临床应用聚焦超声减脂塑形治疗的有效性研究

目的 探讨临床应用聚焦超声减脂塑形治疗的有效性.方法 采用随机、双盲、阴性平行对照的临床试验方法,应用聚焦超声减脂塑形机,对40例自愿受试者的腹部脂肪堆积部位进行减脂治疗.治疗于受试者入组的第1、7天进行,每次对治疗部位进行3次聚焦超声的扫描.随访时间为试验的第1、7天治疗后即刻以及试验的第14、35天,测量指标包括腹围及影像资料等.结果 36例受试者完成了聚焦超声减脂塑形2次(6遍)的局部治疗及随访.试验组受试者2次治疗后腹围分别减少了(1.03±0.38)cm、(0.65±0.53)cm,第14、35天随访腹围较治疗前分别减少了(2.52±1.04)cm、(3.31±0.67)cm,与对照组相比,差异有统计学意义(P ＜0.05).结论 研究证明,聚焦超声减脂塑形治疗有效.     

聚焦超声减脂塑形机用于腹部减脂塑形的临床观察

目的 探讨聚焦超声减脂塑形机用于腹部减脂塑形的安全性和有效性.方法 选取40例健康受试者,随机分为实验组和对照组,每组20例,按照单盲法实验原则.采用JCS-01型聚焦超声减脂塑形机对受试者的腹部区域做间隔7d的2次治疗.治疗时,固定治疗探头,操作仪器使治疗床按指定区域自行移动.对照组在治疗时调整器械无能量输出.在两次治疗前及治疗后第14天和第35天进行腹围测量、局部拍照以及安全性随访,第35天实验结束时调查受试者满意度.结果 40例受试者中失访1例,其余39例均未发生皮肤红斑、水肿或丘疹,实验室检查未发现有临床意义变化.在治疗后各时间点,实验组中腹围减少＞0.5 cm的受试者,所占的比例均明显高于对照组(P＜0.05).在第35天时两组的腹围减少差异最为显著,20例实验组的受试者中有19例的腹围减少0.83～6.33 cm,平均减少值约3.09 cm,总有效率为95％,受试者满意率为75％.结论 聚焦超声减脂塑形机具有较高安全性,用于腹部减脂塑形有一定效果.     

国产聚焦超声减脂塑形设备临床应用疗效观察

目的：观察国产聚焦超声减脂塑形设备临床应用的疗效。方法：应用北京汇福康医疗技术有限公司生产的JCS-01型聚焦超声减脂塑形机,以超声波频率1.9MHz、平均声功率（550±20%）W、对67例就医者的腹部脂肪堆积部位进行减脂塑形治疗。设备治疗头固定,治疗床按程序自行移动,在设定治疗范围内逐行扫描。每位就医者一次治疗聚焦超声在腹部扫描3遍,3天后再重复治疗一次,4周后随访。结果：有67例门诊就医者接受了聚焦超声减脂塑形治疗,其中,61例完成2次6遍扫描并接受随访,平均腹围减少（3.49±1.66）cm;在此批就医者中,有18例在随访后又接受了第2循环治疗,腹部共承受了4次12遍聚焦超声的扫描,第二次随访时腹围减少（4.64±1.12）cm。治疗过程中,治疗部位未见皮肤红肿、水疱、溃疡。结论：应用聚焦超声进行减脂塑形治疗,临床证明有效。临床治疗效果可以通过增加治疗次数获得加强。     

非侵入性聚焦超声融脂的临床疗效观察

目的：为观察非侵入性聚焦超声融脂机的临床疗效。方法：应用以色列Ultrashape公司生产的聚焦超声ContourI塑形治疗仪,以功率密度17.5W/cm2,声波频率（200±30）KHz,脉冲周期400ms,治疗用声波输出持续时间1s,对38例患者的腹部皮下脂肪进行减脂塑形治疗。患者间隔两周治疗一次,最末次治疗后两周随访。结果：38例患者中,28例治疗了3次,6例治疗了4次,4例治疗了6次。治疗过程中,治疗部位未见皮肤红肿、水疱、溃疡。38例患者治疗前后体重平均下降（0.45±1.24）Kg,3次治疗腹围减少（2.20±1.94）cm,4次治疗腹围减少（2.92±2.31）cm,6次治疗腹围减少（4.75±2.52）cm。结论：应用聚焦超声融脂机进行减脂塑形治疗,临床证明有效,为临床提供了一种新的无创、非侵入性治疗方法。     

