注射美容填充引起非血栓性肺栓塞——病例报告及文献回顾  

Non-thrombotic pulmonary embolism after cosmetic filler injection: a case report and literature review

作　　者：王晨羽[1] 王晓军[1] 俞楠泽[1] 张明子[1] 黄久佐[1] 龙笑[1] 刘继海[2] 

机构地区：[1]中国医学科学院北京协和医院整形美容外科,北京100730 [2]中国医学科学院北京协和医院急诊科,北京100730

出　　处：《中国美容整形外科杂志》2017年第11期662-665,共4页Chinese Journal of Aesthetic and Plastic Surgery

摘　　要：目的结合注射自体脂肪继发非血栓性肺栓塞的病例报告进行文献回顾。方法自2000年1月至2017年4月,以注射美容填充、脂肪填充、透明质酸、肺栓塞和cosmetic injection、autologous fat、hyaluronic acid、pulmonary embolism为关键词,于Pubmed等数据库搜索文献;统计研究者信息、患者自然情况、注射治疗信息、并发症及预后。结果共纳入14篇文献,19例患者,均为女性(其中男性变女性2例)。临床表现:14例出现了气促、呼吸困难,1例以胸痛为主诉,1例胸痛合并意识障碍,2例以意识障碍、恶心呕吐、心动过缓为主诉。临床症状出现的时间为术后即刻至术后2个月。8例动脉血气分析提示低氧血症;11例行肺部CT检查,主要表现为双肺散在的"玻璃样"影;13例活检或尸检确认为肺栓塞;15例患者描述治疗状况时,以机械通气改善低氧血症为主,辅助使用激素、抗生素、支持疗法治疗等。12例改善或痊愈,6例死亡,1例不详。结论非血栓性肺栓塞为注射美容填充少见的严重并发症,需引起高度重视。Objective Relevant literature was reviewed and combined with the case report of a patient who had non-thrombotic pulmonary embolism after receiving autologous fat injection. Methods From January 2000 to April 2017, articles were collected from domestic and overseas databases, with the following keywords：＂filler injection＂＂autologous fat＂＂hyaluronic acid＂and＂pulmonary embolism＂Information about researchers, patients′ natural condition, injection, complications, therapy, and prognosis was collected. Results A total of 14 articles concerning 19 patients were involved in the study. All patients were female, except two cases of male degeneration. Among the patients, clinical manifestations included dyspnea and shortness of breath in 14 patients, pectoralgia in 1 patient, pectoralgia combined with unconsciousness in 1 patient, and a final patient experienced disturbance of consciousness, nausea, vomiting and bradycardia. The duration of the clinical symptoms ranged from immediately to 2 months after the operation. Arterial blood gas suggested hypoxemia in 8 cases. Eleven patients underwent CT examination, which showed scattered shadows like glass in both lungs. Thirteen patients were diagnosed with pulmonary embolism by biopsy or autopsy. Fifteen patients received treatment to improve symptoms, to include mechanical ventilation to improve hypoxemia, adjuvant treatment with hormones, antibiotics, or supportive care. Twelve patients were improved or cured, 6 patients died, and the outcome of one patient was not mentioned. Conclusion Non-thrombotic pulmonary embolism is a rare but severe complication of cosmetic filler injection, and should not be ignored.

关 键 词：注射美容填充 并发症 脂肪移植 透明质酸 肺栓塞 

分 类 号：R62[医药卫生—整形外科]