豫南地区150名成年女性腹部皮下脂肪厚度及体积测量研究

目的 为了解成年女性腹部皮下脂肪堆积及分布情况，获得腹部脂肪厚度及体积量学指标。方法 用全身彩超测试腹部皮下脂肪厚度，在５８６计算机ＵＣＤＯＳ环境下，应用Ｆｏｘｂａｓｅ＾＋下的生物医学数据处理程度进行计算分析。结果 脐部、上腹部、下腹部皮下脂肪明显高于其它部位Ｐ〈０．０１，当以上区域皮下脂肪厚度分别超过２５ｍｍ、２４ｍｍ、１２ｍｍ时，应做为脂肪抽吸术的适应证范围。并提出了计算腹部皮下脂肪厚度及体积的方程式。结论 本测量方法，较为准确的测量出成年女性腹部皮下脂肪的厚度、体积及范围，其结果对皮下脂肪的厚度、体积及范围，其结果对皮下脂肪抽吸术适应证的选择，抽吸量的估计，抽吸范围的确定具有一定的指导意义。     

豫南地区150名成年女性腹部皮下脂肪厚度及体积测量研究

目的为了解成年女性腹部皮下脂肪堆积及分布情况,获得腹部脂肪厚度及体积量学指标.方法用全身彩超测试腹部皮下脂肪厚度,在586计算机UCDOS环境下,应用Foxbase+下的生物医学数据处理程度进行计算分析.结果脐部、上腹部、下腹部皮下脂肪明显高于其它部位P＜0.01,当以上区域皮下脂肪厚度分别超过25mm、24mm、12mm时,应做为脂肪抽吸术的适应证范围.并提出了计算腹部皮下脂肪厚度及体积的方程式.结论本测量方法,较为准确的测量出成年女性腹部皮下脂肪的厚度、体积及范围,其结果对皮下脂肪的厚度、体积及范围,其结果对皮下脂肪抽吸术适应证的选择,抽吸量的估计,抽吸范围的确定具有一定的指导意义.     

共振吸脂术四肢塑形临床报告

目的:为了提高吸脂效率,减少术中出血,缩短手术时间,降低对皮肤神经血管等的组织损伤,改善手术效果,对操作技巧进行总结。方法:接受四肢吸脂者共86例,根据其要求,分别对上臂(35例)、大腿部(30例)以及小腿部(21例)进行共振吸脂术,记录所注入的麻醉药量和吸出的纯脂肪量,以及吸前和吸后1～3个月的周径变化。结果:随访示效果满意,大腿正中围缩小3～12cm,小腿正中围缩小2～8cm,上臂正中围缩小2～6cm。皮肤平坦、无严重并发症发生、无反弹迹象。结论:共振吸脂用于四肢塑形的治疗,是一种安全、可靠、有效的方法,医师的熟练操作技巧是手术成功至关重要的因素。     

肿胀吸脂治疗皮下脂肪瘤

目的：介绍一种简单、安全、有效、创伤小、恢复快且瘢痕少的治疗皮下脂肪瘤的手术方法。方法：采用肿胀麻醉,用吸脂针在脂肪瘤中均匀细致抽吸以达到治疗目的。结果：23例患者术后皮肤无或仅轻度瘀青,术后无瘢痕,未发生感染、皮下积血积液、局部凹陷等并发症,随访1～18个月,病灶无复发,效果理想,医患双方均满意。结论：采用肿胀抽吸术治疗皮下脂肪瘤,术后切口瘢痕少,手术操作简单、安全有效、创伤小、恢复快、易掌握、医患双方均易接受,值得临床推广应用。     

体外超声吸脂术200例观察

目的：观察体外超声吸脂术的效果。方法：用体外超声吸脂系统对200例不同部位脂肪堆积者进行吸脂术，术后对161例随访3-12个月。结果：手术无严重并发症，临床有效率达100％。有12例自觉不满意（占被随访者的7.45％），其中小腿4例，大腿3例，臀部3例，上腹2例。结论：体外超声吸脂术是安全有效的方法，其最佳适应对象是轻度肥胖或腹部局限性脂肪堆积者。     

吸脂管进脂孔与吸脂量关系的实验研究

目的 探讨吸脂管进脂孔与吸脂量的关系。方法 根据进脂孔形状，面积、接与不接电刀，分4组抽吸入离体脂肪，定量分析。结果 双二齿形孔管吸脂量大于二齿形孔，菱形孔等吸脂管；进脂孔面积为2倍管腔截面积时吸脂量最大；配接电刀的管吸脂量大于不配接管。结论 进脂孔面积是管腔截面积2倍，形状为孔缘有锐刃的多锐角组成。配接高频电刀的吸脂管较佳。     