非侵入性聚焦超声减脂塑形机临床应用安全性的探讨

目的 探讨临床应用非侵入性聚焦超声减脂塑形机进行塑形治疗的安全性.方法 应用JCS01型非侵入性聚焦超声减脂塑形机,对40例自愿受试者进行随机、盲法、阴性平行对照的临床试验.分别间隔6d对受试者腹部脂肪堆积部位进行2次(每次治疗自动扫描3次)治疗,对治疗时的局部反应进行即时观察和随访,并分别于治疗前及第1次治疗后14d进行肝功能及血脂等多项检查.结果 40例受试者中,36例(实验组与对照组各18例)完成了应用非侵入性聚焦超声减脂塑形机减脂塑形治疗的全部临床试验内容,治疗后局部塑形效果明显,试验组4例受试者自述有局部的微热或轻微的刺痛感,1例受试者末次治疗第7天血甘油三酯(三酰甘油)检查结果升高,2周后再复查恢复正常.其他受试者无局部不良反应,各项实验室检查结果无异常.结论 在2次间隔6d,每次不超过500 cm2的治疗面积下,临床应用非侵入性聚焦超声减脂塑形机进行塑形治疗是安全的.     

选择性非接触式射频设备对亚洲人腰腹部减脂塑形的疗效及安全性研究

目的:观察选择性非接触式射频设备对亚洲人腰腹部减脂塑形的治疗效果及安全性。方法:选取16例健康就医者,使用选择性非接触式射频设备(BTL Vanquish征服,英国BTL公司)进行腰腹部照射减脂和塑形。每次治疗45min,每周治疗1次,总共4次,不接触皮肤。观察治疗前后就医者腹围、卡尺测量皮下脂肪厚度和彩超测定皮下脂肪厚度变化,治疗疼痛度、主观评分及安全性。结果:16例就医者治疗4次后随访3个月,治疗前平均腹围、平均腹部卡尺测量皮下脂肪厚度、平均腹部彩超测量皮下脂肪厚度、平均体重分别为(97.94±8.64)cm、(40.97±3.54)mm、(30.93±6.48)mm、(72.07±11.96)kg,治疗后为(94.15±8.11)cm、(37.07±2.91)mm、(26.44±4.70)mm、(70.50±11.50)kg,差异有统计学意义(P0.05)。就医者主观评价腰腹部平坦度和皮肤紧实度得到改善,治疗过程中未观察到不良反应。结论:选择性非接触式射频设备可有效进行腰腹部减脂塑形且安全有效。     

1064nmNd:YAG秒级激光联合长脉宽Er∶YAG激光对腰腹部减脂塑形的疗效及安全性

目的:观察1064nm Nd:YAG秒级激光联合长脉宽Er:YAG激光对腰腹部减脂塑形的治疗效果及安全性。方法:30例就医者,先后使用1064nm Nd:YAG秒级激光和长脉宽Er:YAG激光(SP Dynamis激光治疗仪,Fotona)进行腰腹部照射减脂和塑形。每10～15d治疗1次,连续8次。观察治疗前后就医者腹围和B超下皮下脂肪层厚度变化,治疗疼痛度、主观评分及安全性。结果:29例就医者完成了治疗,就医者的上、中、下腹围均值减小,治疗前分别为(83.550±9.212)cm、(90.047±8.009)cm和(94.384±7.326)cm,治疗后为(80.209±8.219)cm、(87.606±7.695)cm和(92.128±6.478)cm,差异具有显著性(P0.01)。同样观察到腰腹部皮下脂肪厚度均值较前减少(P0.05)。疼痛VAS评分为4.48±0.91(Nd:YAG激光)和3.28±0.75(Er:YAG激光)。就医者主观评价腰腹部皮肤紧实度和腹部平坦度得到改善,腰围减小(P0.01),治疗过程中未观察到不良反应。结论:1 064nm Nd:YAG秒级激光联合长脉宽Er:YAG可有效进行腰腹部减脂塑形,且具有较好的安全性。     

