医用聚丙烯酰胺水凝胶注射隆乳后硅凝胶假体置入时机的选择

背景：医用聚丙烯酰胺水凝胶注射隆乳的并发症较多,取出后再次置入硅凝胶假体的时机尚不明确。 目的：探讨医用聚丙烯酰胺水凝胶注射隆乳后取出,再次行硅凝胶假体置入隆乳的最佳时机。 方法：纳入聚丙烯酰胺水凝胶注射隆乳后出现不良反应的18例患者,共33只乳房,聚丙烯酰胺水凝胶取出6个月后行硅凝胶假体置入隆乳。置入后随访,调查内容包括局部体征、乳房的轮廓形态、大小、位置、手感、影像学检查结果和心理状况等,将反馈信息分为优、良、中、差4个等级。 结果与结论：随访6个月~2年,聚丙烯酰胺水凝胶取出6个月后行硅凝胶假体置入隆乳优良率超过90%,乳房外形丰满圆润,呈水滴形,轮廓自然柔美,手感柔软有弹性,无压痛,无硬结及游走性包块。提示医用聚丙烯酰胺水凝胶注射隆乳后出现不良反应或患者要求取出者,取出6个月后再行硅凝胶假体置入隆乳可最大限度地避免聚丙烯酰胺水凝胶以及取出手术创伤对隆乳后效果的影响。 关键词：聚丙烯酰胺水凝胶;注射隆乳;硅凝胶假体置入;手术时机;并发症 doi:10.3969/j.issn.1673-8225.2012.12.022     

聚丙烯酰胺水凝胶隆乳后的并发症及其临床验证

目的:探讨聚丙烯酰胺水凝胶注射隆胸后并发症的临床表现和原因及处理方法。方法:应用计算机检索1993-01/2009-10中国期刊全文数据库、万方数据库相关文章。检索有关聚丙烯酰胺水凝胶隆乳后的并发症分析及治疗研究文章,关键词为"聚丙烯酰胺水凝胶,注射隆乳,并发症"。排除重复研究、普通综述或Meta分析类文章,筛选纳入21篇文献进行评价。结果:聚丙烯酰胺水凝胶注射隆乳并发症的种类及特点:①硬结、疼痛、肿胀、感染、发热、无菌性炎症、渗漏、移位等。②同一患者常数种并发症共存,而以其中一、二种为主。③乳房内包块为分散的,位于乳腺组织内,表现为多发的,深浅不一,表浅的可直接位于皮下。聚丙烯酰胺水凝胶注射隆乳并发症的处理方法:肿胀稀释负压吸引术,该方法一般用于凝胶集中而硬结及其他合并症较少的患者,而且不适合于硬结弥散的处理;手术切除水凝胶浸润的腺体组织,水凝胶弥散渗入到周围组织中,需彻底清除,否则就会侵及正常组织;切开引流间断灌洗术,严重感染者,建立双向引流、间断灌洗,符合外科原则。结论:根据患者的具体情况,分别采用不同方法处理水凝胶注射隆乳术后并发症是切实有效的可行方法。     

聚丙烯酰胺水凝胶的不良事件分析研究

目的:聚丙烯酰胺水凝胶注射隆乳术不良事件发生原因及防治方法。方法:对39例聚丙烯酰胺水凝胶隆乳术出现的并发症进行分析、调查。结果:聚丙烯酰胺水凝胶隆乳术不良事件多在1年内发生,其中硬结的发生率最高,达87%,其次是胸大肌内凝胶滞留、胸大肌炎、感染、血肿、皮下凝胶移位等。结论:聚丙烯酰胺水凝胶注射隆乳术不良事件多与手术者操作不规范及患者术后护理不当有关,应加强手术者的操作规范及术后护理的宣教工作,患者也应当到正规医院进行手术。     

