聚丙烯酰胺水凝胶注射隆乳术后远期乳房组织的组织病理变化  

Pathological changes of breast tissue after long-term polyacrylamide hydrogel injection for augmentation mammoplasty

作　　者：聂芳菲[1] 李比[1] 夏有辰[1] 马建勋[1] 张洁[1] Nie Fangfei, Li Bi, Xia Youchen, Ma Jianxun, Zhang Jie(Department of Plastic Surgery, Peking University Third Hospital, Beijing 100191, China)

机构地区：[1]北京大学第三医院成形外科,100191

出　　处：《中华医学美学美容杂志》2018年第5期328-331,共4页Chinese Journal of Medical Aesthetics and Cosmetology

摘　　要：目的探讨聚丙烯酰胺水凝胶（PAHG）隆乳术后远期乳房组织无菌性坏死的病理机制。方法纳入胸部注射PAHG后无明显临床症状且要求手术取出，除外合并有假体植入的患者。收集术中取出物进行大体和镜下观察。连续切片行苏木精-伊红（HE）、Mallory染色、甲苯胺蓝染色，观察组织基本形态结构，初步鉴定胶原纤维和炎症细胞；行CD31和α-平滑肌肌动蛋白（α-SMA）抗体免疫组织化学染色，进一步鉴定血管内皮细胞和血管平滑肌细胞。分析注射年限与病理变化发生的相关性。结果无明显临床症状或硬结、变形移位为主。局部组织基本病理变化主要有：异物反应、慢性炎症反应、结缔组织纤维化和组织坏死；半数组织中有小血管平滑肌层增厚、管腔狭窄等组织病理变化。未发现各类型病理变化与患者病程长短有明显的相关性。结论求美者注射PAHG后远期有或无明显的临床症状，但其组织病理学变化客观存在。患者局部组织坏死可能是异物反应和炎症反应造成，也可能是由于小血管平滑肌增生、管腔狭窄，局部缺血所致。ObjectiveTo study the pathological mechanism of aseptic necrosis of breast tissue after long-term breast augmentation injected with polyacrylamide hydrogel （PAHG）.MethodsWe included patients who had no obvious clinical symptoms and underwent surgical removal of the PAHG in our hospital, excluding patients with a history of breast prosthesis implantation. Extracts were collected, and then underwent a careful gross observation and serial sections followed by HE, Mallory, and toluidine blue staining, to observe the histological structure of collagen fibers and inflammatory cells. Immunohistochemistry for CD31 and α-smooth muscle actin （α-SMA） antibody was used to further identify vascular endothelial cells and vascular smooth muscle cells, respectively. Analysis of the correlation between injection time and the incidence of different pathological changes were done.ResultsWe included 22 females （mean age 39.14 years, range 22-55 years） who requested surgical removal of the PAHG. The mean duration of PAHG injection was 9.27 years （range 4-14 years）. They had no clinical symptoms or only had induration, deformation and displacement. The basic pathological changes of local tissue included foreign body reaction and chronic inflammation, fibrosis and tissue necrosis; and half of the tissue had also histological changes, such as small vascular smooth muscle layer thickening, lumen stenosis, etc. No significant correlation was found between the pathological changes and the duration of the disease and the clinical symptoms.Conclusions Patients with PAHG injection for augmentation mammoplasty can histopathological changes of local tissues even without experiencing discomfort. The tissue necrosis in some patients may be caused by foreign body reaction and inflammatory reaction. It may also be due to local ischemia caused by small vascular smooth muscle hyperplasia, luminal stenosis etc.

关 键 词：聚丙烯酰胺水凝胶 注射隆乳术 远期 组织病理学 小血管 

分 类 号：R655.8[医药卫生—外科学]