光电技术应用于减脂塑形的进展

随着生活水平的提高,人们对于良好体形和完美塑形的需求日益增多。非损伤性的减脂塑形治疗方法成为当今整形外科的研究热点,光电技术在其中发挥了重要作用,主要包括射频、高频聚焦超声、弱激光、冷冻溶脂等。现就其减脂机制、临床表现、优缺点进行概述比较,以期为临床应用减脂塑形提供一定的参考依据。     

非手术减脂塑形的现状与展望

非手术减脂塑形技术是一种安全、有效改善局部脂肪堆积的方法,具有疼痛感较低、不良反应较小、无误工期等优势,受到患者的青睐。现对激光减脂塑形、射频减脂塑形、聚焦超声减脂塑形、冷冻减脂塑形这4种技术进行概括总结,并对每种方法的原理、特点以及临床效果及治疗风险等方面作一综述,以期对今后临床工作的开展提供参考。     

肠梗阻导管在腹部术后早期炎性肠梗阻治疗中的应用

目的探讨经鼻型肠梗阻导管在腹部术后早期炎性肠梗阻治疗中的作用。方法对我院2004年6月至2006年6月期间40例腹部术后早期炎性肠梗阻患者,随机分成经鼻型肠梗阻导管组和鼻胃管组。观察腹胀改善情况(腹围)、胃肠减压量、腹部X线平片、气液平面消失时间等指标,对结果进行分析比较。结果经鼻型肠梗阻导管组患者的胃肠减压量(1021.2±265.4)ml/d较鼻胃管组(642.5±325.4)ml/d明显增多,且腹围(15.2±5.5)cm减少较鼻胃管组的(5.7±3.6)cm更明显,气液平面消失时间(10.3±8.5)d较鼻胃管组的(15.6±11.7)d明显缩短,差异有统计学意义(P<0.05)。结论经鼻型肠梗阻导管能更有效胃肠减压,减轻腹胀,促进肠蠕动,治疗腹部术后早期炎性肠梗阻作用显著。     

Body contouring by non-invasive transdermal focused ultrasound

BACKGROUND AND OBJECTIVES: The risks of currently available invasive procedures in body contouring motivate a need for safer, non-invasive technologies for improving the appearance of body silhouette. A new device has been developed that uses focused therapeutic ultrasound to reduce adipose tissue non-invasively. The aim of this study was to assess the efficacy and safety of a novel non-invasive focused ultrasound system (UltraShape Ltd, Tel Aviv, Israel) in reducing localized fat deposits to improve body contours. STUDY DESIGN/PATIENTS AND METHODS: A prospective study was conducted on 30 healthy patients. All patients underwent three treatments, at 1-month intervals, and were followed for 1 month after the last treatment. Areas treated were the abdomen, inner and outer thighs, flanks, inner knees, and breasts (males only). No other body contouring procedure was used during the study. Efficacy was determined by change in fat thickness, assessed by ultrasound measurements, and by circumference measurements. Weight change was monitored to assess whether reduction in fat thickness or circumference was dependent on or independent of weight loss. Safety was determined by clinical findings, assays of serum triglycerides, and liver ultrasound evaluation for the presence of steatosis. RESULTS: All patients showed significant reduction in subcutaneous fat thickness within the treated area. The mean reduction in fat thickness after three treatments was 2.28+/-0.80 cm. Circumference was reduced by a mean of 3.95+/-1.99 cm. Weight was unchanged during the treatment and follow-up period. No adverse effects were observed. CONCLUSIONS: This study shows the efficacy and safety of focused ultrasound, using the UltraShape Contour I, as a non-invasive transdermal method for reducing unwanted fat deposits in the body. Multiple treatments combined with appropriate patient and treatment area selection can produce dramatic improvements in body contour.     

