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中华医学美学美容杂志
中华医学美学美容杂志

彭庆星

双月刊

1671-0290

cmac9@vip.sohu.com

010-66352462

100120

北京市安外黄寺大街9号

中华医学美学美容杂志/Journal Chinese Journal of Medical Aesthetics and CosmetologyCSTPCD
查看更多>>中华医学会主办。本刊是以医学美学与美容学的基础理论研究和临床应用为重点的高级学术刊物,是面向中高级医学美学与美容学专业人员为主的学术性期刊。本刊专业领域涵盖美容外科,整形外科,美容皮肤科,美容牙科,和医学美容。刊登美容外科、美容皮肤科、美容牙科、美容内科、物理美容、药物美容、中医美容和美容护理等研究和应用。栏目有：临床论著、实验研究、医学美学、经验总结、病例报告、技术革新、综述、讲座，继续教育园地等。
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    白癜风靶向治疗的研究进展

    鲁严冯奕菲陆佳维曹雪琛...
    1-6页
    查看更多>>摘要：白癜风是一种皮肤黏膜色素脱失为特征的获得性自身免疫性皮肤病。炎症细胞因子，如干扰素(IFN)-γ、白细胞介素(IL)-17、肿瘤坏死因子(TNF)-α、IL-6、IL-8、IL-21、IL-33、磷酸二酯酶(PDE)-4及转化生长因子(TGF)-β，在该病的进展中起着重要的作用，特别是IFN-γ/趋化因子配体(CXCL)10轴。近年来，靶向治疗通过调节与白癜风发病机制相关的细胞因子及其相应受体，对其治疗发挥了重要作用，JAK抑制剂及其与光疗联合治疗已被临床证实具有较好的治疗前景。本文全面评估各种生物制剂在白癜风治疗中的疗效和个体化用药选择，以期为临床药物治疗决策提供参考。 Vitiligo is a dermatological condition of autoimmune origin, characterized by the acquired loss of pigmentation in the skin and mucous membranes. Inflammatory cytokines, including interferon (IFN)-γ, interleukin (IL)-17, tumor necrosis factor (TNF)-α, IL-6, IL-8, IL-21, IL-33, phosphodiester enzyme (PDE)-4, and transforming growth factor (TGF)-β, play a crucial role in the progression of vitiligo. Among these, the IFN-γ/chemokine ligand (CXCL) 10 axis is particularly significant. In recent times, the advent of targeted therapeutic approaches, focusing on modulating cytokines and their corresponding receptors implicated in the pathogenesis of vitiligo, has assumed paramount significance. JAK inhibitors and their combination therapy with phototherapy have been clinically proven to have promising therapeutic prospects. This review undertakes a comprehensive appraisal of the therapeutic efficacy and tailored drug selection pertaining to diverse biological agents employed in the management of vitiligo, aiming to provide valuable insights for clinical therapeutic decisions.

    白癜风JAK抑制剂靶向治疗MiRNATreg

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    CO 2点阵激光治疗女性阴道松弛对盆底结构及功能的影响

