创新“七步法”在单孔腔镜男性乳腺发育症手术中的应用

The application of a novel"seven-step procedure"in single-port endoscopic subcutaneous mastectomy for gynecomastia

目的:总结并归纳单孔腔镜男性乳腺发育手术的技术要点及易于临床推广的规范手术步骤。方法:回顾分析2022年4月至2023年4月收治132例男性乳腺发育症患者的临床资料,患者17~47岁,平均(23.3±6.1)岁,均行单孔腔镜乳腺切除术,总结治疗经验,以形成具有精确操作步骤、外科技巧的临床手术方案。结果:132例患者均在全麻下顺利完成单孔腔镜手术,无中转开放手术。手术时间平均(86.37±21.52)min,术中出血量(28.20±12.25)mL,切除乳房容量(178.20±67.53)mL,术后引流量(58.20±27.56)mL,平均住院(3.54±1.70)d,术后出现3例局部血肿,1例局麻下清除淤血,2例予以注射器间断抽液后恢复;1例患者出现单侧皮下凹陷轻度不对称,经佩戴胸带加压、适当锻炼后缓解,术后随访6个月恢复良好。未发生皮下气肿、皮肤坏死、乳头感觉异常、感染等并发症。结论:单孔腔镜男性乳腺发育症手术的“七步法”包含标准化操作步骤,有助于单孔腔镜技术在男性乳腺发育手术中的普及与发展。

Objective:To summarize the technical points of single-port endoscopic subcutaneous mastectomy for gynecomastia,and conclude standardized surgical procedures that are simple to promote in clinical practice widely.Methods:Clinical data of 132 p atients with gynecomastia from Apr.2022 to Apr.2023 were retrospectively analyzed.The patients were between 17 and 47 years old,with an average age of(23.3±6.1)years old.All of them underwent single-port endoscopic mastectomy after a thorough examination and strict implementation of surgical indications.Treatment experiences were summarized to develop the clinical surgical protocols with precise procedures and surgical techniques.Results:All 132 patients underwent single-port endoscopic operation under general anesthesia without conversion to open surgery.The operation time was(86.37±21.52)min,the intraoperative blood loss was(28.20±12.25)mL,the mastectomy volume was(178.20±67.53)mL,the postoperative drainage volume was(58.20±27.56)mL,and the hospital stay was(3.54±1.70)d.There were 3 cases of local hematoma after the operation,and 1 case was removed under local anesthesia,two cases r ecovered after intermittent drainage with syringes.One patient suffered from unilateral subcutaneous depression and slight asymmetry,which relieved after proper exercise with chest strap compression,and recovered well in postoperative follow-up after 6 months.There were no complications such as subcutaneous emphysema,skin necrosis,nipple paraesthesia,or infection.Conclusions:The"seven-step method"in single-port endoscopic surgery for gynecomastia contains standardized operation steps,has advantages of being easy to r emember,easy to learn,easy to promote,is conducive to the popularization and development of single-port endoscopy technology in g ynecomastia surgery.