目的 通过问卷调查,对假体隆乳术后患者的生活质量进行评估.方法 自2014年6月至2016年12月,上海交通大学医学院附属第九人民医院整复外科依据Breast-Q,编写了针对隆乳术后患者生活质量满意度的主观问卷,并回顾性分析51例假体隆乳患者,术后生活质量的调查问卷.结果 51例患者术后随访21～52个月,假体隆乳术明显改善了患者术后生活质量,具体体现在患者自信心提升及性生活满意度两方面.结论 假体隆乳术不仅能明显改善患者乳房体积及外观,也能够改善患者术后的生活质量.

目的 探索聚葵二酸甘油酯(PGS)材料用于构建特定形状组织工程脂肪的可行性.方法 将PGS通过盐析法制备成三维多孔支架.电镜观察PGS支架的表征;体外细胞黏附实验观察PGS支架的细胞相容性;将处理后的脂肪组织与支架复合,植入裸鼠皮下,4周后取材行大体观察和组织学检测.结果 SEM观察显示,ADSCs接种PGS支架后7 d,支架材料上可见细胞黏附并大量增殖,显示出良好的细胞相容性;体内培养4周后取材,大体观察显示支架高度及直径维持良好,HE染色显示支架周围有脂肪细胞浸润生长,植入物内有炎性细胞浸润,Masson染色显示植入物周围包裹了一层纤维包膜,支架侧面脂肪细胞浸润面积明显多于底部.结论 PGS支架对于构建特定外形脂肪组织具有潜在应用价值.

Objective:To present a new method of vermilion tubercle reconstruction in secondary cleft lip repair.Methods:39 secondary cleft lip repair patients underwent the operation of vermilion tubercle reconstruction with a vermilion flap transferred vertically. The procedures of the reconstruction mainly included three processes, restoring the vermilion tubercle tissue in the cleft area, widening the vermilion with the vermilion flap, and augmenting the volume of the tubercle with the muscle tissue underlying that vermilion flap. The width of the vermilion and the projection of the vermilion tubercle were measured before and after operation, and then two sets of data were analyzed with paired-samples t test. A patient satisfaction survey was performed postoperatively to evaluate the effect of the reconstruction.Results:The reconstructions of vermilion tubercle were successful in all patients and no complications occurred. The most of new vermilion tubercles located in midline and appeared plump. Follow-up had been completed in 28 patients and the average follow-up period was (9.71±5.02) months. The effective vermilion width increase was from (5.32±0.91) mm, (3.98±0.89) mm, (4.30±0.86) mm before operation to (6.35±0.87) mm, (7.75±1.03) mm, (7.48±0.97) mm after operation in the midline of lip, the peak of cleft side and the midline of short arm, respectively. The postoperative width of vermilion in the cleft side was widened significantly. The projection of the tubercle was increased significantly from (0.38±0.46) mm to (0.83±0.51) mm. 96.4% (27) patients achieved satisfied results of vermilion tubercle reconstruction after operation.Conclusions:The vermilion flap transferred vertically has been found to be an effective method of vermilion tubercle reconstruction in the secondary repair of cleft lip.

Objective:To evaluate the morbidity and causes of long-term abnormal sensation of breasts after typy Ⅰ dual-plane breast implant augmentation via endoscopic assisted axillary approach.Methods:A retrospective analysis was conducted on 53 patients who underwent endoscopic assisted transaxillary type Ⅰ dual plane breast implant augmentation by a same surgeon from July 2014 to December 2016. All patients were followed up for more than 18 months. Hyperesthesia, hypoesthesia and numbness of nipple-areola complex and imframammary fold and breast pain were accessed.Results:According to the palpation and consultation of the surgeon, a total of 10 patients presented with post-operative long-term abnormal sensation of breasts, of which 6(11.3% of the total number) patients presented with hypoesthesia of nipple-areola complex, 1 patient (1.9% of the total number)presented with hyperesthesia of nipple-areola complex, and 2 patients (3.8% of the total number)presented with hypoesthesia of inframammary fold region. One patient (1.9% of the total number) had long-term postoperative breast pain. According to the questionnaire designed to assess breast sensation, a total of 33 patients (64.7%) presented with long-term postoperative breast pain, a total of 12 patients (23.5%) presented with post-operative long-term hyperesthesia of nipple-areola complex, another 5 patients (9.8%) presented with transient hyperesthesia of nipple-areola complex.Conclusions:It is clear that the incidence of post-operative long-term abnormal breast sensation following endoscopic assisted transaxillary type Ⅰ dual-plane breast implant augmentation is comparatively low and controllable.And the main reason for this complication is the peripheral nerve innervation of the nipple areolar complex.

