聚丙烯酰胺水凝胶注射隆乳术后并发症处理临床分析

目的探讨聚丙烯酰胺水凝胶注射隆乳术后并发症的处理方法。方法本组病例12例,注射聚丙烯酰胺水凝胶隆乳术后14～51个月,出现乳腺感染脓肿2例,多发性硬结形成或移位8例,有恐惧心理要求取出水凝胶2例。所有患者术前均行彩超或MRI检查定位。经乳晕切口取出9例,其中3例行一期硅胶假体隆乳术,2例乳腺脓肿感染经乳房下皱襞切口切开引流。结果随访3～12个月,患者均对取出术效果满意,乳房外形对称,无明显硬结扪及,无感染复发。术后B超检查仍可见少量水凝胶存在于乳腺组织中。结论水凝胶取出术采用乳晕切口直视下手术较为合理,对于乳腺脓肿选择乳房下皱襞切口。是否一期硅胶假体隆乳取决于胸大肌组织受累程度、患者的要求和术者的经验。水凝胶注射隆乳术后假体很难彻底清除,应加强对患者的术后随访和心理疏导。

The Clinical Analysis of the Effects of Treating Complications Resulted from Polyacrylamide Hydrogel Injection for Augmentation Mammaplasty

Objective To explore the effects of treatment of complications resulted from augmentation mammaplasty with polyacrylamide hydrogel (PAHG) injection. Methods 12 cases underwent augmentation mammaplasty with PAHG fourteen months to fifty-one months ago. Among them, 2 cases suffered from mammary abscess formation. Induration or displacement of PAHG was found in 8 cases. 2 cases felt scared about PAHG and insisted on removal of PAHG. All patients had color Doppler or MRI examination to localize the position of PAHG. PAHG was removed from a peri-areolar approach in 9 cases while in 2 cases from a low inframammary fold for the drainage of the abscess. One stage silicon breast implantation was performed for augmentation mammaplasty in 3 cases. Results The follow-up ranged from three months to one year. All patients were satisfied with the result. The appearance of breasts was symmetry without significant induration. No recurrent infection was found. Postoperative ultrasound examination still detected small amounts of PAHG in the mammary tissues. Conclusions The peri-areolar incision was feasible in removing PAHG due to its direct operational vision. In the case of abscess formation, the low inframammary fold was the approach of the choice. In regarding to one-stage silicon breast implantation, it depended on the extent of involvement of the major pectoralis muscle, the requirement of the patients and the experience of the operators. It is still very difficult to remove PAHG completely. Therefore, an intensive postoperative follow-up and psychological treatment play an important role in care of patients with PAHG implantation.