    王媛丽党二乐于磊文伟...
    7-12页
    查看更多>>摘要：目的 探讨CO2点阵激光治疗女性阴道松弛对盆底结构及功能的影响。 方法 2020年3月至2021年11月，空军军医大学第一附属医院皮肤科接诊女性阴道松弛患者28例，年龄26～59(37.5±8.3)岁。经CO2点阵激光治疗仪进行阴道内微创治疗，每月1次共3次。根据治疗前后阴道横径、女性性功能评分、阴道内环境健康指数评分、阴道触觉成像系统、盆腔超声及磁共振、组织活检、患者满意度、疼痛度评分、术后不良反应等指标评估临床疗效及安全性。 结果 28例患者治疗后，其中21例自觉阴道松弛相关症状改善。所有患者在治疗前、治疗后1个月各指标均有改善，阴道横径从(3.00±0.39)指降至(2.71±0.40)指(P<0.05)；阴道健康指数评分从(17.12±3.97)分升至(21.69±3.61)分(P<0.05)；女性性功能指数评分从(23.11±3.70)分提高至(27.43±5.33)分(P<0.05)。阴道触觉成像系统检查显示，阴道肌力及弹性均有不同程度改善，与治疗前对比差异有统计学意义(阴道前壁总收缩力t＝26.23，P<0.001；阴道后壁总收缩力t＝39.02，P<0.001；阴道前壁平均收缩力t＝17.92，P<0.001 阴道后壁平均收缩力t＝22.57，P<0.001)。13例合并轻中度压力性尿失禁的患者尿失禁评分(ICI-Q-SF量表)与治疗前比较降低[术前(8.97±2.99)分，第3次治疗1个月(7.18±1.79)分]，差异有统计学意义(t＝2.79，P<0.01)。盆腔超声及磁共振检查提示阴道壁结构紧致，盆腔超声观察到膀胱颈移动度降低，膀胱尿道旋转角减小，阴道组织活检提示治疗后阴道黏膜厚度增加，胶原纤维数量增加、排列更规律。所有患者治疗满意度高，且治疗过程中无感染、出血等不良反应。 结论 经阴道内CO2点阵激光治疗可改善阴道周围相关盆底结构及功能，治疗女性阴道松弛、压力性尿失禁、女性性功能障碍，临床疗效显著，安全性较好。 Objective To observe the changes of pelvic floor structure and function in female vaginal laxity after CO2 fractional laser transvaginal treatment. Methods This study reviewed the improvement of pelvic floor structure and function after CO2 fractional laser transvaginal treatment in 28 female patients [aged 26-59 (37.5±8.3) years] with vaginal laxity syndrome seen at the Department of Dermatology, the First Affiliated Hospital of Air Force Medical University from March 2020 to November 2021. A total of 28 female patients with vaginal laxity syndrome underwent intravaginal treatment by CO2 fractional laser instrument once/month for 3 times. The clinical efficacy and safety were evaluated according to the pre- and post-treatment transverse vaginal diameter, FSFI score of female sexual function, VHIS score of vaginal environment, vaginal tactile imaging system (VTI), pelvic ultrasound and MRI, tissue biopsy, patient satisfaction, pain score, and postoperative adverse effects. Results Twenty-one of the twenty-eight female patients with vaginal laxity syndrome showed significant improvement in symptoms related to vaginal laxity syndrome after intravaginal treatment with CO2 fractional laser therapy. All patients showed improvement in all indexes before and 1 month after treatments the mean vaginal transverse diameter decreased from (3.00±0.39) fingers to (2.71±0.40) fingers (P<0.05), VHIS increased from (17.12±3.97) to (21.69±3.61) (P<0.05), FSFI score improved from (23.11±3.70) to (27.43±5.33) (P<0.05), and VTI examination showed that vaginal muscle strength and elasticity were improved to different degrees, and there was a statistical difference compared with that before treatment (total contractility of the anterior vaginal wall:t=26.23, P<0.001 total contractility of posterior vaginal wall:t=39.02, P<0.001 the mean contractility of the anterior vaginal wall:t=17.92, P<0.001 the mean contractility of the posterior vaginal wall:t=22.57, P<0.001). At the same time, questionnaire score of international consultation on incontinent questionnaire short form (ICI-Q-SF scale) of 13 patients with combined mild to moderate stress urinary incontinence showed a statistically significant decrease compared with those before treatment (8.97±2.99 before treatment and (7.18±1.79) one month after treatment t=2.792, P<0.01). Pelvic ultrasound and magnetic resonance examination indicated a tightening of the vaginal wall structure, and pelvic ultrasound observed a significant decrease in bladder neck mobility and a significant decrease in vesicourethral rotation angle. Vaginal tissue biopsy indicated an increase in the thickness of the vaginal mucosa and an increase in the number and more regular arrangement of collagen fibers after treatment. All patients had high treatment satisfaction and there were no adverse effects such as infection and bleeding during the treatment. Conclusions Transvaginal CO2 fractional laser treatment can improve the pelvic floor structure and function around the vagina, treat female vaginal laxity syndrome, stress urinary incontinence and female sexual dysfunction, with significant clinical efficacy and good safety.

    阴道阴道松弛CO2点阵激光阴道触觉成像组织活检

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    A型肉毒毒素联合注射改善面颈部老化的效果及安全性

