• 四川大學(xué)華西醫(yī)院燒傷整形科（成都，610041）;

【摘要】　目的　 探討肥胖人群減肥后體重急劇下降導(dǎo)致腹壁松弛行腹壁整形手術(shù)的療效。　方法　 2003年4月-2009年10月，24例減肥后體重下降導(dǎo)致腹壁松弛患者中男3例，女21例，年齡28~44歲，平均36歲。其中1例合并甲狀腺功能亢進(jìn)，1例合并糖尿病病史；20例均通過運動、控制飲食等方式致體重下降，4例接受胃減容手術(shù)后體重下降。體重下降穩(wěn)定后至腹壁整形手術(shù)時間間隔2~4年，平均2.5年；減肥前至腹壁整形手術(shù)前體重下降37~67 kg，平均下降45 kg。手術(shù)采用屈髖位，切除松弛皮膚組織，收緊腹壁及腰部松弛組織，恥骨上沿皮瓣遠(yuǎn)端去表皮后與恥骨上沿骨膜縫合固定。所有患者隨訪5個月~2年。　結(jié)果　 23例術(shù)后2周皮瓣完全成活，切口愈合良好，無切口感染；1例術(shù)后出現(xiàn)恥骨上切口約2 cm表皮裂開，換藥2周后切口愈合，術(shù)后腹壁平整、對稱，無皮下血腫發(fā)生。隨訪期間切口疤痕隱蔽，陰阜無上移，腹壁平坦、對稱。　結(jié)論　 該腹壁整形手術(shù)方式效果良好，術(shù)后并發(fā)癥少，值得推廣。
From April 2003 to October 2009, 24 obese patients, including three males and 21 females, developed abdominal chalastodermia caused by weight loss. Their age ranged from 28 to 44 years old with an average age of 36 years. Among them, one had hyperthyroidism and one had a medical history of diabetes. Twenty patients lost weight by exercise and diet, while the other four lost weight through stomach reduction surgery. Time span from weight loss to abdominal plastic surgery was two to four years, averaging at 2.5 years. During the time from before weight loss until the surgery, weight loss ranged from 37-67 kg, averaging at 45 kg. The surgery adopted the position of bending hip. The loose skin was removed; abdominal wall and loose waist tissues were tightened; and the far end of flap without skin along the upper edge of pubis was sutured with the periosteum. All patients were followed up for a time ranged from five months to two years.　Results　 Flaps survived within two weeks after the surgery, incision healed perfectly, and no infection occurred to the incision for all the patients except in one case, there was a 2 cm of skin fissure in the upper incision which was cured after two weeks of dressing. After the surgery, the abdominal wall was flat and symmetrical without subcutaneous hematoma. During the follow-up, scars were well hidden, mons pubis was not shifted upward, and the abdominal wall was flat and symmetrical.　Conclusion　 The abdominal wall plastic surgery has a good clinical outcome with few complications, which is worth being popularized.

