术中即时超量扩张技术在内镜辅助隆乳术中的应用

Clinical application of intraoperative sustained skin and soft-tissue expansion in augmentation mamma- plasty using transaxillary approach with endoscopic assistance

目的探索在内镜辅助剥离下隆乳术中先置入扩张器进行即时超量注水扩张，完成后再置换假体的隆乳术方法及临床效果。方法按照术前设计，腋下入路在内镜辅助下完成双平面剥离后，置入乳房假体前预先置入组织扩张器，注入生理盐水至术前预定假体的容量，观察注水后扩张器大小和位置并调整至合适程度．调整后注水量作为选择假体体积的参考。在此基础上继续即时超最汴水至2倍体积．保持扩张30～60min后，取出扩张器，置入乳房假体，完成手术。结果120例，术后除3例早期出现血清且叶，后自然吸收，2例位置不佳进行Ⅱ期调整，1例出现包膜挛缩经修复后好转外，其余通过半年至2年随访，均表现为手感、动感自然，外形和谐对称．满意率达95％。结论隆乳于术中预先置入扩张器以便进行位置调整，可以避免置入假体后再做调整对假体有损伤，可以通过增减注水量使两侧乳房大小对称。预估最后采用假体的体积，尤适用于两侧乳房不对称患者。有减轻隆乳患者术后乳房胀痛、改善乳房外形和手感的效果。

Objective To ewduate the results of prosthesis augmentation, relieve suffering patient experience, improve shape and touch of breast. Methods According to design, in dual-plane mammaplasty transaxillary approach with endoscopic assistance, we used soft-tissue expansion before prosthesis, saline volume in expander was the same as prosthesis size at beginning; adjusting expander volume and position, then determined prosthesis size according to expander volume lastly, after intraoperative sustained expansion for 30 to 60 minutes twice prosthes volume, replace expander with prosthesis. Results This method was applied in 120 patients, showing that pain significantly reduced after expansive without use of analgesia pump; complications included that 3 patients appeared seroma and absorbed soon; 2 patients had poor prosthese location, which was adjusted in reoperation; one capsular contracture was repaired later. After 6-months to 2-years follow-up, the results showed that breast was nature and dynamic; satisfactory rate reached to 95 %. Conclusions In augmentation mammaplastic operation, pre-adoption of an expander can make it easy to adjust the location of prosthesis, to avoid being injured and to determine prosthesis volume by expander injection of saline volume, espe cially for patient with different size of both breasts.