非侵入性聚焦超声辐照活猪皮下脂肪层即刻结果的组织学观察

目的:观察聚焦超声照射活体实验用小型猪皮下脂肪后的组织学即刻表现。方法:采用频率1.9MHz,焦域不大于12mm,平均声功率(550±20%)W的聚焦超声照射猪背部皮下脂肪,即刻切取包括皮肤全层与肌肉浅层的标本块制作病理切片,HE染色,组织学观察。结果:镜下可见脂肪层内存在大量点状脂肪细胞破坏损伤灶。损伤灶有10个细胞大小,灶内脂肪细胞破裂、消失,多个损伤灶可融合成较大损伤区。照射区与损伤灶内均未见出血与游离红细胞,未见皮肤和肌层损伤。结论:脉冲输出的聚焦超声可选择性破坏脂肪细胞。     

Combination therapy of focused ultrasound and radio-frequency for noninvasive body contouring in Asians with MRI photographic documentation

Previous studies have shown that single or multiple treatments by focused ultrasound are effective and safe. However, most include focused ultrasound only and not radio-frequency treatment. There is paucity of magnetic resonance imaging (MRI) measurements and pictures in the literature. This study aimed to assess the efficacy, safety, and pain and satisfaction levels of the combination therapy of focused ultrasound and radio-frequency for improving body contours. Thirty-two Asian patients received 3 sequential treatments every 2 weeks in the abdominal region. Safety parameters and adverse events were recorded. The subjects’ pain and satisfaction levels were evaluated using a five-point Likert scale. Two patients underwent MRI study randomly. There was a mean reduction in circumference of 3.91?±?1.8 cm (p?≤?0.001). In MRI measurement, the average in fat thickness reduction was 21.4 and 25 % on the upper and lower abdomen, respectively. There were three mild and self-limited localized adverse events. The satisfaction survey showed that 71.9 % was satisfied with the results, while pain level evaluation showed that 90.5 % felt no pain. Combination therapy of focused ultrasound and radio-frequency for noninvasive body contouring is an effective, safe, and painless procedure in Asians. Although the change is minor compared to traditional surgical procedure, it is real, definite, and effective.     

Long-term follow-up for noninvasive body contouring treatment in Asians

There are versatile modalities to achieve noninvasive fat reduction, and most of them have proven to be effective for circumferential reduction of local fat tissue, without any serious or permanent adverse effects. However, the follow-up time is short, ranging from 1 to 24 weeks. Most of the patients would like to know how long will its effect last and whether there is long-term side effect or not. The aim of this study was to assess the long-term efficacy and safety of combination therapy of focused ultrasound and radio frequency for noninvasive body contouring. Thirty-two Asian subjects received three sequential combination therapies of focused ultrasound and radio-frequency treatments every 2 weeks in the abdominal region and were followed up 1 month and 1 year after the last treatment. After a year, 5 patients were loss follow-up and 2 were pregnant. Finally, 25 healthy Asian subjects (18 females and 7 males) were enrolled in this study. Safety parameters and adverse events were recorded. The mean body weight change remained constant without a significant change 1 year after treatment and was 0.1?±?1.2 kg (p?=?0.513). The mean abdominal circumference change between 1 month and 1 year after the last treatment was 0.4?±?1.2 cm and was not significant (p?=?0.169). The relationships between weight change and circumference change of the 23 patients were tested using Spearman’s rho correlation coefficient. There was a correlation between weight change and circumference change (0.73; p?=?0.000). The procedure was safe without a recordable long-term adverse event. The combination therapies of nonthermally focused ultrasound and radio-frequency treatments for body contouring in the abdominal region are effective and may show positive results for at least a year if patients can maintain their body weight. The procedure is safe without recordable long-term adverse events in this study.     

超声诊断腹膜粘连的临床评价——20年文献分析

通过对20年来腹膜粘连超声评价的有关文献分析,探讨超声评价腹膜粘连的临床意义.共29篇文献纳入分析,分为3类：超声评价腹膜粘连的方法学研究,以超声观察＂内脏滑动＂方法研究腹腔镜手术入路的安全性,对超声诊断腹腔内粘连的评价.通过对这些文献的分析与总结,得出以下结论：以内脏纵向滑动距离＜1 cm作为诊断腹膜粘连的标准;对腹壁局部进行重点超声扫查是目前比较合理的策略;临床上可用于术前评估腹部手术、腹腔镜入路的安全性,还可用于防粘连效果的评估.     