隆乳术后CT扫描及多维重建

目的探讨CT诊断乳房植入物有无破裂和/或逸漏或并发症,以及隆乳术后乳腺组织有无病变的临床价值.方法对21例隆乳术后患者行CT扫描并图像后处理多维(矢状位、冠状位等)影像重建.结果行硅胶囊乳房假体植入8例16个乳房,4例内充填液态硅橡胶中3个纤维囊挛缩变硬,2个破裂逸漏;4例内充填生理盐水,1侧乳房并发感染.行聚丙烯酰胺凝胶注射植入13例26个乳房,11例双侧乳房腺体内、外有注射植入物颗粒,其中5例植入物呈结节、团块状弥漫分布于腺体、胸肌内外.1例单侧乳腺组织感染,1例单侧纤维腺瘤,1例单侧硬化型腺病,9例14个乳腺小叶增生,3例5个囊性增生.1例意外发现肺癌并纵隔内转移.结论 CT检查可明确隆乳术的类型、位置;明确植入物有无逸漏或并发症;为临床手术提供准确定位;为随诊复查提供客观资料;对发现乳腺病变及其周围病变有极高的敏感性.     

隆乳术后CT扫描及多维重建

目的 探讨CT诊断乳房植入物有无破裂和／或逸漏或并发症，以及隆乳术后乳腺组织有无病变的临床价值．方法 对21例隆乳术后患者行CT扫描并图像后处理多维(矢状位、冠状位等)影像重建．结果 行硅胶囊乳房假体植入8例16个乳房，4例内充填液态硅橡胶中3个纤维囊挛缩变硬，2个破裂逸漏；4例内充填生理盐水，1侧乳房并发感染．行聚丙烯酰胺凝胶注射植入13例26个乳房，11例双侧乳房腺体内、外有注射植入物颗粒，其中5例植入物呈结节、团块状弥漫分布于腺体、胸肌内外．1例单侧乳腺组织感染，1例单侧纤维腺瘤，1例单侧硬化型腺病，9例14个乳腺小叶增生，3例5个囊性增生．1例意外发现肺癌并纵隔内转移．结论 CT检查可明确隆乳术的类型、位置；明确植入物有无逸漏或并发症；为临床手术提供准确定位；为随诊复查提供客观资料；对发现乳腺病变及其周围病变有极高的敏感性．     

聚丙烯酰胺水凝胶注射后伴发乳房恶性肿瘤:2例报道

背景:聚丙烯酰胺水凝胶注射隆胸在中国一些医疗单位已经应用了近10年,因出现并发症而要求行注射物取出或同时进行再次隆胸的患者不在少数。在诊治过程中可能伴发乳房恶性肿瘤,临床上应给予足够的重视。目的:回顾聚丙烯酰胺水凝胶注射填充物取出患者中确诊乳腺浸润性导管癌的2例个案,提高对于乳房恶性肿瘤检诊重要性的进一步认识。方法:收集聚丙烯酰胺水凝胶隆乳术后发生并发症要求注射物取出的患者41例(共计82侧乳房),其中2例伴发单侧乳房恶性肿瘤,术后病理均提示:乳腺浸润性导管癌;回顾分析病史特点、物理诊断、影像学诊断、病理检查等资料。结果与结论:因聚丙烯酰胺水凝胶注射隆胸术后就诊的患者,应提高对于乳房恶性肿瘤检诊重要性的进一步认识;诊疗过程中强调对物诊及多种影像学检查结果做综合分析,手术过程中对可疑结节多点取材,取材过程中应注意"无瘤操作"手法,及时送冰冻病理检查,一旦确诊乳房恶性肿瘤,需及时按照乳房肿瘤诊疗规范来进行相关处理,以避免医源性操作失当导致的肿瘤漏诊、加速转移和播散。     

