio of 10% (p < 0.01), and these patients were referred to psychiatrists. Even if patients of aesthetic surgery have no disorder in the perception of their body images, they reflect their aesthetic problems in their eating attitude; however they have no problem in the fat tissue distribution of their body. The aesthetic imperfection could impede the normal daily life of a patient and adaptation to the social life, and this defect is a health problem that should be solved as soon as possible. Presented at the XVI Congress of International Society of Aesthetic Plastic Surgery (ISAPS), 26–29 May 2002, Istanbul, Turkey     

Adolescent paraplegia, morbid obesity, and pickwickian syndrome: outcome of gastric bypass surgery

Loss of mobility, such as what occurs as a consequence of spinal cord injury or malformation, is a risk factor for excess weight gain and can confound weight management efforts. Despite well-documented outcomes of bariatric surgery in ambulatory patients, little information is available regarding weight loss surgery in adult or adolescent paraplegic patients. A 15-year-old adolescent boy with a body mass index of 60 kg/m² and complete paraplegia caused by spina bifida developed metabolic dysfunction, severe obstructive sleep apnea, and hypoxemia syndrome. In an effort to avoid a tracheostomy for worsening pickwickian syndrome, he was referred for weight loss surgery. Laparoscopic Roux-en-Y gastric bypass surgery was safely performed and resulted in loss of 55% of body weight (83.8% excess weight loss) for 2 years. Risk factors for cardiovascular disease markedly improved, and polysomnography demonstrated complete reversal of sleep apnea with substantial subjective improvement in daytime breathlessness and quality of life. Body composition analysis demonstrated preferential reduction in body fat mass compared with lean mass, without detrimental effect on bone mineral density. This case illustrates that paraplegia does not necessarily impair either weight loss efficacy or comorbidity resolution after Roux-en-Y gastric bypass surgery.     

Power-Assisted Lipoplasty Versus Traditional Suction-Assisted Lipoplasty: Comparative Evaluation and Analysis of Output

Power-Assisted lipoplasty (PAL) is a new method introduced to simplify and standardize surgical results of traditional suction-assisted lipoplasty (SAL). Comparative studies already have demonstrated PAL to be a handy, atraumatic, time- and fatigue-sparing technique. The authors performed a pilot study to compare the output capacity of PAL and SAL in 15 healthy female patients. The general and the specific per area outputs over 1 min from symmetrical areas were assessed. The results confirmed the efficiency of PAL (17.41% increase in average specific area output, as compared to SAL) and the distribution of fat in major fat storage areas such as the abdomen and the anterior thigh. Specific per area output indicated a higher suction capacity for PAL in all areas except the inner thigh. The efficiency of PAL seemed to be less influenced than that SAL by fat distribution.This study was not sponsored by any manufacturers     

Short-term changes in affective,behavioral, and cognitive components of body image after bariatric surgery

Background

Many bariatric surgery candidates report body image concerns before surgery. Research has reported post-surgical improvements in body satisfaction, which may be associated with weight loss. However, research has failed to comprehensively examine changes in affective, behavioral, and cognitive body image.

Long term changes in total body water, total exchangable sodium and total body potassium before and after ileostomy.

In 10 patients with inflammatory bowel disease, total body water, total body potassium and total exchangable sodium were measured both before and 6 months after the establishment of a permanent iseostomy. All 10 patients underwent elective surgery for their inflammatory bowel disease but all were malnourished before surgery when their body composition was first measured. Six months later, when the body composition was again determined, all the patients were in good health and had normally functioning ileostomies. As a group they had gained 6-8 kg in body weight and 372 mEq total body potassium over the 6-month period. When the 'normal' total body water was calculated for each patient, a deficit of 12-4 per cent for the group was found before surgery and this was still present (11-1 per cent) 6 months later. The concentration of exchangable sodium in the body water fell from an abnormally high level before surgery to within the normal range 6 months later. These data show that defictis in total body water occurring preoperatively are not repaired in the months following the establishment of a well-functioning ileostomy, and that a reduction of total exchangeable sodium is present in patients with an ileostomy who are otherwise well. It is suggested that these findings should encourage the surgeon managing patients with intractable inflammatory bowel disease to strive for good nutrition and normal body composition before embarking on excisional surgery and the establishment of a permanent ileostomy.     