体外超声吸脂500例

目的　探讨体外超声吸脂术的疗效、安全性以及寻求各部位术后体围变化的规律。方法　对 5 0 0例患者的 5 95个部位进行体外超声吸脂术。记录各部位人均注入肿胀麻醉液量及吸出的纯脂肪量 ,并经 1～ 3个月跟踪调查 ,记录各部位术前术后体围的变化 ,对各部位各体围测量点的体围缩小值进行比较和统计学分析。结果　腰腹部、大腿部注入的麻醉液及吸出的脂肪量最高 ,各部位术后均有不同程度的体围缩小 ,随肥胖程度加重 ,腰腹部体围变化越为明显 ,最小腰围、脐围、最大腰围的变化有逐渐减少的趋势 ,但当最小腰围超过 111cm以后 ,术后以脐围的改变最为明显 ,大腿部以及上臂部以中上段改变最为明显。术中术后患者出血量较少 ,痛苦程度轻 ,术后恢复较迅速 ,皮肤平坦 ,无严重并发症发生。患者术后各部位未见反弹迹象 ,结论　体外超声吸脂术安全可靠 ,效果确切 ,受术者易接受。吸脂术后体围的变化可能有规律可循 ,对指导术前咨询以及效果预测有一定的临床意义。     

激光吸脂术的动物实验研究

目的　评价激光吸脂术相对于常规吸脂术的优缺点。方法　将实验动物分为激光吸脂术、常规吸脂术和对照组 3组。对两手术组动物以术后皮肤有否瘀斑、水肿及抽吸物的脂 血容量比值、术前术后血红蛋白含量和血生化指标改变进行比较。结果　激光吸脂术在术后皮肤瘀斑、水肿、抽吸物脂 血比值和更少并发症方面优于常规吸脂术。且术后皮肤瘀斑和抽吸物的脂 血比值差异有显著性意义 (P <0 0 5 ) ;两组术前及术后血红蛋白含量变化差异无显著性意义 ;激光吸脂术对动物肝肾功能无影响。结论　激光吸脂术术中出血、术后皮肤瘀斑和水肿等比常规吸脂术明显减少 ,并不会导致实验动物肝肾功能损害。     

吸脂在面部轮廓塑形的应用

目的探讨并分析面颊、颌下吸脂在面部轮廓塑形和面部年轻化中的应用。方法在肿胀麻醉下,用钝头单侧孔细吸脂管对面颊、颌下进行低负压、等同平面吸脂。结果本组共327例,323例结果满意,满意率98%。有4例效果欠佳,经再次手术处理后达到预期效果。结论面颊部、颌下吸脂在面部轮廓塑形及面部年轻化手术中具有良好的效果。     

Postliposuction histologic alterations of adipose tissue

The author studied seven patients who received suction assisted lipectomy prior to classic abdominal dermolipectomies. The liposuction sessions were performed 180, 150, 60, 30, 15, 12, 8, and 5 days before the abdominoplasties. Histologic studies disclosed extensive amounts of dead adipocytes and free fat within the aspirated area. The pockets left behind were filled with serum hemorrhagic material and evolved to the healing process. Collagen synthesis was increased initially then followed by gradual decrease and a remodeling process. Our findings suggest that liposuction techniques preserve some vessels and nerves, but the final resolution may take several months or years, depending on the amount of tissue damage.     

Study of aspirated adipose tissue

The author studied the components of aspirated adipose tissue. The several phases of this material were dissociated through decantation and centrifugation. The components were studied “in vitro” by fresh observation with loupes and microscopes. Histologic preparations were also used in this study. The results disclosed a heterogeneous material composed of free fat, blood components, fragments of adipose tissue of different shapes and sizes, collagen septa, vessels and nerves, clots, ruptured cells, and macromolecules of proteases, hemoglobin, and inflammatory proteins. These findings were present in the fat aspirated both with liposuction devices and with syringes.     