Regional differences in ultrasonic assessment of subcutaneous fat thickness in the abdomen: effects on the TRAM flap

The authors describe the results of fat thickness patterning of the abdominal sites in 50 patients, all of whom required breast reconstruction with a transverse rectus abdominis musculocutaneous flap. The thickness of the abdominal fat was measured at 12 anatomic locations with an ultrasonic instrument. The highest value of the subcutaneous fat thickness was 29.0+/-10.0 mm at a site 2 cm below the umbilicus at the center of the rectus abdominis muscle. The lowest value of the subcutaneous fat thickness was 17.8+/-7.6 mm at a site 2 cm above the umbilicus on the anterior superior iliac spine. Average subcutaneous fat thickness over the abdomen of 50 patients was 24.0+/-9.4 mm. There were 13 patients (group 1) who had an abdominal fat thickness of more than 30 mm, 19 patients (group 2) with an abdominal fat thickness less than 30 mm and more than 20 mm, and 18 patients (group 3) with an abdominal fat thickness less than 20 mm. Complications occurred in 12 of 50 flaps (24%). Among groups 1, 2, and 3 there was no significant difference (p<0.01) in the overall flap complications (15.4: 36.8: 16.7). In summary, subcutaneous fat thickness showed the higher value at the center of the abdomen and the lower value at the lateral site. Abdominal fat thickness is not a risk factor for necrosis of pedicled transverse rectus abdominis musculocutaneous flaps in patients who are thin, average, or mildly obese. Preoperative examination of the abdominal subcutaneous fat thickness should provide useful information for detailed simulation of a reconstructive operation.     

腹腔开放疗法治疗严重腹腔感染的临床疗效

目的 探讨腹腔开放疗法治疗严重腹腔感染的临床疗效.方法 回顾性分析2009年1月至2014年1月兰州军区兰州总医院收治的36例严重腹腔感染患者的临床资料.所有患者完善检查后,行早期复苏,遵循“损伤控制外科”原则开腹清创,一期手术行腹腔开放疗法,腹腔感染控制后于14 d内行二期关闭腹腔术.术中吸取腹腔内脓液行细菌培养.术后予以抗休克、抗感染、保护脏器功能、营养支持和对症治疗.采用门诊和电话方式进行随访,随访时间截至2014年3月.结果 所有患者顺利完成一期和二期手术,二期术后因感染性休克和MODS死亡6例,治愈出院30例,其中行2次手术8例.两期手术时间为（157±26） min,术中出血量为（230±64） mL,术后胃肠功能恢复时间为（44 ±7）h,术后住院时间为（16±5）d.所有患者成功行腹腔脓液细菌培养,共分离出菌株48株,其中革兰阴性菌31株,革兰阳性菌17株,根据药物敏感试验结果选用亚胺培南和头孢哌酮等抗生素.30例患者术后均获得随访,中位随访时间为6个月.随访期间,6例患者发生粘连性肠梗阻,2例患者发生腹壁切口疝,均经肠粘连松解术或切口疝修补术治疗后痊愈.其余22例患者无并发症发生.结论 对能够耐受手术的严重腹腔感染患者,采用腹腔开放疗法早期开腹清创疗效确切.     

肿胀麻醉下外超声与非超声吸脂术的比较研究

目的：比较肿胀麻醉法下的外超声吸脂与单纯负压吸脂术的差别，以探讨外超声吸脂术的优点，方法：将10－例吸脂者的腹部均分为左右两侧，在肿胀麻醉下一侧行外超声吸脂，另一侧行单纯负压吸脂，比较吸脂效果并分析吸出物，结果：临床吸脂患者中，外超声作用侧所吸出的上层脂肪占总吸出量的百分比大于非超声吸脂侧（P＜0．001），吸出物中外超声吸脂侧血红蛋白浓度低于非超声吸脂侧（P＜0．001），三酰甘油浓度高于非超声吸脂侧（P＜0．001），血红蛋白与三酰甘油的比值低于非超声侧（P＜0．001），提示外超声吸脂明显较非超声吸脂术脂肪乳化好，出血亦少，且操作省力，术后并发症轻，皮肤收缩效果好，结论：外超声吸脂术是一种去除局部堆积脂肪的更为安全，有效的方法。