目的 探讨内窥镜辅助下腋窝入路假体隆乳术的术后长期效果.方法 回顾分析自2014年7月至2016年12月,实施内窥镜辅助下腋窝入路双平面假体隆乳术的53例患者,术后随访时长均大于18个月.测量术后乳房各径线,对各项与假体隆乳相关的并发症进行评估,对患者术后满意度进行评估.结果 患者双侧锁乳线、胸乳线长度及经乳头胸围,术后均较术前明显增加(P<0.05),而经下皱襞胸围术前、术后无统计学差异(P>0.05).共有29例患者在术后出现各类并发症,其中绝大多数患者(98％)属于轻症并发症(如乳头感觉改变、乳房假体边缘可触及),仅1例患者(2％)出现严重并发症(Ⅲ～Ⅳ级包膜挛缩).结论 内窥镜辅助下腋窝入路双平面假体隆乳可明显增大患者乳房体积,并发症少,值得临床推广应用.

千百年来,人类始终在孜孜以求地追寻长生不老、延年益寿之法,以对抗机体逐渐衰落、老化的自然法则.面部年轻化是其中的重要内容之一,即通过一种或多种美容外科技术来改善或延缓面部衰老,恢复人面部年轻的容貌外观.随着科学技术的发展和进步,各种富有时代烙印要求的技术飞速发展,以满足老化的各个不同面部组织层次年轻化的需求.现针对主要的年轻化方法及其选择作一评述.

Objective Secondary deformities are common in people born with unilateral cleft lip and palate.In recent years,more and more attempts and efforts have been directed toward the restoration of normal muscle anatomy.The authors present a new method of orbicularis oris repair in secondary cleft lip repair.Methods From July 2009 to December 2011,24 patients underwent this procedure in the authors' department.Muscle reconstruction was divided into three units that dealed with the nasal base,white lip and red lip.Common anatomic pathologies including the displacement of upper lip,flared ala,blunted ala-facial groove,depressed nasal floor,lateral bulge,lack of philtrum column,free border deficiency and unapparent vermilion tubercle were corrected in a single operation.Results The average follow-up period was 16.79±6.23 months.No major complications occurred.All the patients were satisfied with their nasolabial appearance.Conclusions "Three-unit" muscle repair has found to be effective and practical in secondary repair.Favorable results demonstrate that improved aesthetic and functional results can be achieved with this comprehensive procedure.

Objective To explore the effect of Salvia miltiorrhiza on proliferation and differentiation of 3T3-L1 cells, so as to provide evidence for further research and clinical application of fat transplantation. Methods The differentiating 3T3-L1 cells after adipogenic induction were incubated with different concentration of S.miltiorrhiza (0.6 g/L, 0.3 g/L, 0.15 g/L, 0.075 g/L, 0.04 g/L, 0.02 g/L). After the 3T3-L1 cells differentiated into mature adipocyte, the cell proliferation viability was determined by CCK-8 assay kit. The lipid droplets accumulation of adipocyte were observed by Oil Red O staining and Image Pro Plus 6.0. The adipogenesis was quantified by measuring lipid content using triglyceride GPO-POD assay kit. Results S. miltiorrhiza promoted a dose-and time-dependent increase in 3T3-L1 cell proliferation viability. The earlier the dosing time was, the better the cell proliferation viability would be; The higher the concentration was, the better the cell proliferation viability would be. Within the six S.miltiorrhiza concentrations confine, S.miltiorrhiza also promoted a dose-dependent increase in 3T3-L1 cell differentiation ability, enhanced the lipid droplets accumulation of 3T3-L1 adipocyte. Conclusion S.miltiorrhiza can promote the increase of adipocyte number via the proliferation and differentiation of 3T3-L1 cells.