THE INFLUENCE OF ANAESTHESIA AND SURGERY ON PLASMA CORTISOL, INSULIN AND FREE FATTY ACIDS

The plasma cortisol level of patients anaesthetized for 1 hourwith thiopentone and nitrous oxide was found to remain unchanged.During body surface surgery it rose slightly, and during intra-abdominalsurgery it rose to more than double the resting value. The bloodsugar under the same circumstances changed in a qualitativelysimilar manner and the free fatty acids appeared to fall duringanaesthesia without surgery, changed little during body surfacesurgery, and rose during intra-abdominal surgery. Plasma insulinduring both types of surgery showed no significant change.     

Body Composition and Metabolic Changes Following Bariatric Surgery: Effects on Fat Mass, Lean Mass and Basal Metabolic Rate

Background: Bariatric surgery has become the method of choice for weight loss in severely obese patients. While the incidence of obesity and its co-morbidities have been well-documented, less is known about the outcomes of the surgery as it relates to body composition and metabolic changes. Methods: 19 bariatric surgery patients (14 female, 5 male) were assessed for basal metabolic rate (BMR), percent fat, fat mass, and lean body mass (LBM) just prior to surgery and at 1, 3 and 6 months after surgery. Results: Analysis of Variance (ANOVA) using the general linear model indicated significant changes in all measures of body composition for each time period. Linear regression was developed for each of these measures. Of the 39.7-kg weight loss, 26.4 kg (66.5%) was fat mass loss and 13.3 kg (33.5%) was LBM loss. BMR significantly decreased from pre-surgery (2091 kcals) to 1 month post-surgery (1758 kcals), with no significant changes in subsequent time periods. Repeated measures ANOVA for the ratio of BMR/LBM indicated no significant differences for any comparison of time periods (F=2.29, P=.111), suggesting that there is no adaptation of an energy-conserving mechanism in these patients. Conclusion: Bariatric surgery was highly successful in inducing significant changes in body weight (39.7 kg), fat mass (26.4 kg), % body fat (7.9%) but also lean body mass (13.3 kg). The 440 kcal decrease in BMR, while significant, was not greater than expected due to significant decreases in LBM.     

Dimethylsulfoxide (DMSO) for human single-stage intraoperative tissue expansion and circulatory enhancement

Dimethylsulfoxide (DMSO) has been in clinical use since the early 1960s. In 1967 the discovery that DMSO can greatly reduce ischemia in experimental pedicle flaps stimulated its use in plastic surgery by the authors since 1976. In 1987 its ability to soften collagen, thus permitting degrees of immediate intraoperative tissue expansion hitherto unknown, was applied clinically for the first time. Evolving use of topical 70% DMSO alone, in combination with intravenous DMSO, and intravenous DMSO alone with greater efficacy is discussed. Cases of intraoperative tissue expansion for large lesion excision and use in abdominoplasty to maximize skin resection are discussed. In breast reconstruction, maximal tissue expansion in minutes with immediate placement of large permanent prostheses ends the delay of reconstruction and problems of chronic tissue expander capsule formation and gives this technique a clear advantage over other reconstructive techniques.Presented at the 23rd annual meeting of the American Society for Aesthetic Plastic Surgery, Chicago, Illinois, USA, April 2, 1990     

Blood use in patients undergoing coronary artery bypass surgery: impact of cardiopulmonary bypass pump, hematocrit, gender, age, and body weight

