乳头腺瘤切除-乳头成形术的临床应用

Nipple adenoma excision -- nipple forming technique clinical practice

目的：乳头部腺瘤（adenoma of nipple,AN）生长于乳头,切除后可能导致乳头缺血坏死或乳头变形.这严重地影响了乳房的整体外观.本文探讨一种简易可靠的乳头腺瘤切除-乳头成形术,以解决这一难题.方法：以临床中应用两种切口的2例患者为例,描述切口设计、术野显露、残留乳头缝合等技术要领.一种切口为双倒U形,切口从乳头基底延长到乳头顶部,越过顶部,再延长到乳头基底;两条U形切口在乳头的顶部十字交叉.术中应用缝线牵开显露术野;可吸收线间断缝合切口,缝合时注意乳头形状的恢复.另一种切口为单个纵行切口,从乳头的基底延长到乳头顶部.显露及缝合同上.结果：两种切口进行的乳头腺瘤切除及乳头成形术,完整地切除了病灶,第一种切口,术后出现了乳头不分区域可疑坏死,结后痂脱落后愈合.但随访8月后,乳头外形无明显变化.第二种切口,乳头无坏死.术后乳头外观良好.结论：单个纵行切口,一般能满足乳头腺瘤切除显露的需要;应该尽量避免双倒U形切口的应用,以免乳头部份坏死.这种单个纵行切口的乳头腺瘤切除-乳头成形术适用于大部分AN的切除.

Objective：The young forehead adenoma （adenoma of nipple, AN） grows in the nipple, after the excision possibly causes the nipple to lack the blood necrosis or the nipple distortion. This has affected the breast overall outward appearance seriously. This article discusses one kind of simple reliable nipple adenoma excision - nipple forming technique, solves this difficult problem. Methods. Take 2 example patients who clinical applies two kind of margins as the example,the description margin design,the technique wild appearance, the residual nipple suture and so on the technical main point. One kind of margin for the pair of U shape,the margin lengthens but actually from the nipple basis to the nipple crown,crossed the crown,again lengthens to the nipple basis;Two U shape margin in nipple crown cross overlapping. In the technique pulls the appearance technique using the sewing thread to be wild;May absorb the space to break sutures the margin,sutures when pays attention to the nipple shape the restoration. Another kind of margin for the single vertical good margin, lengthens from the nipple basis to the nipple crown. Revealed and sutures same. Results. Two kind of margins carry on the nipple adenoma excision and the nipple forming technique,have excised the focus of infection completely,the first kind of margin,after the technique appeared the nipple not to be divided the region suspicious necrosis,after the knot the scab falls off heals. But after revisit in August,nipple contour not obvious change. The second kind of margin, the nipple does not have necrosis. After technique nipple outward appearance good. Conclusion： The single vertical good margin, can satisfy the nipple adenoma excision appearance generally the need;Should avoid the pair of but actually U shape margin as far as possible the application,in order to avoid nipple part necrosis. This kind of single vertical good margin nipple adenoma excision -- nipple forming technique is suitable for the majority of AN excision.