Objective To explore the significance of accurate measurement of breast volume by 3D scan in selecting breast aug-mentation models. Methods The patients with breast asymmetry underwent breast augmentation. 3D scanning and accurate volume cal-culation were performed before the operation. The prostheses were selected according to measurement results. Results Twenty patients were admitted in this study. There were 13 patients with bilateral breast size difference of 10 ml to 20 ml. They chose the same type of bi-lateral breast implant. Other patients with bilateral breast size difference of 37 ml to 110 ml chose a different type of bilateral breast imp lant. The absolute value of bilateral breast volume difference between pre- and postoperation was (27.4±3.7) ml and (12.7±4.7) ml, respec-tively. The difference was statistically significant (P<0.05). Conclusion Breast volume measurement by digital imaging before surgerycan provide an objective basis for prosthesis selection. It improves the effects of surgery and patients’satisfaction with breast prosthesis implant.

Objective To discuss the feasibility and clinical effect of the nasal base reduction with internal nasal incisions and tightening nasolabial bundles of orbicularis oris.Methods From January 2014 to June 2015, 16 patients of broad nasal base were treated with nasal base reduction. During operations, we employed the internal nasal incisions and released the pyriform ligaments, then tightened nasolabial bundles of orbicularis oris. All of patients were followed up to observe the long-term effect. The interalar to intercanthal ratio was measured in pre-operation and post-operation, then two sets of data were analyzed with t test.Results 6-18months follow-up had been completed in 16 patients. No severe complication was observed. 93.8% patients achieved satisifed results with reductive nasal base width and natural appearance at 6 months after operation.Conclusion The nasal base reduction with internal nasal incision and tightening nasolabial bundles of orbicularis oris is a reliable and effective surgical manipulation.

Objective To evaluate the therapeutic effect of autologous fat grafting in secondary cleft lip.Methods Grafting of autologous fat granules was applied to correct lip under-capacity.The technique was used in 40 patients with secondary cleft lip from June 2011 to December 2015.The ratios between the point of upper lip peak to vermilion height and to white lip height on the affected side were measured by Photoshop CS6.Results Satisfactory results were achieved with all 40 patients;the lip contour and morphology improved.The preoperative ratio was 0.417±0.190 and the postoperative ratio was 0.499±0.197, which increased average 26.02%, with statistically significant (P<0.05).Conclusions Autologous fat grafting to correct lip under-capacity with secondary cleft lip is a safe, effective and micro-invasive method which can be sustained over a lengthy period.

Objective To evaluate the safety of L-shaped polyethylene sheet implant for nasal elongation. Methods From January 2007 to December 2009, 78 patients received nose elongation were concluded for retrospective study. 38 patients received L-shaped polyethylene sheet implantation were involved in observation group, while 40 patients without polyethylene sheet implantation were involved in control group. All occurring complications were recorded. The incidence of complications was analyzed by Fisher's test. Results Patients were followed up for average 30.6 months (18 months to 5 years). In observation group, the incidence of complications was 7.8 %, and one major complication was observed during the follow-up period. In control group, the incidence of complications was 12.5% without major complication. The exact probability showed no significant difference between the observation and control group. Conclusion The high density polyethylene is a kind of safe and effective implant material for nasal elongation.

目的 观察中药丹参、黄芪注射液对自体脂肪移植成活率的影响,为后续实验及临床应用提供依据.方法 建立新西兰白兔自体脂肪移植动物模型,实验组分别予以腹腔注射丹参、黄芪注射液,于不同时间点采血、取材,测定血清VEGF表达水平和脂肪存活率,HE染色观察组织细胞形态,血小板-内皮细胞黏附分子CD31、周脂素免疫组化染色观察毛细血管密度及细胞活性.结果 自体脂肪移植术后第12周,实验组脂肪存活率显著高于对照组;各时间点实验组血清VEGF表达水平均显著高于对照组;HE、CD31、周脂素染色示,实验组在细胞形态、新生毛细血管密度及细胞活性方面均明显优于对照组.结论 配合应用丹参、黄芪注射液,能够显著提高新西兰白兔自体脂肪移植的存活率.