We investigated the impact of cardiopulmonary bypass pump (CPB), hematocrit, gender, age, and body weight on blood use in patients undergoing coronary artery bypass graft surgery at a major university hospital. Participants were 1235 consecutive patients undergoing primary coronary artery surgery over a period of 2 yr (1999 and 2000); 681 patients underwent coronary surgery with use of CPB, and 554 patients underwent off-pump coronary artery bypass surgery using a median sternotomy incision. There were 881 males and 354 females. Average packed red blood cells (PRBC) transfusion for patients on CPB was 3.4 U compared with 1.6 U for the off-pump group (P = <0.001). Patients on CPB received more frequent PRBC transfusion (72.5%) compared with 45.7% of off-pump patients (P = <0.001). Average PRBC transfusion for males was 2.2 U compared with 3.6 U for females (P = <0.001). A lower percentage of males (52.6%) than females (79.4%) received transfusion (P = <0.001). The impact of CPB, off-pump status, preoperative hematocrit <35%, gender, age >or=65 yr, and weight 相似文献   

Minimally invasive abdominal surgery: lux et veritas past, present, and future

BACKGROUND: Laparoscopic surgery has developed out of multiple technology innovations and the desire to see beyond the confines of the human body. As the instrumentation became more advanced, the application of this technique followed. By revisiting the historical developments that now define laparoscopic surgery, we can possibly foresee its future. DATA SOURCES: A Medline search was performed of all the English-language literature. Further references were obtained through cross-referencing the bibliography cited in each work and using books from the authors' collection. CONCLUSION: Minimally invasive surgery is becoming important in almost every facet of abdominal surgery. Optical improvements, miniaturization, and robotic technology continue to define the frontier of minimally invasive surgery. Endoluminal resection surgery, image-guided surgical navigation, and remotely controlled robotics are not far from becoming reality. These and advances yet to be described will change laparoscopic surgery just as the electric light bulb did over 100 years ago.     

Disturbances in Melatonin, Cortisol and Core Body Temperature Rhythms after Major Surgery

Background It has been suggested that circadian rhythm disturbances are present after major surgery and that this may play a role in the development of postoperative sleep disturbances, fatigue, cognitive dysfunction and cardiovascular morbidity. The objective of this study was to examine the profile of melatonin, cortisol and core body temperature rhythms before and after major surgery. Methods Blood samples (melatonin and cortisol) and core body temperature readings were collected every hour in the 24-h period prior to surgery and the 48 h after surgery from 11 patients undergoing major abdominal surgery. All patients had private rooms. Light exposure was controlled and monitored. Phase markers [50% dim light melatonin onset (DLMO 50%) and offset (DLMOff 50%), cortisol and core body temperature acrophase] for the three circadian rhythm profiles were calculated before and after surgery. The correlation between the melatonin rhythm and time of surgery, duration of surgery and opioid use was examined. Results A median delay in the onset of melatonin was seen on the first postoperative day [median DLMO 50% 22:46 hours (range: 21:15–01:08 hours) on the preoperative day compared with 23:54 hours (range: 19:09–02:46 hours) on the first postoperative day; P ≤ 0.05] . A significant positive correlation existed between the duration of surgery and the time of melatonin onset (r = 0.67, P ≤ 0.05) . There was a significantly reduced basal secretion of melatonin immediately after surgery, with a subsequent significant increase in maximum melatonin values on the second postoperative night. A median delay of up to 4 h was seen in the timing of the peak of the temperature rhythm on the second postoperative day. Both cortisol secretion and core body temperature were increased after surgery and did not return to preoperative values in the 48 h of the postoperative study period. No significant correlation between opioid dose and the basal or maximum melatonin levels or the time of melatonin onset was found. Conclusion We found disturbances in three circadian markers after major surgery. The clinical consequences of postoperative circadian disturbances should be investigated further in the future.     