聚丙烯酰胺水凝胶注射隆乳术后并发症的处理体会

聚丙烯酰胺水凝胶（以下简称水凝胶）注射隆乳自十年前由乌克兰引进后，以其创伤小，使用方便，术后外形及手感好且不留痕迹，受术者易接受而在国内广泛使用。我们自2001年8月开始使用，至2005年3月共120例，隆乳时单侧注入量100～200ml不等。术后随访6个月到3年。出现凝胶孤岛2例，片状硬结4例，其他受术者恢复满意。并发症发生率5％。（其中外院病例3例）。凝胶孤岛穿刺后容易抽出。本文主要讨论片状硬结的处理。现将4年来我们处理过的6例（其中外院病例3例）报告如下，供同道借鉴。     

聚丙烯酰胺水凝胶注射隆乳术后并发症的分析与处理

目的探讨聚丙烯酰胺水凝胶(PAAG)注射隆乳术后并发症及治疗方法。方法 212例PAAG注射隆乳术后患者,对其术后并发症的临床表现及治疗结果进行回顾性分析总结,寻找理想的治疗和处理方法。结果 212例PAAG注射隆乳术后患者主要的并发症包括乳房硬块或硬结131例、乳房或胸部疼痛65例、注射材料移位28例、发热9例、感染14例、乳房畸形或双侧乳房不对称25例。出现1种临床症状者152例,同时有2种及以上临床症状者60例。所有病例均采用经乳晕切口直视下手术或直接用针抽吸取出PAAG。2种手术方法在切口I期愈合率、术后乳房形态满意率及疼痛缓解率无明显差异,但经乳晕切口直视下手术的PAAG清除率及二次手术率要明显优于直接用针抽吸。结论 PAAG注射隆乳术后并发症较多,经乳晕切口直视下手术是取出PAAG及处理相关并发症的有效方法。     

乳房内组织瓣治疗注射隆乳术后巨大移动性瘘道

目的探索乳房内组织瓣治疗注射隆乳术后混合物移位的疗效。方法收集2006年1月至2014年3月78例注射隆乳术后聚丙烯酰胺水凝胶(PAAG)混合物移位患者的临床资料。按手术方法不同分为观察组和对照组,对照组39例将材料移位至胸腹壁,采取手术清洗刮去残腔,观察组39例在消除胸腹壁腔隙后,采用乳腺局部组织瓣的新设计治疗乳房内瘘道,封闭胸、腹壁通道。结果 78例患者术中均见PAAG在乳腺组织、腋窝、胸腹壁间隙广泛淤积,形成瘘道连通。观察组采用组织瓣治疗2周时分泌物减少82%,病变腔隙缩小80%,对照组未用组织瓣治疗引流物减少46%、病变面积缩小45%,2组比较差异具有统计学意义(P0.01);4周时,对比2组愈合率,观察组组织瓣治疗明显优于对照组。结论乳房内PAAG混合物移位所形成的胸腹壁连通的慢性瘘道是造成胸腹壁内流动性包块与巨大空腔效果的主要原因;组织瓣可明显促进胸腹壁瘘道愈合。     

乳腺良性大汗腺囊性乳头状增生性病变肌上皮缺失临床病理学分析

目的探讨乳腺良性大汗腺囊性乳头状增生性病变肌上皮缺失的病理形态学改变和免疫组织化学表型特征。方法收集2016年1月至2021年12月解放军总医院第七医学中心病理科诊断的5例病例(2例本院, 3例会诊)、首都医科大学大兴教学医院病理科诊断的1例病例, 分析6例肌上皮缺失的乳腺良性大汗腺囊性乳头状增生性病变的临床资料、病理形态学特点及免疫组织化学染色表型, 并复习相关文献。结果 6例患者均为女性, 年龄36～61岁(中位年龄46岁)。左、右侧乳腺各3例, 均有乳腺肿物。镜下观察, 6例在乳腺增生病的背景病变内均可见良性大汗腺囊肿, 同时伴有不同程度的大汗腺细胞的微乳头、乳头状增生;其中1例伴有经典型小叶原位癌, 另有1例伴有大汗腺型导管原位癌及腺病腺管内播散。细胞角蛋白5/6、p63、平滑肌肌动蛋白、人肌球蛋白重链(SMMHC)、Calponin、CD10等免疫组织化学染色结果显示呈良性形态的大汗腺囊性乳头状增生性病变腺管周围的肌上皮细胞完全缺失。结论乳腺良性大汗腺囊性乳头状增生性病变的肌上皮细胞可发生异常性改变, 部分甚至完全缺失。诊断时应充分结合细胞形态学(异型性)及组织结构的改变综合...     