基于胎儿超声心动图序列,提出对胎儿左心室分割算法.先人工获取胎儿超声心动图序列第一帧图像的左心室轮廓;对于后续图像序列,基于超声心动图序列的时空关联性,结合增强算法利用字典再分类的多尺度稀疏表示方法由前一帧的分割结果得到当前帧的心室内外各尺度敏感字典和各尺度的权重;由各尺度心室内外敏感字典及权重对当前帧图像分类,获得判别图像;用形态学的方法对判别图像进行分割并对产生的泄露区域进行去除.实验用11例(每例40帧图像)胎儿超声心动图序列进行算法验证,结果表明:该算法能取得较好的判别图像,具有良好的左心室分割性能,其中豪斯多夫距离为3.6mm、平均绝对距离为0.9mm、戴斯系数为86％.因此,本文提出的多尺度稀疏表示字典再分类形态学算法能够有效地对胎儿左心室进行分割.

目的 探讨脂肪移植后脂蛋白脂肪酶(Lipoprotein lipase,LPL)在SVF(Stromal vascular fraction)辅助移植脂肪组织中的表达模式.方法 本实验以新鲜分离的自体SVF细胞辅助移植的脂肪组织为实验组,以脂肪组织与等量生理盐水的混合物为对照组,随机在裸鼠背部两侧注射建立动物模型,对两组移植物进行脂周蛋白免疫组化染色分析、LPL免疫组化染色分析和LPL蛋白含量测定.结果 LPL蛋白含量测定及LPL免疫组化染色分析显示,随着移植时间的延长,实验组和对照组LPL表达逐渐下降,在第2周、第3周、第4周时,实验组LPL表达明显高于对照组.脂周蛋白免疫组化染色分析显示,两组脂肪移植后的存活细胞均逐渐减少,但第2周、第3周、第4周实验组存活细胞数高于对照组.结论 SVF促进脂肪组织表达LPL,表达差异在移植后的第2周开始出现,这可能与SVF提高脂肪组织存活率和ASCs(Adipose-derived stromal cells)成脂分化有关.

Objective Recently, increasing number of patients, who have received polyacrylamide hydrogel injection for augmentation mammoplasty, are seeking to have this gel removed regardless of whether they're suffering from symptoms or not. Blunt aspiration, which is widely performed but removes only free hydrogel, leaves residual hydrogel in the breast. Here we're going to report and discuss our methods and ideas of the treatment for polyacrylamide hydrogel-injected breasts. Methods During the period of February 2005 to December 2013, 170 women who had undergone injection of polyacrylamide hydrogel for augmentation mammoplasty presented to us for treatment. A peri-areolar incision was made on the lower border of the areola, followed by dissection to the outer surface of the infiltrated fascia of polyacrylamide hydrogel. The fascia was dissected away as completely as possible and the free polyacrylamide hydrogel was removed from the cavity. Results Almost all the patients were satisfied with the surgical results, except for 5 patients who complained about the flat appearance of the breasts. Preoperative symptoms such as breast lumps, pain, uncomfortable upper-extremity movement and breast firmness were relieved and disappeared after removal of the free polyacrylamide hydrogel and infiltrated capsule. Conclusion The removal of the infiltrated capsule and free polyacrylamide hydrogel as much as possible may be successful in removing breast lumps, pain, and uncomfortable upper -extremity movement due to breast firmness. To remove polyacrylamide hydrogel as much as possible, the removal of the infiltrated fascia and capsule together with the free polyacrylamide hydrogel is recommended.