    魏妍余怡恒鲁亚青杨莉...
    13-18页
    查看更多>>摘要：目的 评估A型肉毒毒素联合注射改善面颈部老化的临床效果及安全性。 方法 2020年1月至2023年1月，在河南省人民医院皮肤科进行面颈部联合注射A型肉毒毒素女性患者30例，年龄29～66(42.2±8.8)岁。注射部位包括额部、眉间、眼周、鼻背、下颌缘等，注射后4、24周通过皱纹严重程度量表(facial wrinkle scale, FWS)、半颜面中线上下颌缘最低点到内眦水平线距离AB值评估疗效，同时通过面部整体美学改善量表(global aesthetic improvement scale, GAIS)及自我年龄感知(self-perception of age, SPA)评估患者的主观改善度，并评估患者满意度及注射后不良反应。 结果 注射后4周时，上面部各部位皱纹改善总有效30例(100%)，AB值改善差异有统计学意义(t＝28.35，P<0.05)。注射后24周时，上面部各部位皱纹改善总有效率为16.7%(5/30)～36.7%(11/30)，AB值改善差异有统计学意义(t＝3.98，P<0.05)。注射后4周和24周时分别有100%(30/30)和66.7%(20/30)患者经GAIS评估面部状态得到了改善，100%(30/30)和63.3%(19/30)患者认为自己变年轻。患者满意度100%(30/30)。注射后有注射部位轻微瘀斑5例、眉毛上抬无力1例，均在1～2周内自行消失。 结论 A型肉毒毒素面颈部联合注射在面部年轻化的治疗效果明显，患者满意度较高，且无严重不良反应。 Objective To evaluate the clinical effectiveness and safety of combined face and neck injections of botulinum toxin type A to improve face and neck aging. Methods From January 2020 to January 2023, 30 female patients with age of 29-66 years, average (42.2±8.8) years, underwent face and neck combined injection of A-type botulinum toxin in the Department of Dermatology, Henan Provincial People′s Hospital. The injection sites included the forehead, between the eyebrows, around the eyes, the dorsum of the nose, and the mandibular margin, etc. The efficacy was assessed by the wrinkle severity scale (FWS) and the AB value of the distance from the lowest point of the mandibular margin on the midline of the hemiface to the level of the medial canthus at 4 and 24 weeks after the injection, as well as the subjective degree of improvement by the Global Aesthetic Improvement of the Face Scale (GAIS) and the Self-perception of Age (SPA), and the satisfaction of the patients and post-injection adverse reactions. Results At 4 weeks after the injection, the total effective rate of improvement of wrinkles in all parts of the upper face was 100% (30/30), and there was a statistically significant difference in the improvement of AB (t=28.35, P<0.05). At 24 weeks after the injection, the total effective rate of improvement of wrinkles in all parts of the upper face ranged from 16.7% (5/30) to 36.7% (11/30), and the improvement of AB still showed a statistically significant difference (t=3.98, P<0.05). 100% (30/30) and 66.7% (20/30) of patients assessed their facial status as improved on GAIS at 4 and 24 weeks after the injection, respectively, and 100% (30/30) and 63.3% (19/30) of patients perceived themselves as younger. Patient satisfaction was 100% (30/30). After injection, there were 5 cases of slight ecchymosis at the injection site and 1 case of weakness in eyebrow elevation in the 30 patients, which disappeared on their own within 1 to 2 weeks. Conclusions The therapeutic effect of face and neck combined injection of botulinum toxin type A on facial rejuvenation is obvious, with high patient′s satisfaction and no serious adverse reactions.

    肉毒毒素类面颈部除皱下面部提升满意度

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    黄金微针结合氨甲环酸透皮给药治疗痤疮炎症后色素沉着的效果