Very Superficial Ultrasound-Assisted Lipoplasty for the Treatment of Axillary Osmidrosis

Treatment of axillary osmidrosis has been mainly concerned with surgical excision of glandular tissues and involved major surgical procedures with high morbidities and many complications. Search for a less invasive procedure for axillary osmidrosis resulted in the use of liposuction. However, there have been controversies over the efficacy of this method. The problem was that liposuction could not effectively remove the apocrine gland located in the dermis and dermosubcutaneous junction. A high rate of residual malodor and dissatisfaction were reported. The author used ultrasound-assisted lipoplasty (UAL) in the very superficial plane to remove the apocrine gland located in the dermis and dermosubcutaneous junction. The purpose of this study was to prove the efficacy of the very superficial UAL (VSUAL) for the treatment of axillary osmidrosis. From December 1998 to December 1999, 21 consecutive patients underwent UAL in their axilla for axillary osmidrosis. The follow-up period ranged from 2 to 12 months (mean: 8 months). UAL was performed in the very superficial plane with an amplitude of 40%. The very superficial UAL (VSUAL) was done mainly in a withdrawing manner with the tip of the cannula against the skin. The UAL (VSUAL) was done aggressively until the skin changed slightly erythematous. The results were assessed subjectively and objectively, and classified as excellent, good, fair, and poor. Nineteen patients were graded as excellent and one patient as good. The total satisfaction rate was 95.2%. One patient complained of residual malodor in her left axilla. There were no cases of skin necrosis, hematoma, or seroma. Histology showed partial removal of the subcutaneous layer and deep dermis, and degenerative epithelial changes in the apocrine glands in the residual deep dermis. These microscopic findings meant near-total functional ablation of the apocrine gland in the axilla comparable to ``flap-to-graft conversion' or surgical excision of axillary skin. The UAL (VSUAL) for axillary osmidrosis has the advantages of a high success rate with minimal complications. Rapid recovery, less restriction of movement, and tiny scars were other major benefits of this technique. Therefore, UAL (VSUAL) is a viable option for treatment of axillary osmidrosis.     

Life Satisfaction, Self-Esteem, and Body Image: A Psychosocial Evaluation of Aesthetic and Reconstructive Surgery Candidates

Psychology should be an important part of a plastic surgery procedure in order to buoy up the patient so that he gains a consequent relief of psychiatric and social problems. It is a fact that reconstructive surgery patients also seek psychological stability and a better appearance that is acceptable to society. While the life satisfaction, self-esteem, and body image of the individual who seeks aesthetic plastic surgery has been a special concern in the plastic surgery literature, data about reconstructive surgery patients are usually lacking. To understand the factors influencing the aim of an individual seeking plastic surgery, this prospective controlled clinical study was designed. We hypothesized that they should have lower life satisfaction and self-esteem and more distorted body images than the ``normal' population. Three hundred individuals were included in the study. Both the aesthetic surgery group (AG) and the reconstructive surgery group (RG) consist of 100 (n= 100) subjects. Individuals chosen randomly from the total population seen in the 12-month period were included regardless of the type of procedure, body region, or type of trauma as well as whether or not their wish for surgery was justified by the staff. The third group, the control group (CG), also consists of 100 (n= 100) subjects and was chosen from the ``normal' population. All 300 subjects were asked to complete four scales: the Socio-Demographic Questionnaire, Life-Satisfaction Index (LSI), Self-Esteem Inventory (SEI), and Body-Image Inventory (BII). Results were collected and compared. The LSI results for the two surgical groups were found to be similar to those for the CG, with the RG demonstrating the lowest level. For the SEI there was a significant difference between the two surgical groups, being in favor of the AG, and a greater difference was noted between the CG and the RG. BII results showed no significant difference among the three groups. As a result, although there may be some, a regular person who seeks an aesthetic procedure should not be considered a psychologically disturbed individual at face value and each case should be evaluated individually in the preoperative consultation. Similarly, individuals who present for reconstructive procedures and wish further aesthetic refinements should be evaluated and treated exactly as pure aesthetic candidates.