BACKGROUND:Autologous free-fat transplantation is limited by fat absorption and fibrosis due to fat necrosis. In this study, we explored the feasibility of using bone mesenchymal stem cells (BMSCs) transfected by vascular endothelial growth factor (VEGF) 165 gene to improve the survival of transplanted fat tissues in a rat model. METHODS:Bone mesenchymal stem cells with (group A) and without (group B) VEGF165 gene transfection were each mixed with free transplanted fat tissue; then, they were injected subcutaneously at sites on the backs of 36 Sprague-Dawley rats. A control group (group C) was established by using low-glucose Dulbecco modified Eagle medium. The transplants from groups A, B, and C were gathered respectively at 30, 90, and 180 days after transplantation. Transplanted tissue volume and histology were evaluated, and revascularization was quantified by counting the number of capillaries. RESULTS:The survival rate of the A group was significantly higher than that of the B group (P < 0.05), which was significantly higher than that of the C group (P < 0.05). Histologic analysis revealed that both groups A and B had significantly less fat necrosis and fibrosis (P < 0.05). Group A had significantly higher capillary density than the other 2 groups (P < 0.05), and its chloromethyl-1-1'-dioctadecyl-3,3,3', 3'-tetramethylindocarbocyanineperchlorate-labeled BMSCs were also von Willebrand factor positive. CONCLUSIONS:When transfected by the VEGF165 gene, the BMSCs of a rat can better promote the regeneration of capillaries, which can improve the survival rate of transplanted free-fat tissue. This experiment combined correlative theory and techniques of stem cell research, genetic technology, and autologous free-fat transplantation. It may provide a new way to improve the survival of tissue undergoing autologous free-fat transplantation.

Objective To explore the influence of astragalus on the survival rate of fat particle auto-transplantation.Methods Autologous fat particle was transferred on New Zealand white rabbit to establish an animal model.The experimental groups were given different doses of astragalus by intramuscular injection.The expression level of VEGF in serum were assayed,the residual quality of the fat grafts were measured and the survival rates were calculated.After HE staining,adipocyte morphology and density of blood vessels was observed.Immunohistochemical staining of vascular endothelial cells factor Ⅷ were used to observe the capillary growth and density.Results The survival rate of fat transplantation in experimental groups was higher than that in control group.The level of VEGF expression in experimental groups was higher than that in control group.HE staining and immunohistochemical staining of vascular endothelial cells factor Ⅷ showed the number,the shape,the degree of the fat transplantation fibrosis and the newborn micro-vessle density were better in experimental groups than that in control group.Conclusion Astragalus can significantly promote the survival rate of autologous fat particle transplantation in the model of New Zealand white rabbit.

目的 探讨重叠褥式缝合在口轮匝肌功能复位的基础上重建患侧人中嵴的方法.方法 对单侧完全性唇裂患者施行唇裂术后鼻唇畸形整复术,同时采用重叠褥式缝合法重建人中嵴.自2010年6月至2011年6月,共治疗23例患者.结果 所有患者均Ⅰ期愈合,随访3～11个月,平均5.6个月.其中19例非常满意,2例效果一般,2例效果欠佳.结论 通过重叠褥式缝合法可增高人中嵴处的肌肉厚度,加深人中凹,使部分患者人中嵴的外观接近正常.人中嵴的静态美与动态美都有明显的改善.

[Abstract] Objective To explore the feasibility of repairing the bony defect in cleft palate using autologous bone marrow stromal cells with coral in a lamb model.Methods Isolated bone marrow stromal cells were expanded and osteogenically induced in vitro.Coral and osteogenically induced BMSCs in passage three were applied to repair the bone defects in the complete cleft palate,and others served as controls using coral alone to repair the defects.The engineered bone was evaluated by 3D-CT scan on the postoperative week 2,12,24 and 32,and gross and histological examination and Micro-CT measurement on the postoperative week 24 and 32 respectively.Results 3D-CT scan,gross and histological examination showed the cell-coral composite was substituted by new bone in experimental groups and the bony defects were mainly healed,whereas evident degradation was seen in control group,with the cleft not repaired.It was shown that an average of (88.52 ± 10.95)％ and (90.52 ±8.12)％ of each defect volume had been repaired in experimental group on the postoperative week 24 and 32 respectively; while on the control side,only limited bone formed at the periphery of the defect (P ＜ 0.05).Micro-CT measurement demonstrated well the bony-union in experimental group,with the same bone mineral density as normal bone (P ＞0.05).Conclusion The bony defect in cleft palate in a lamb model can be repaired with the tissue-engineered bone generated by autogenous ostegenic BMSCs and coral scaffold.