乳房假体隆乳术后并发硬结的细针吸取细胞学观察

目的 观察乳房假体隆乳术后并发硬结的细针吸取细胞病理学(FNAC)改变。方法 对20例采用2种假体(凝胶、自体脂肪颗粒)隆乳术后引起的硬结进行FNAC检查，其中4例行病理组织学观察。结果 主要细胞学改变是见不同假体物，如紫蓝、淡蓝色胶样物或变性坏死的脂肪细胞，中性粒细胞及多核巨细胞等。4例FNAC与病理组织学检查基本相符。结论 乳房假体可引起不同程度的组织反应，还可出现其他并发症。首要表现为硬结；某些假体(如硅胶)可能对机体组织有一定的毒性作用。因此，隆乳应谨慎，特别是未婚妇女，隆乳术后须密切随访。     

硅胶假体隆乳6个月~8年并发症19例

背景：有很多选择可用于硅胶假体隆乳后并发症的矫治。 目的：观察硅胶假体隆乳并发症患者的再次隆乳效果。 方法：选择2005-09/2009-09郑州大学第一附属医院整形外科收治的固体硅胶假体隆乳后6个月~8年出现假体移位、乳房下垂、纤维包膜挛缩女性患者19例。行以乳头为圆心,以假体的半径加3 cm为半径画圆标记出分离胸大肌后腔隙边缘,采用乳晕缘下半环切口入路,更换硅胶假体,将乳房假体置入胸大肌后间隙,然后将醋酸曲安奈德注射液50 mg以及庆大霉素注射液160 mg注入囊腔,一期完成并发症的矫治。 结果与结论：19例患者再次假体置入后8~10周不良形态消失,均未再出现过假体移位、乳房下垂、纤维包膜挛缩等并发症。19例患者随访时间大于6个月,恢复效果满意。     

Silicone granulomas: report of three cases and review of the literature

Since silicone is rapidly becoming one of the most commonly used biomaterials in modern medicine, pathologists will be observing increasing numbers of cases of silicone-related disease. Although numerous case reports have established that silicone elicits a characteristic response in tissues, the varying tissue reactions to silicone gels, liquids, and elastomers (rubber) have not been emphasized. Three cases are reported, and the literature is reviewed to illustrate the varying features of tissue reaction to silicone in its different forms. The first case is an example of silicone lymphadenopathy in an inguinal lymph node. This case demonstrates exuberant foreign body granuloma formation in response to particles of silicone elastomer. The second case involves a patient who had facial subcutaneous liquid silicone injections, and the third case is that of a woman in whom breast carcinoma developed 13 years after mammary augmentation with liquid silicone injections. These two cases illustrate the characteristic reaction to silicone liquid, with numerous cystic spaces and vacuoles in the soft tissues but minimal or no foreign body giant cell reaction. Scanning electron microscopy and energy dispersive x-ray analysis were performed in the first two cases, confirming the presence of silicon. Silicone migration and the clinical significance of various silicone-induced lesions are discussed.     

Cotton-ball granuloma mimicking axillary lymphadenopathy in a breast cancer patient

Foreign body granuloma is a reaction to either a biodegradable substance or inert material. In a breast cancer patient who had undergone an excision or mastectomy with axillary clearance, a foreign body granuloma in the axilla may be misinterpreted as an axillary lymph node. We report our experience with a case of cotton-ball granuloma of the axilla in a breast cancer patient, which mimics a lymph node radiologically from the CT scan, mammogram and ultrasonography. Following biopsy and excision, the mass was diagnosed histologically as a foreign body granuloma.     

