内镜下经腋路双平面隆乳术的应用解剖研究

Applied anatomic study of transaxillary dual-plane breast augmentation under endoscope

目的 对女性新鲜尸体的乳房及胸大、小肌附着点,血管支配和联合腱膜等进行局部解剖学观察,为内镜下经腋路双平面隆乳术提供解剖学基础.方法 解剖并观察成年女性新鲜人体标本,精准识别乳腺,胸大、小肌的相对位置关系,重要神经、血管的走行以及与周围肌肉的腱膜连接,测量胸骨体的宽度.模拟再现手术过程,并阐明手术要点.结果 ①胸小肌外缘在胸大肌外缘后下方,其后间隙较疏松,有较密集的神经、血管分支.②胸大肌的肋部与腹直肌腱膜、腹外斜肌腱膜及前锯肌筋膜均有较致密的联合.③胸骨体中下2/3的平均宽度 （3.0±0.5）cm.结论 ①经腋路极易误入胸小肌后间隙,分离易损伤血管造成出血.②双平面腔隙内侧缘间距安全距离至少为3.0cm.③胸大肌的肋部与其他比邻肌肉腱膜的连接较致密,在直视下才能确切离断松解,使肌肉回缩形成真正的双平面假体放置腔隙,维持乳腺-胸大肌-假体三者的动力关系平衡.④内窥镜辅助在经腋路双平面隆乳术中是必要的.

Objective To observe the local anatomical characteristics of female breasts, attachment point of the pectoralis major and minor muscle, vascularity, joint aponeurosis and so on through dissecting fresh corpses, which will provide the anatomical basis for transaxillary dual-plane breast augmentation under endoscope. Methods Adult female fresh specimens were dissected and observed. Mammary gland, the pectoralis muscles and joint aponeurosis and their relative position relations, vascularity and innervation were accurately identified. The operation process was simulated to represent, and key points were elucidated. Results （1） Pectoralis minor was located behind pectoralis major. Post pectoralis minor space was loose with dense vascularity and innervation. （2） There were relatively dense aponeurosis connection among costal part of pectoralis major, rectus abdomiuis, external oblique and serratus anterior muscle. （3） The average width of two thirds of lower gladiolus was （ 3.0±0.5 ） cm. Conclusion （1） Adopting axillary approach, post pectoralis minor space is likely entered by mistake , which will cause unnecessary bleeding. （2） 3.0 cm is the minimum safety distance between bilateral inner edge of dual-plane porket. （3） Only under direct vision can exactly release pectoralis ma- jor because of dense aponeurosis connection. In order to keep the dynamic balance among mammary gland- pec- toralis major-implant, endoscope technique is much better than traditional operation under blindsight. In addition, with assistance of endoscope, dual-plane technique will be more precise and safe, and less complications. （4） Endoscope is necessary to transaxillary dual-plane breast augmentation.