    李贞施银银侯将莹蔡宏...
    19-23页
    查看更多>>摘要：目的 探讨黄金微针结合氨甲环酸透皮给药治疗痤疮炎症后色素沉着的临床疗效。 方法 2022年1—10月，空军特色医学中心皮肤激光医学中心就诊的面部痤疮炎症后色素沉着患者36例，男10例、女26例，年龄21～42(28.3±4.8)岁，分为观察组和对照组，每组18例。观察组用黄金微针结合氨甲环酸透皮给药治疗，对照组用0.5 mm微针结合氨甲环酸透皮给药治疗；两组均治疗2次，每次间隔2个月。末次治疗4周后对临床效果、痤疮后色素沉着指数(PAHPI)、紫外线色斑、棕色斑、毛孔、纹理、不良反应等进行评估。 结果 观察组17例有效，占94.4%；对照组11例有效，占61.1%；观察组疗效优于对照组，两组比较差异有统计学意义(P<0.05)。两组PAHPI评分及紫外线色斑、棕色斑、毛孔、皮肤纹理评分的比较，差异均有统计学意义(t值分别为3.10、2.52、2.71、2.43、3.54；P值分别为0.004、0.017、0.001、0.021、0.001)。两组患者治疗后均有不同程度的灼热感、红斑、水肿、干燥等，均于治疗后3 d缓解，无需特殊处理。 结论 黄金微针结合氨甲环酸透皮给药治疗面部痤疮炎症后色素沉着是一种安全有效的方法。 Objective To evaluate the efficacy of gold microneedle combined with tranexamic acid transdermal administration for the treatment of post-inflammatory hyperpigmentation caused by acne vulgaris. Methods From January 2022 to October 2022, 36 patients with post-inflammatory hyperpigmentation of facial acne who went to the Laser Medical Center, Air Force Medical Center were treated, including 10 males and 26 females, with 21-42 (28.3±4.8) years of age. The patients were divided into observation group and control group, with 18 cases in each group. The observation group was treated with gold microneedle combined with transdermal administration of tranexamic acid, the control group with 0.5 mm microneedles combined with transdermal administration of tranexamic acid. Both groups were treated for 2 times with an interval of 2 months. The total effective rate, post acne hyperpigmentation index (PAHPI), UV spots, brown spots, pores, skin texture, and adverse reaction were evaluated at 4 weeks after the last treatment. Results Clinical observation was completed in all 36 patients. In the observation group, 17 cases were effective, accounting for 94.4%, and in the control group, 11 cases were effective, accounting for 61.1%, The curative effect of the observation group was better than that of the control group, and the difference between the two groups was statistically significant (P<0.05). The differences in PAHPI score, UV spots, brown spots, pores, and skin texture between the two groups were also statistically significant (t=3.10, 2.52, 2.71, 2.43 and 3.54 P=0.004, 0.017, 0.001, 0.021 and 0.001). The patiens in both groups had different degrees of burning sensation, erythema, edema. dryness and other symptoms after treatment, which were relieved 3 days after treatment without special treatmet. Conclusions Gold microneedle plus transdermal administrationof tranexamic acid is a safe and effective method for the treatment of post-inflammatory pigmentation caused by acne vulgaris.

    痤疮联合治疗炎症后色素沉着黄金微针氨甲环酸

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    1 064 nm PicoWay超皮秒激光联合强脉冲光治疗黄褐斑的效果

    周明郭乔娜刘成波王延婷...
    24-28页
    查看更多>>摘要：目的 1 064 nm PicoWay超皮秒激光联合强脉冲光治疗黄褐斑的临床疗效。 方法 2022年5—8月，西安国际医学中心医院医学美容中心就诊的黄褐斑女性患者92例，年龄25～50(35.0±3.5)岁。采用随机数字表法分为两组：激光联合组46例，用精准强脉冲光联合1 064 nm PicoWay超皮秒激光治疗；激光组46例，用单一1 064 nm PicoWay超皮秒激光治疗。评估两组患者治疗前后黄褐斑皮损面积严重度指数(MASI)评分、VISIA评分及临床疗效。 结果 治疗前激光联合组、激光组MASI评分分别为12.58(11.04，13.99)、13.16(11.47，14.14)分，治疗后激光联合组、激光组评分分别为5.75(3.79，7.19)、7.15(5.42，5.85)分；两组治疗后MASI评分较治疗前均下降，激光联合组治疗后评分低于激光组，差异有统计学意义(Z＝－4.05，P<0.001) 。治疗前激光联合组、激光组VISIA评分分别为(173.72±43.77)、(175.65±34.9)分，治疗后激光联合组、激光组评分分别为(135.46±41.63)、(145.26±33.33)分，两组治疗后VISIA评分均较治疗前下降，激光联合组治疗后评分低于激光组，差异有统计学意义(t＝－2.52，P<0.05)。激光联合组治疗后有效率(80.43%，37/46)高于激光组(69.56%，22/46)(P<0.05)。 结论 1 064 nm PicoWay超皮秒激光联合精准强脉冲光治疗黄褐斑的疗效优于单一1 064 nm PicoWay超皮秒激光治疗。 Objective To investigate the clinical efficacy of a 1 064 nm picosecond laser combined with intense pulsed light in the treatment of melasma. Methods From May to August 2022, ninety-two female patients with melasma were admitted to the Medical Cosmetology Center, Xi′an International Medical Center Hospital, aged 25-50 years, with an average age of (35.0±3.5) years. The were divided by random number table method. Forty-six cases were divided into laser combined group, which were treated with precise intense pulsed light combined with a 1 064 nm picosecond laser. Forty-six cases in the laser group were treated with a 1 064 nm picosecond laser. The area and severity score of melasma (MASI), VISIA score and clinical efficacy were evaluated. Results The MASI scores of laser combined group were 12.58 (11.04, 13.99) before treatment, and the MASI scores of laser group were 13.16 (11.47, 14.14) before treatment. The MASI scores of laser combined group were 5.75 (3.79, 7.19), and the MASI scores of laser group were 7.15 (5.42, 5.85) after treatment. The MASI scores of the two groups were decreased compared with those before treatment, and the MASI score of the laser combined group was lower than that of the laser group. The difference was statistically significant (Z=-4.05, P<0.01). The median VISIA scores of the laser combined group were (173.72±43.77), and the median VISIA scores of the laser group were (175.65±34.9) before treatment. The median VISIA scores of the laser combined group were (135.46±41.63), and the median VISIA scores ofthe laser group were (145.26±33.33) after treatment. The VISIA scores of the two groups were decreased compared with those before treatment. The scores of the laser combined group were lower than those of the laser group. The difference was statistically significant (t=-2.52, P<0.05). The effective rate of the laser combined group (80.43%, 37/46) was higher than that of the laser group (69.56%, 22/46,P<0.05). Conclusions The curative effect of 1 064 nm picosecond laser combined with precise intense pulsed light in the treatment of melasma is better than that of a 1 064 nm picosecond laser alone.