制备表面图案化的聚丙烯酰胺-丙烯酸水凝胶

背景:聚丙烯酰胺水凝胶具备良好的生物相容性,但力学性能较差,影响了其在生物材料领域的应用。目的:通过微模塑图形化压印制备具有特殊尺寸的聚丙烯酰胺-丙烯酸水凝胶。方法:依次将不同体积的聚丙烯酰胺溶液、丙烯酸与过硫酸铵溶液混合,加入含有微模塑图形化印章的孔板中,制备聚丙烯酰胺-丙烯酸水凝胶:A组聚丙烯酰胺溶液1.4 mL,丙烯酸0.1 mL;B组聚丙烯酰胺溶液1.3 mL,丙烯酸0.2 mL;C组聚丙烯酰胺溶液1.2 mL,丙烯酸0.3 mL;D组聚丙烯酰胺溶液1.1 mL,丙烯酸0.4 mL;E组聚丙烯酰胺溶液1.0 mL,丙烯酸0.5 mL;F组聚丙烯酰胺溶液0.9 mL,丙烯酸0.6 mL。6组过硫酸铵溶液均为50 L。光镜下观察水凝胶的图案化结构,电子万能试验机检测水凝胶的力学性能。结果与结论:光镜显示各组水凝胶表面的条纹清晰可见;丙烯酸的加入有效改良了水凝胶的力学性能,随着丙烯酸比例的不断增加,水凝胶的力学性能逐渐增强。结果表明,聚丙烯酸-丙烯酰胺水凝胶具有良好的力学性能,有望在组织工程损伤修复领域具有良好的应用前景。     

人精子细胞膜结合型透明质酸酶在乳腺癌的表达及临床病理意义

目的 研究人精子细胞膜结合型透明质酸酶(PH20)在人原发、转移乳腺癌中的蛋白及mRNA表达,探讨其在肿瘤转移中的作用。方法 合成两个高抗原性人PH20多肽,免疫于兔皮下,检测、鉴定、纯化抗PH20抗体。应用免疫组织化学抗生物素蛋白-生物素复合物(ABC)法检测53例乳腺癌原发及淋巴结转移灶PH20的表达;Western印迹法检测5例新鲜乳腺癌组织PH20的表达。合成两条PH20寡核苷酸探针,应用原位杂交检测乳腺组织芯片,包括28例乳腺癌组织,5例乳腺癌旁组织,15例正常乳腺组织。结果 PH20免疫组织化学示：正常乳腺组织无表达(0／3),53例乳腺癌中31例呈阳性表达(58．4％),其中乳腺癌不伴有淋巴结转移阳性率48．2％,乳腺癌伴有淋巴结转移原发癌70．8％,转移癌83．3％。Western印迹法示5例乳腺癌均有PH20相应阳性条带的表达。寡核苷酸探针原位杂交显示75％(21／28)乳腺癌中有PH20 mRNA表达。17例正常乳腺组织中2例乳腺小叶呈弱阳性表达。结论 PH20的表达似乎与乳腺癌的浸润转移行为呈正相关,提示透明质酸酶可能消化乳腺癌周围组织,并释放纤维母细胞生长因子-2而促进其肿瘤生长和转移。     