人脂肪源细胞外囊泡联合脱细胞脂肪组织支架构建组织工程脂肪

目的探讨人脂肪源细胞外囊泡(human adipose tissue derived extracellular vesicle,hAT-EV)联合脱细胞脂肪组织支架(decellularized adipose tissues,DAT)构建组织工程脂肪的可能性,为临床上软组织缺损修复提供新方案。方法将吸脂手术患者自愿捐赠的脂肪组织分为2份,1份脂肪组织进行脱细胞处理,并采用组织学(HE、Masson染色)、扫描电镜观察,Ⅰ、Ⅳ型胶原及层粘连蛋白免疫组织化学染色和Western blot检测进行表征。另1份脂肪组织使用去外泌体的完全培养基孵化48 h,离心收集培养基上清并使用超高速离心法获取hATEV。使用透射电镜观察其形态,纳米颗粒跟踪分析仪NanoSight分析hAT-EV粒径分布范围,Western blot检测分析hAT-EV膜表面蛋白。将PKH26荧光标记的hAT-EV与脂肪干细胞(adipose derived stem cells,ADSCs)共培养后,共聚焦荧光显微镜观察hAT-EV能否进入ADSCs;将hAT-EV与ADSCs共培养15 d,油红O染色评估其成脂效果。将DAT组织剪碎并注射至8只6周龄雌性C57小鼠背部两侧,左侧每周注射0.2 mL hAT-EV作为实验组,右侧每周注射0.2 mL PBS作为对照组。12周后处死小鼠,取两侧DAT新生物进行湿重称量,并通过HE染色和围脂滴蛋白免疫荧光染色评估hAT-EV在体内诱导脂肪新生的能力。结果脂肪组织经脱细胞后,HE、Masson染色示DAT主要由排列松散的胶原构成,未见细胞核;扫描电镜示DAT中未发现细胞和细胞碎片,同时可见到粗大的胶原纤维束;免疫组织化学染色及Western blot检测示,DAT中保留了Ⅰ、Ⅳ型胶原和层粘连蛋白。经鉴定,hAT-EV呈双层包膜的球形,高表达CD63、凋亡诱导因子6相互作用蛋白抗体、肿瘤易感基因101,97.9%粒径分布范围为32.67~220.20 nm,峰值为91.28 nm。共聚焦荧光显微镜和油红O染色示,hAT-EV被ADSCs摄取并诱导其成脂分化。大鼠体内实验显示,实验组新生脂肪组织湿重显著高于对照组(t=2.278,P=0.048);HE染色示,实验组脂滴结构较对照组多,对照组胶原含量高于实验组;围脂滴蛋白免疫荧光染色示,实验组DAT新生物中脂肪组织比例高于对照组(t=4.648,P=0.017)。结论DAT搭载hAT-EV可作为一种诱导脂肪组织新生的新方法,在软组织缺损修复中具有潜在应用前景。     

The subcutaneous adipose turnover flap: successful coverage of a difficult electrical burn wound of the wrist

Skin-grafted subcutaneous adipose turnover flaps can be very useful in providing cover of exposed joints especially in critically ill patients. An exposed wrist joint due to a full-thickness electrical burn was successfully covered with a large turnover pure subcutaneous flap harvested from the forearm. Stable cover and good function with minimal donor site morbidity was achieved (22 months follow-up). The planning and the anatomical bases of this useful flap are discussed.C. Tremolada     

Influence of motor complete spinal cord injury on visceral and subcutaneous adipose tissue measured by multi-axial magnetic resonance imaging

Objective

Abdominal obesity conveys substantial health risks, in association with high levels of visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT) and an increased proportion of VAT to SAT. The purposes were to determine the influence of spinal cord injury (SCI) on the associations between single axial cross-sectional area (CSA) slices and the average CSA or volumes of VAT and SAT across multi-axial slices of magnetic resonance imaging (MRI); and the relationships relative to the whole body composition and anthropometrics.

Methods

Thirteen healthy male participants with traumatic motor complete SCI underwent fast spin-echo MRI to measure VAT and SAT across multi-axial slices, followed by dual-energy X-ray absorptiometry to measure whole body fat-free mass (FFM) and fat mass (FM). Waist circumference (WC) was also measured in the seated position.

Results

The trunk CSAs of VAT and SAT were 99 ± 51 and 164 ± 69 cm², respectively, and the ratio of VAT to SAT was 0.68 ± 0.33. The CSAs of VAT and SAT at a single slice strongly predicted the average CSA and modestly predicted the volumes across multi-axial slices. VAT and SAT represented 5.7 ± 1.8% and 9.7 ± 3.2% of the total body FM, respectively. Percent body FFM was negatively related to VAT and SAT volumes, but not to a single axial CSA.

Conclusion

A single slice CSA can modestly predict the volume of multi-axial slices in individuals with SCI, yet it is not related to any of the body composition variables. Increased percent FFM is associated with a reduction in VAT and SAT volumes measured across multi-axial slices. The ratio of VAT to SAT is greater than 0.4, suggesting that individuals with SCI are at high risk of developing metabolic sequelae.     