    激光强脉冲光黄褐斑联合治疗

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    强脉冲光联合药物治疗玫瑰痤疮的Meta分析

    李月莹常昕雨王李雯
    29-35页
    查看更多>>摘要：目的 评估强脉冲光联合药物对玫瑰痤疮的治疗效果。 方法 2022年12月至2023年4月，陕西中医药大学附属医院皮肤科检索PubMed、Embase、Cochrane Library、中国知网、万方、维普、CBM等中、英文数据库，收集强脉冲光联合药物治疗玫瑰痤疮的随机对照研究，共纳入6个试验559例患者进行Meta分析。 结果 强脉冲光联合药物治疗玫瑰痤疮疗效明显优于单纯药物治疗(Z＝6.15，P<0.001)。进行亚组分析后，强脉冲光联合四环素类药物治疗玫瑰痤疮疗效优于单用四环素类药物(Z＝3.17，P<0.05)，强脉冲光联合米诺环素治疗玫瑰痤疮疗效优于单用米诺环素(Z＝2.37，P<0.05)。临床评估改善红斑、丘疹脓疱、瘙痒及毛细血管扩张等方面的评分差异均有统计学意义(均P<0.05)。 结论 强脉冲光治疗玫瑰痤疮疗效确切，与外用或口服药联用疗效优于单纯用药，但效果稳定性需要更多高质量的随机对照试验证实。 Objective To evaluate the therapeutic effect of intense pulsed light on rosacea. Methods From December 2022 to April 2023, the Dermatology Department of the Affiliated Hospital of Shaanxi University of Chinese Medicine searched PubMed, Embase, Cochrane Library, CNKI, Wanfang, VIP, CBM and other Chinese and English databases to collect clinical randomized controlled studies on intense pulsed light treatment of rosacea for ameta-analysis. Results A total of 559 patients were included in 6 randomized controlled trials. The efficacy of the combination of strong pulsed light and medication in the treatment of rosacea was significantly better than that of medication alone (Z=6.15, P<0.001). After subgroup analysis, the combination of strong pulsed light and tetracycline drugs was more effective in treating rosacea than using tetracycline drugs alone (Z=3.17, P<0.05). The efficacy of the combination of strong pulsed light and minocycline in the treatment of rosacea was better than that of minocycline alone (Z=2.37, P<0.05), and clinical evaluation showed the improvements of erythema, papules, and pustules. The differences in scores for itching and capillary dilation were statistically significant (P<0.05). Conclusions The efficacy of intense pulsed light therapy for rosacea is definite, and its combination with topical or oral medication is superior to that of medication alone. However, the stability of the effect needs to be confirmed by more high-quality randomized controlled trials.