Differenzialdiagnostik des rheumatoiden Granuloms

Rheumatoid granuloma (RG) is histomorphologically defined as a subcutaneous palisading granuloma with central fibrinoid necrosis. Clinically, it presents as a nodule typically localized at pressure points near the joints. From the rheumatic pathological point of view, the main diagnostic challenge is the differentiation of RG from granuloma anulare, especially if clinical information on the site of removal, known diseases, duration of illness, medication and existing American College of Rheumatology (ACR) criteria are missing. Other granulomatous lesions, such as mycobacterial infections, foreign body granulomas, necrobiosis lipoidica or sarcoidosis, can be differentiated from RG by histopathological criteria or by additional examinations such as pathogen specification or PCR. An immunohistochemical marker for the differential diagnosis of granulomas is not yet available. Diagnosis is based on conventional H-E staining, alcian blue-PAS staining, polarizing analysis or PCR. In the following article, the most important granulomatous entities in the differential diagnosis of RG are introduced and the main diagnostic characteristics are discussed.     

YKL-40 expression in benign and malignant lesions of the breast: a methodologic study.

Elevated serum levels of the protein YKL-40 are associated with a poor prognosis in patients with solid and hematologic malignancies including breast cancer. The aim of this study was to develop a valid reproducible immunohistochemical method to visualize YKL-40 expression in normal breast tissue as well as in benign and malignant breast lesions. The presence of YKL-40 in breast tissue was verified by in situ hybridization and protein extraction procedures. An immunohistochemical method was developed and 4 different antibodies directed against YKL-40 were tested. Ten patients with normal breast tissue and benign breast lesions and 53 patients with localized breast carcinomas were analyzed immunohistochemically. The presence of YKL-40 in normal epithelial cells as well as in malignant tumor cells of the breast was established; however, a difference in staining intensity and staining pattern was observed. In normal breast tissue, a weak YKL-40 immunoreactivity was found in the cytoplasm of the epithelial cells with an additional strong dotlike staining between the nucleus and the gland lumen. In malignant lesions, 81% of the in situ carcinomas and 64% of the invasive carcinomas showed strong diffuse cytoplasmic YKL-40 immunoreactivity. No nuclear and membrane staining was found. A subpopulation of cells of macrophage morphology in normal breast tissue and in malignant lesions showed strong YKL-40 immunoreactivity.     

Fc-receptor-bearing macrophages isolated from hypersensitivity and foreign-body granulomas. Delineation of macrophage dynamics, fc receptor density/avidity and specificity.

Foreign-body and delayed hypersensitivity granulomas were induced in mice; and the dynamics of macrophages isolated from dispersed, 1--4-week-old lesions was delineated. The size and histologic complexity of the lesions increased as shown: adjuvant greater than schistosome egg greater than methylated bovine serum albumin greater than bead. Esterase staining, spreading on glass, and the percentage of Fc-receptor--bearing macrophages present in the various granulomas reflected the same gradient. The Fc receptors were examined by rosetting with rabbit-antibody--SRBC complex (EA). Whereas more than 90% of the population of macrophages of the dermal adjuvant granuloma contained undiminished numbers of receptor-bearing macrophages throughout the 4 weeks, the percentage of macrophages that displayed receptors in pulmonary foreign-body (40%) and delayed hypersensitivity granulomas (70%) peaked at 1 week and subsequently declined. The EA rosetting of the foreign-body and delayed hypersensitivity granuloma macrophages was strongly inhibited by monomeric IgG2a-specific and weakly by aggregated IgG2b-specific mouse myeloma proteins. Also, macrophages of the delayed hypersensitivity granulomas rosetted in higher percentages with SRBCs coupled with monomeric IgC2a than with those coupled with aggregated IgG2b myeloma proteins. Macrophages of the foreign-body lesion did not react with aggregated IgG2b--SRBC. Rosetting with monomeric IgG2a--SRBC or aggregated IgG2b--SRBC could not be cross-inhibited by the myeloma proteins. Both the monomeric IgG2a--SRBC and aggregated IgG2b--SRBC complexes were readily phagocytized. Trypsin treatment of the macrophages inhibited rosetting with EA or myeloma-protein--coupled SRBCs. The display of Fc receptors on the granuloma macrophages seems to be related to the etiology of the lesion and the intensity and duration of the inflammatory reaction.