引用本文： 盧元剛,岑瑛. 肥胖人群減肥后的腹壁整形. 華西醫(yī)學(xué), 2011, 26(4): 540-543. doi: 復(fù)制

1. 　Shermak MA. Hernia repair and abdominoplasty in gastric bypass patients[J]. Plast Reconstr Surg, 2006,117(4):1145-1150.
2. 　Arash M, Matthas H, Holger B, et al. The "rising-sun-technique" in abdominoplasty[J]. Ann Plast Surg, 2008, 60(4): 343-348.
3. 　王曉軍, 龍笑. 減重手術(shù)后的整形治療[J]. 中國醫(yī)學(xué)科學(xué)院學(xué)報, 2010, 32 (1): 23-24.
4. 　Hurwitz DJ, Rubin JP, Risin M. Correcting the saddlebag deformity in the massive weight loss patient[J]. Plas Reconstr Surg, 2004, 114(5): 1313-1325.
5. 　Hurwitz J. Single-staged total body lift after massive weight loss[J]. Ann Plast Sur, 2004, 52(5): 435-441.
6. 　John M, James A, Prasad TM, et al. Analysis of complications from abdominoplasty, areview of 206 causes at a university hospital[J]. Ann Plast Surg, 2007, 58(3): 292-298.
7. 　Pollock H, Pollock T. Progressive tension sutures: atechnique to reduce local complications in abdominoplasty[J]. Plast Reconstr Surg, 2000, 105(7): 2583-2586.
8. 　Xerfan NF, Masako NF, Charles J. Does quilting suture prevent seroma in abdominoplasty?[J]. Plast Reconstr Surg, 2007, 119(3): 1060-1063.
9. 　Joseph G, Eric TC, Lillian N, et al. The effect of weight loss surgery and body mass index on wound complications after contouring operations[J]. Ann Plast Surg, 2008, 61(3): 235-242.
10. 　靳小雷, 滕利, 徐軍. 脂肪抽吸與腹壁整形相結(jié)合的腹壁體形重塑術(shù)[J]. 中華醫(yī)學(xué)美容雜志, 2005, 11(5): 267-270.
11. 　Uemura T. Superior epigastric atery perforator flap: preliminary report[J]. Plast Reconstr Surg, 2007, 120(1): 1-5.
12. 　Steven W. Treating the abdominotorso region of massive weight loss patient: an algorithmic approach[J]. Plast Reconstr Surg, 2008, 121(4): 1431-1441.
13. 　Loren J, Arren W. Modified vertical abdominoplasty in the massive weight loss patient[J]. Plast Reconstr Surg, 2007, 119(6): 1191-1921.
  1. 1. 　Shermak MA. Hernia repair and abdominoplasty in gastric bypass patients[J]. Plast Reconstr Surg, 2006,117(4):1145-1150.
  2. 2. 　Arash M, Matthas H, Holger B, et al. The "rising-sun-technique" in abdominoplasty[J]. Ann Plast Surg, 2008, 60(4): 343-348.
  3. 3. 　王曉軍, 龍笑. 減重手術(shù)后的整形治療[J]. 中國醫(yī)學(xué)科學(xué)院學(xué)報, 2010, 32 (1): 23-24.
  4. 4. 　Hurwitz DJ, Rubin JP, Risin M. Correcting the saddlebag deformity in the massive weight loss patient[J]. Plas Reconstr Surg, 2004, 114(5): 1313-1325.
  5. 5. 　Hurwitz J. Single-staged total body lift after massive weight loss[J]. Ann Plast Sur, 2004, 52(5): 435-441.
  6. 6. 　John M, James A, Prasad TM, et al. Analysis of complications from abdominoplasty, areview of 206 causes at a university hospital[J]. Ann Plast Surg, 2007, 58(3): 292-298.
  7. 7. 　Pollock H, Pollock T. Progressive tension sutures: atechnique to reduce local complications in abdominoplasty[J]. Plast Reconstr Surg, 2000, 105(7): 2583-2586.
  8. 8. 　Xerfan NF, Masako NF, Charles J. Does quilting suture prevent seroma in abdominoplasty?[J]. Plast Reconstr Surg, 2007, 119(3): 1060-1063.
  9. 9. 　Joseph G, Eric TC, Lillian N, et al. The effect of weight loss surgery and body mass index on wound complications after contouring operations[J]. Ann Plast Surg, 2008, 61(3): 235-242.
  10. 10. 　靳小雷, 滕利, 徐軍. 脂肪抽吸與腹壁整形相結(jié)合的腹壁體形重塑術(shù)[J]. 中華醫(yī)學(xué)美容雜志, 2005, 11(5): 267-270.
  11. 11. 　Uemura T. Superior epigastric atery perforator flap: preliminary report[J]. Plast Reconstr Surg, 2007, 120(1): 1-5.
  12. 12. 　Steven W. Treating the abdominotorso region of massive weight loss patient: an algorithmic approach[J]. Plast Reconstr Surg, 2008, 121(4): 1431-1441.
  13. 13. 　Loren J, Arren W. Modified vertical abdominoplasty in the massive weight loss patient[J]. Plast Reconstr Surg, 2007, 119(6): 1191-1921.