面部自体脂肪注射后脑和肺部脂肪栓塞1例  

Case report:cerebral and pulmonary fat embolism after facial autologous fat injection

作　　者：左俊 马少林[2] 曲一泓 方卫婷 游咏 谢红炬 Zuo Jun;Ma Shaolin;Qu Yihong;Fang Weiting;You Yong;Xie Hongju(Department of Plastic Surgery,the Second Affiliated Hospital of Hainan Medical University,Haikou 570100,China;Department of Plastic Surgery,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830000,China;Department of Forensic Science,the School of Basic Medical Sciences,Central South University,Changsha 410013,China;Department of Neurology,the Second Affiliated Hospital of Hainan Medical University,Haikou 570100,China)

机构地区：[1]海南医学院第二附属医院整形外科,海口570100 [2]新疆医科大学第一附属医院整形美容科,乌鲁木齐830000 [3]中南大学基础医学院法医系,长沙410013 [4]海南医学院第二附属医院神经内科,海口570100

出　　处：《中华整形外科杂志》2023年第2期176-181,共6页Chinese Journal of Plastic Surgery

基　　金：海南省高等学校重点科研项目(HnkyJJ2021ZD-17);湖南省自然科学青年科学基金项目(2021JJ40487)。

摘　　要：脑脂肪栓塞合并肺脂肪栓塞是一种极其罕见且严重的脂肪注射后并发症。该文报道了1例面部自体脂肪注射后同时发生脑和肺脂肪栓塞患者的诊疗过程及病理结果,以期提高对该并发症发生机制的认知。患者女,34岁,2021年3月在外院行右侧面颊自体脂肪注射后出现昏迷,1.5 h后送至海南医学院第二附属医院急诊科,CT提示右大脑半球大面积梗死及双侧急性肺炎。在重症监护室给予患者脱水、抗感染、抗凝和改善微循环等治疗,之后患者因病情危重死亡。通过尸体解剖和组织病理学检查得出以下诊断:缺血性脑卒中伴出血转化;肺栓塞伴急性肺炎。作者推测脂肪栓子通过受损的右侧面动脉主干或分支,然后依次逆行至右侧颈外动脉、颈总动脉和颈内动脉,从而引发大脑中动脉栓塞;同时栓子随上述动脉的伴行静脉回流至右心房,经由肺循环到达肺血管床引发肺栓塞。整形外科医生在进行面部脂肪移植手术时必须熟知面部血管的解剖结构,掌握安全注射技术,提高预防脂肪栓塞的风险意识。Cerebral fat embolism(CFE)combined with pulmonary fat embolism(PFE)is an extremely rare and serious complication after fat injection.In order to improve the understanding of the mechanism of this complication,this article reported the diagnosis,treatment and pathological results of a patient with CFE and PFE after facial autologous fat injection.A 34-year-old female underwent an injection of autologous fat in her right cheek at another institution in March 2021 and developed into a coma.1.5 hours later,she was taken to the Emergency Department of the Second Affiliated Hospital of Hainan Medical University.CT revealed a massive infarction in the right cerebral hemisphere and bilateral acute pneumonia.The patient was treated with dehydration,anti-infection,anticoagulation and microcirculation improvement in the intensive care unit.But the patient died due to the critical condition.Postmortem autopsy and histopathological examination,revealed ischemic stroke with hemorrhagic transformation,and pulmonary embolism with acute pneumonia.It was speculated that the fat embolus passed through the damaged main trunk or branch of the right facial artery,and then retrograde to the right external carotid artery,common carotid artery and internal carotid artery to cause middle cerebral artery occlusion.At the same time,the embolus returned to the right atrium along with the accompanying vein of the above artery,and reached the pulmonary vascular bed through the pulmonary circulation,resulting in pulmonary embolism.Plastic surgeons should have extensive knowledge with the anatomical structure of facial blood vessels,master the injection techniques,and improve the awareness of fat embolism when performing facial fat transplantation.

关 键 词：栓塞 脂肪 脑栓塞 肺栓塞 自体脂肪注射 尸体剖检 病理学 

分 类 号：R622[医药卫生—整形外科]