7月18日,据外媒报道,巴西网一位网红整形外科医生在家中为患者进行注射隆臀治疗,过程中患者出现不适感并于若干小时后死亡,该医生则潜逃消失。巴西警方于7月19日将其抓捕,经证实操作者并非医生本人,而是由非专业人士实施,注射材料为丙烯酸玻璃,而患者最终死于心肌梗塞。该事件引发巴西整形外科协会的重视,并强调整形手术必须由专业人士在医疗场所开展,同时必须使用安全的产品,丙烯酸玻璃这种聚合体材料很危险,在拉丁美洲已经引发过多起女性致死案例。
网红医生Dr. Bumbum在Instagram上有65万粉丝
在对巴西隆臀术致死患者的研究中,工作组发现了4点共性:
1. Fat in the gluteal muscles
脂肪在臀肌中
2. Fat beneath the muscles
脂肪位于肌肉下方
3. Damage to the superior or inferior gluteal vein
损伤臀上静脉或臀下静脉
4. Massive fat emboli in the heart and/or lungs
心脏和/或肺部大量脂肪栓塞,此外,工作组总结了增加手术风险的影响因素以及预防或避免风险的措施,给出了10条建议:
1. Avoid injecting fat into the deep muscle. No deaths have occurred with fat found only in the subcutaneous plane (under skin but over muscle).
避免将脂肪注射至肌肉深层。在皮下层注射(皮肤下方肌肉上方)的患者未发现死亡案例;
2. Avoid gluteal veins and the sciatic nerve. Fat should only be grafted into the superficial planes with the subcutaneous space considered safest.
规避臀静脉和坐骨神经。脂肪只能移植至皮下浅表层,这个层次被认为最安全;
3. Use a >4.1 mm single hole injection cannula and instrumentation that offers control, avoiding bendable cannulas and mobile luer connections. Vibrating cannulas may provide additional tactile feedback.
使用直径大于4.1mm的单孔注射针或工具以保证操作可控性,避免使用可弯曲注射针以及移动式鲁尔接头。采用振动式注射针可能会提供一些触觉反馈;
4. Avoid downward angulation of the cannula.
避免使用向下角度的注射针;
5. Position patient and place incisions to create a path that will avoid deep muscle injections.
将患者置于合适的位置,确认切口位置,制造不宜导致深层肌肉注射的路径;
6. Maintain constant three-dimensional awareness of the cannula tip.
对针头位置保持3维认知;
7. Only inject when the cannula is in motion to avoid high pressure bolus injections.
仅在针头移动过程中进行注射以避免高压快速浓注;
8. Consider pulmonary fat embolism in unstable intra- and post-operative patients.
对于术中及术后不稳定的患者,要考虑脂肪肺栓塞风险;
9. Review gluteal vascular anatomy and draw landmarks to identify and avoid injection into the pedicle.
回顾臀部血管解剖并做术前标记,避免注射至椎弓根;
10. Include risk of fat embolism and surgical alternatives in the informed consent process.
在术前就充分考虑脂肪栓塞的风险以及备用手术方案。