Aspiration lipectomy and adipose tissue injection pathophysiologic commentary

Summary The subcutis, made up of connective and adipose tissue, may consist of one or two layers, depending on the part of the body. The superficial layer, up to 10 mm in thickness, has the function of giving contour. In localizations where one typically sees relatively large fat deposits a padding layer is added to the contour layer, and this may be centimeters in thickness. Aspiration lipectomy should be limited to reducing the padding layer. The advancing cannula perforates the supportive structures in the subcutis and breaks up the fat lobules. Analysis of the aspirated material suggests that residues of fat lobules remain adhering to the chamber walls; it may be assumed that they necrose and are removed by the mechanisms of foreign body reaction. Some stiffening of the reduced subcutis due to fibroproductive processes appears to be inevitable. Implantation of fat fragments obtained through lipectomy offers little biological advantage; at the same time one must expect extensive necrosis of the implanted tissue. With fat cell suspensions, failure to heal seems to be due to inadequate restoration of the capillary bed. The use of cultured preadipocytes to build up adipose tissue is an attractive idea, but the method is still at the experimental stage. Presented on the 19th Congress of the German Society for Plastic Surgery in Düsseldorf, September 27–30, 1989     

Study of the histologic alterations and viability of the adipose graft in humans

The authors describe a series of sections of adipose autografts in humans, focusing on the histological viability and the alterations observed in a postgraft followup. Five female patients aged 29 to 43 years were subjected to seven grafting sessions prior to a classic abdominoplasty. The autologous adipose tissue was grafted in the infraumbilical region. The grafting intervals were 60, 30, 21, 15, 8, 5, and 2 days before the surgical procedure. The grafted tissue of all groups was surrounded by a collagen capsule. The viable tissue was observed in the peripheral zone approximately 1.5 ± 0.5 mm from the edge of the graft. A loss of approximately 60% of the grafted tissue was still noticed in this viable zone.     

肿胀麻醉脂肪抽吸术284例

目的探讨应用肿胀麻醉抽吸术治疗局限性肥胖的安全性和手术技巧。方法术前设计选择隐蔽切口,采用肿胀技术,负压为0.06kPa,选择直径2.8-4.0mm的钝头侧孔吸脂针,沿术前设计抽吸范围分层、隧道内、放射状抽吸脂肪。结果本组284例患者,术后157例随访3-20个月,术区平整对称,切口瘢痕隐蔽细小,效果满意。结论该方法麻醉效果彻底且作用时间较长,出血少,组织损伤小。正确的脂肪抽吸方法和精细操作,是手术成功的关键。     

Benefits of healthy adipose tissue in the treatment of diabetes

The major malfunction in diabetes mellitus is severe perturbation of glucose homeostasis caused by deficiency of insulin. Insulin deficiency is either absolute due to destruction or failure of pancreatic β cells, or relative due to decreased sensitivity of peripheral tissues to insulin. The primary lesion being related to insulin, treatments for diabetes focus on insulin replacement and/or increasing sensitivity to insulin. These therapies have their own limitations and complications, some of which can be life-threatening. For example, exogenous insulin administration can lead to fatal hypoglycemic episodes; islet/pancreas transplantation requires life-long immunosuppressive therapy; and anti-diabetic drugs have dangerous side effects including edema, heart failure and lactic acidosis. Thus the need remains for better safer long term treatments for diabetes. The ultimate goal in treating diabetes is to re-establish glucose homeostasis, preferably through endogenously generated hormones. Recent studies increasingly show that extra-pancreatic hormones, particularly those arising from adipose tissue, can compensate for insulin, or entirely replace the function of insulin under appropriate circumstances. Adipose tissue is a versatile endocrine organ that secretes a variety of hormones with far-reaching effects on overall metabolism. While unhealthy adipose tissue can exacerbate diabetes through limiting circulation and secreting of pro-inflammatory cytokines, healthy uninflamed adipose tissue secretes beneficial adipokines with hypoglycemic and anti-inflammatory properties, which can complement and/or compensate for the function of insulin. Administration of specific adipokines is known to alleviate both type 1 and 2 diabetes, and leptin mono-therapy is reported to reverse type 1 diabetes independent of insulin. Although specific adipokines may correct diabetes, administration of individual adipokines still carries risks similar to those of insulin monotherapy. Thus a better approach is to achieve glucose homeostasis with endogenously-generated adipokines through transplantation or regeneration of healthy adipose tissue. Our recent studies on mouse models show that type 1 diabetes can be reversed without insulin through subcutaneous transplantation of embryonic brown adipose tissue, which leads to replenishment of recipients’ white adipose tissue; increase of a number of beneficial adipokines; and fast and long-lasting euglycemia. Insulin-independent glucose homeostasis is established through a combination of endogenously generated hormones arising from the transplant and/or newly-replenished white adipose tissue. Transplantation of healthy white adipose tissue is reported to alleviate type 2 diabetes in rodent models on several occasions, and increasing the content of endogenous brown adipose tissue is known to combat obesity and type 2 diabetes in both humans and animal models. While the underlying mechanisms are not fully documented, the beneficial effects of healthy adipose tissue in improving metabolism are increasingly reported, and are worthy of attention as a powerful tool in combating metabolic disease.