探讨B超在男性乳腺发育症的Cohen分型及整形外科治疗中的应用

Application of breast ultrasound in classification and plastic surgical management of gynecomastia

目的探讨利用乳房B超检查，进行男性乳腺发育症的Cohen分型及指导整形外科手术治疗的可行性。方法近3年来，在男性乳腺发育的患者术前均行乳房B超检查，标记患者胸壁乳腺范围并确定Cohen分型，根据分型采用不同术式，指导术中操作，治疗男性乳腺发育患者共40例，其中腺体型患者行腺体切除术，脂肪型患者行脂肪抽吸术，腺体脂肪型患者则联合应用两种手术方式，先行脂肪抽吸，再切除腺体，必要时再次进行脂肪抽吸。结果术中切除单侧乳房腺体重量为30～180g．抽暇脂肪总量为200-1200ml。手术方法简便，手术损伤小，并发症少，疗效好。随访6个月至3年，疗效满意、外观良好、切口瘢痕轻微。结论根据乳房B超的检查结果，对男性乳腺发育患者进行Cohen分型，指导手术方式选择及辅助术中操作，能够减少手术创伤及并发症，获得良好的手术效果。

Objective To investigate the possibility of using the results of breast ultrasound and Cohen-classification to determine the gynecomastia patients＇ subtype, and to evaluate the effectiveness of different surgical methods based on the classification. Methods In the past 3 years, 40 patients with gynecomastia were treated in this hospital. The patients＇ age ranged from 18 to 50 years, with an average of 21.38. All the patients had the bilateral lesions, and their pathological diagnosis was gynecomastia. The mammary gland resected from each side weighted from 30 to 180 grams. The total fat volume liposueted ranged from 200 ml to 1 200 ml. As a routine, we performed breast ultrasound examination before the operation on each patient. According to the different echo, we marked the extent of breast gland on the chest walls and determine the Cohen classification of the patients. For breast tissue hyperplasia, we only resected the gland under the direction of the chest wall marks. For fat tissue hyperplasia, we just performed liposuction. For patients with mixed fat and gland hyperplasia, we combined these two methods rationally. If necessary, the procedures was repeated. Results With the help of breast ultrasound examination, the operating procedure was more accurate and simple, as a result, our treatments had less injury and no severe complications. After a following-up of 6-36 months, satisfactory results were achieved, with normal male chest appearance and small obscure scar. Conclusions Male breast surgery is totally different from the females. The Cohen classification has been determined for each gynecomastia patient, based on the resuhs of breast ultrasound examination, which helps choose the surgical methods and procedures and decrease surgical injuries and complications, with satisfactory results.