聚丙烯酰胺水凝胶注射隆乳取除术157例分析

目的探讨聚丙烯酰胺水凝胶（polyacrylamide hydrogel，PAHG）注射隆乳术后并发症分析与处理策略。方法对157例行PAHG注射隆乳术后因并发症受术者的病历资料进行回顾性分析。术前所有受术者均行MRI检查，其中23例行注射物三维重建，71例行血清丙烯酰胺单体检测，23例行PAHG中和12例行PAHG周围组织中丙烯酰胺单体含量检测，7例于PAHG清除后即时置入硅胶乳房假体。结果MRI三维重建可直观、详细地显示注射物的位置、范围、层次及完整性。7例血清、5例PAHG和3例周围组织中检测出丙烯酰胺单体。131例受术者术后效果满意。所有受术者随访3～6个月，乳房触诊均未发现硬结。7例即时置入硅胶乳房假体者乳房外形及手感良好。结论术前首选MRI检查，条件允许时可进一步行三维重建。就目前检测手段尚无PAHG在体内分解为丙烯酰胺单体的有力证据。取除手术应在直视下尽量清除注射物及周围包膜和变性组织，切忌盲视下抽吸。在受术者有强烈要求、肌肉保存完整和无炎症的的前提下，可考虑即时行硅胶乳房假体置入重建乳房形态。

Postoperative management of breast augmentation by polyacrylamide hydrogel injection:a report of 157 cases

Objeetive To discuss a reasonable postoperative management of breast augmentation by polyacrylamide hydrogel (PAHG) injection.Methods The retrospective study was used to analyze 157 cases which received breast augmentation by PAHG injection.MRI was used in all of cases preoperatively.Among these patients,23 were located by three-dimensional (3D) reconstruction,the content of mono acrylamide in the serum of 71 cases were examined in the hydrogel of 23 cases and in the tissue around the hydrogel of 12 cases,respectively.The silicone gel implants were planted after the removal of PAHG in 7 cases.Results MRI-3D could show the injectants location,scope,layer and integrality more intuitional and more detailed.The momo acrylamide was found in the serum with 7 cases,in the hydrogel with 5 cases,in the tissue around the hydrogel with 3 cases.131 cases gained satisfactory results.All the cases received 3 to 6 months follow-up.The scleroma was not found after the palpation of breast.In the 7 cases that were planted with the silicone gel implants immediately,the shape and texture of the breast were both great.Conclusions The preoperative MRI examination is a first-choice,and if possible,3D reconstruction is better.With the detecting methods so far,there is no strong evidence to support the possibility of PAHG resolving into poisonous acrylamide inside the human body.During the operation,the injectant,the integument around the hydrogel and degenerative tissue should be orthoptically cleared-up as much as possible.Sucking the injectant blindly is not commended.The silicon gel prosthesis is planted to reconstruct the shape of breast immediately,but the prerequisite is that the patients have this demand and that the muscle is intact without inflammation.