    玫瑰痤疮强脉冲光米诺环素四环素硫酸羟氯喹伊维菌素乳膏Meta分析

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    小耳畸形患儿扩张法耳再造后强脉冲光脱毛术的效果

    刘莹张玲胡守舵黄绿萍...
    36-41页
    查看更多>>摘要：目的 探讨强脉冲光在扩张法耳再造过程的不同时期用于耳区脱毛的安全性和疗效。 方法 2018年1月至2021年12月，中国医学科学院整形外科医院激光中心对小耳畸形患儿扩张法耳再造后不同治疗时期进行脱毛治疗131例，男61例、女70例，年龄6～10(7.6±1.8)岁，用德国Lumenis公司M22TM平台进行脱毛治疗和效果评估，并记录不良反应。 结果 不同扩张器容积患儿在扩张期接受相同治疗次数后，毛发密度降低差异无统计学意义[15(13～19)比16(15～19)根/cm2，P>0.05]。接受2次脱毛治疗后，扩张期患儿毛发密度低于非扩张期患儿[15(13～19)比17(15～21)根/cm2，P<0.05]。扩张法患儿脱毛治疗次数与治疗效果高度相关[Kendall′ stat b＝0.74(95%CI: 0.71～0.77), P<0.05]。发生3例毛囊炎、2例水疱，及时治疗后痊愈，均未造成扩张器暴露或软骨吸收。 结论 强脉冲光脱毛术可安全地用于扩张法外耳再造手术的不同治疗阶段。扩张器容积不影响脱毛效率。扩张期脱毛效率优于非扩张期。5次治疗可达到再造耳"无毛"或"少毛"的理想效果，3次治疗可达到次优效果。 Objective To investigate the safety and efficiency of depilation with intense pulsed light (IPL) in congenital microtia patients during different phase of reconstruction treatment sessions. Methods The hairy skin was treated with the M22TM system (Lumenis, German) using a filter of 695-1 200 mm. A three pluses mode of the radiant setting with a pulse width of 3.5 ms, a delay of 60 ms, and an energy density of 16-18 mJ/cm2 was applied in the expanded patients. Depilation efficacy was evaluated as follows: excellent (hair density reduction >75%), good (50%-75%), fair (25%-50%), and poor (<25%). The depilation effect was compared between different phases. And the adverse effect was observed. Results A total of 131 cases were included. There was no difference of the hair density reduction between patients with different expander volume after same IPL depilation treatments [15 (13-19) vs. 16 (15-19) root/cm2, Wilcoxon rank analysis]. The hair density reduction in the expansion group was lower than the non-expansion group after two IPL depilation treatments [15 (13-19) vs. 17 (15-21) root/cm2, P<0.05, Wilcoxon rank analysis]. The depilation efficacy was highly related with the numbers of IPL depilation treatments the patients received [Kendall′ stat b=0.74 (95%CI: 0.71-0.77), P<0.05]. There were 3 cases of folliculitis, 2 cases of blisters occurred in this study, and no expander exposure and cartilage absorption were observed. Conclusions Hair removal with IPL is a safe and effective photo-epilation method during all stages of ear reconstruction using tissue expander. The volume of the expander does not significantly affect the hair removal efficiency. Depilation in the expansion phase is more efficient than that in the non-expansion phase, and the ideal result of " hair-free" or " less hairy" reconstructed ears can be achieved in 5 treatments, with suboptimal results in 3 treatments.

    先天性小耳畸形强脉冲光脱毛耳再造术软组织扩张

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    "短距、多段"埋没导引缝合法矫正隆乳术后早期假体位置过低的效果

    余文超蒋治远陈再洪游晓波...
    42-46页
    查看更多>>摘要：目的 探讨"短距、多段"埋没导引缝合法在矫正隆乳术后早期假体位置过低中的手术技巧和疗效。 方法 2019年8月至2022年1月，四川省人民医院整形外科收治因小乳症行腋窝入路假体隆乳而术后早期出现假体位置过低的女性患者15例，年龄23～35(27.3±3.6)岁；假体位置异常16～35 (23.8±5.8) d。12例患者表现为单侧假体位置过低，3例为双侧假体位置过低。采用"短距、多段"埋没导引缝合法予以矫正，即以2-0不可吸收缝线短距、多段缝合消除过低的假体腔隙下极。手术前后测量患者双侧乳头至胸骨中线距离、胸骨切迹至乳头距离、乳头至乳房下皱襞距离和锁骨中点至乳房下皱襞距离，并进行统计学分析，以评估"短距、多段"埋没导引缝合法对隆乳术后早期假体位置过低的疗效。 结果 15例患者术后伤口均一期愈合，无血肿、感染、瘢痕增生等并发症。均随访6～12(8.0±1.9)个月。14例患者对矫正后效果满意，1例患者进行2次矫正后得到满意结果。矫正后乳头至乳房下皱襞距离缩短0.8～1.4(1.2±0.2) cm,锁骨中点至乳房下皱襞距离缩短1.0～1.6(1.3±0.4) cm，差异均有统计学意义(t＝31.17、33.78，均P<0.05)。矫正后乳头至胸骨中线距离变化0.1～0.3(0.16±0.10) cm，胸骨切迹距离至乳头距离变化0～0.2(0.12±0.10) cm，差异均无统计学意义(均P>0.05)。 结论 采用"短距、多段"埋没导引缝合法矫正隆乳术后早期假体位置过低效果确切，具有操作简单、创伤小、无附加切口等优点，值得临床应用。 Objective To introduce a surgical technique of " short distances and multi-segment" buried-guiding suture method and its effects in the surgery of early descent of prosthesis after augmentation mammaplasty. Methods From August 2019 to January 2022, 15 cases of early descent of prosthesis after augmentation mammaplasty due to axillary approach breast augmentation for micromastia were admitted to the Plastic Surgery Department of Sichuan Provincial People′s Hospital, aged 23-35 years (27.3±3.6) and duration of dislocation from 16 to 35 days (23.8±5.8). There were 12 patients showed unilateral prosthesis drops and 3 patients showed bilateral prosthesis drops. " Short distances and multi-segment" buried-guiding suture method was used to solve the problem, i. e., 2-0 non-absorbable sutures were used to eliminate the lower pole of prosthetic cavity with " short distances and multi-segment" sutures. The distance from the nipple to the midline of the sternum, the distance from the sternotomy to the nipple, the distance from the nipple to the inframammary fold and the distance from the midclavicular point to the inframammary fold were measured bilaterally before and after surgery, and statistical analysis was performed to evaluate the efficacy of the " short distances and multi-segment" buried-guiding suture method for early descent of prosthesis after breast augmentation. Results All incisions healed by first intention without complications such as hematoma, infection, or scar hyperplasia. 15 patients were followed up for 6-12 months (8.0±1.9). 14 patients were satisfied with the results after surgery, and 1 patient received satisfactory results after secondary surgery. The distance from nipple to inframammary fold was shortened by 0.8-1.4 cm after surgery (1.2±0.2), and the distance from mid-clavicle to inframammary fold was shortened by 1.0-1.6 cm (1.3±0.4), and the differences were statistically significant as compared with the values before surgery (t=31.17, P<0.05 t=33.78, P<0.05). After surgery, the change in the distance from nipple to sternal was 0.1-0.3 cm (0.16±0.10), and the change in the distance from sternal notch to nipple was 0-0.2 cm (0.12±0.10), and the differences were not statistically significant (P>0.05). Conclusions With the advantages of simple operation, little trauma and no additional incision, the " short distance and multi-stage" buried-guiding suture method in the surgery of early descent of prosthesis after augmentation mammaplasty is worthy of clinical application.

    乳房成形术埋没导引隆乳术假体移位并发症

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    季铵盐壳聚糖新型液体敷料对面部裂伤促愈合及抑制瘢痕的影响

    邓俊楠蔡震陈再洪崔玮...
    47-51页
    查看更多>>摘要：目的 探讨季铵盐壳聚糖新型液体敷料对面部裂伤促愈合及抑制瘢痕形成的影响。 方法 2022年5月至2023年2月，四川省人民医院整形外科颜面部皮肤软组织裂伤患者113例，男52例、女61例；年龄18～30(25.8±5.2)岁。分为两组，试验组62例在缝合中用季铵盐壳聚糖冲洗伤口，并在换药时于创面喷洒季铵盐壳聚糖新型液体敷料；对照组51例，缝合与换药过程中的季铵盐壳聚糖新型液体敷料替换为等量的生理盐水，其余过程同试验组。术后30、60、90 d进行随访。术前、术后即刻、换药前后、随访时均进行拍照，记录并评估患者面部裂伤疼痛评分、愈合等级、瘢痕评分及患者满意度。 结果 患者113例无失访。术后换药过程中，数字评分法(numerical rating scale, NRS)：试验组患者1 d NRS (1.03±0.18)分、3 d NRS (2.69±0.53)分、5 d NRS (0.53±0.50)分均低于对照组患者1 d NRS (2.35±0.59)分、3 d NRS (3.27±0.75)分、5 d NRS (0.80±0.40)分(均P<0.05)。甲级愈合率：试验组患者58例(93.5%)高于对照组40例(78.4%)(χ2＝5.56，P<0.05)。温哥华瘢痕评分量表总分：试验组患者30 d (1.65±0.48)分、60 d (3.97±1.11)分、90 d (2.90±0.76)分均低于对照组30 d (2.43±0.50)分、60 d (5.16±1.21)分、90 d (3.55±0.78)分(均P<0.05)。患者满意度：试验组58例(93.6%)高于对照组42例(82.3%)(χ2＝8.16，P<0.05)。 结论 季铵盐壳聚糖新型液体敷料可减轻伤口疼痛、促进创口愈合、减轻瘢痕形成、提高患者满意度。 Objective To investigate the effect of a novel liquid dressing of quaternary chitosan on facial laceration healing and inhibition of scar formation. Methods This study was a prospective study, including 113 cases of facial skin soft tissue laceration 52 males, 61 females, age range of 18-30 years, with mean (25.8±5.2) years in the Department of Plastic and Reconstructive Surgery, Sichuan Provincial People′s Hospital from May 2022 to February 2023. Patients were divided into two groups: the experimental group (62 cases) used quaternary ammonium chitosan rinsing wounds in the suture, and trauma spray quaternary ammonium chitosan liquid dressing in the dressing change saline instead of an equal amount of chitosan was used to rinse wounds during the suture process and routine dressing change in the control group (51 cases). Follow-up visits were carried out in 30 d, 60 d, and 90 d postoperatively, and standardized photographs were taken preoperatively in the immediate postoperative period, before and after dressing change. The healing of the patients′ facial lacerations and patient satisfaction were recorded and assessed at the follow-up visits. Results A total of 113 patients were included in this study, with no lost visits. During postoperative dressing change, 1 d NRS (1.03±0.18), 3 d NRS (2.69±0.53), and 5 d NRS (0.53±0.50) were lower in the experimental group than those in the control group [1 d NRS (2.35±0.59), 3 d NRS (3.27±0.75), and 5 d NRS (0.80±0.40) (all P<0.05)]. Grade A healing rate was 93.5% (58 patients) in the test group were higher than 78.4% (40 patients) in the control group (χ2= 5.56, P<0.05) the total scores of the Vancouver Scar Rating Scale in the experimental group were lower than those of the control group at 30 d (1.65±0.48), 60 d (3.97±1.11), and 90 d (2.90±0.76) vs. 30 d (2.43 ±0.50), 60 d (5.16±1.21), and 90 d (3.55±0.78) (t=8.48, 5.44, t=4.43 P<0.05) the overall satisfaction rate in the experimental group (93.6%) was higher than that of the control group (82.3%) (χ2=8.16, P<0.05). Conclusions Quaternary chitosan liquid dressing has obvious advantages in reducing wound pain, promoting wound healing, and reducing scar formation. It can improve patients′ satisfaction and worthwhile to be applied clinically.

    面部裂伤壳聚糖季铵盐壳聚糖温哥华瘢痕量表满意度

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    自体脂肪移植填充矫正不同程度鼻唇沟下垂的效果

    姬东硕胡守舵韩星刘莹...
    52-55页
    查看更多>>摘要：目的 探讨自体脂肪颗粒移植治疗不同程度鼻唇沟下垂的临床效果。 方法 2018年9月至2021年9月，北京中西医结合医院整形科收治鼻唇沟下垂女性患者96例，中位年龄41(36～50)岁。患者的鼻唇沟部位进行自体脂肪颗粒移植治疗，术后12个月，用面部整体美容效果改善分级量表进行评估，观察分析应用自体脂肪颗粒移植治疗后的临床治疗效果和并发症。 结果 96例患者中75例1次自体脂肪移植完成，21例患者经2次脂肪移植完成。术后随访12个月，58例(60.4%)患者鼻唇沟下垂较术前得到显著改善，30例(31.3%)患者中度改善，8例(8.3%)患者轻微改善。除2例患者术后早期出现红肿瘀斑外，余无并发症。 结论 自体脂肪颗粒移植填充矫正鼻唇沟下垂疗效可靠，值得临床应用。 Objective To evaluate the clinical effect of autologous fat graft in the correction of varying degrees of nasolabial fold drop. Methods From September 2018 to September 2021, 96 patients mean age of 41 years, with range from 36 to 50 years with nasolabial fold drop admitted in our hospital were treated with autologous fat graft, the improvement of nasolabial fold drop was evaluated by the change of severity (wrinkle severity rating scale, WSRS) to observe the clinical effect and complications of autologous fat graft. Results Among 96 patients, 75 cases were accepted once treatment, the other 21 cases were accepted twice treatment. The patients were followed up for 12 months, 58 cases (60.4%) of patients had significant improvement, 30 cases (31.3%) of patients had moderate improvement, and 8 cases (8.3%) of patients had slight improvement. There were no complications except mild bruising in early postoperative period in some patients. Conclusions Autologous fat graft in the correction of varying degrees of nasolabial fold drop is safe and effective, which could be popularized in clinical practice.

    鼻唇沟下垂自体脂肪移植矫正并发症

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