抽脂联合微创旋切术治疗男性乳腺发育症的临床研究

Clinical study of minimally invasive biopsy combined with liposuction for gynecomastia

目的探讨采用抽脂联合微创旋切术治疗男性乳腺发育症的临床效果。方法本研究系回顾性研究,依据纳入、排除标准,收集2014年1月至2015年12月郑州大学人民医院乳腺外科收治的100例男性乳腺发育症患者为研究对象,将入组对象按照手术方式分成A、B 2个组:A组54例,采用微创旋切术切除腺体;B组46例,先采用负压抽脂法抽取手术区域脂肪,后采用微创旋切术切除腺体。观察患者单侧腺体手术时间、微创旋切刀切取次数、术中出血量、术后近期并发症情况、术后6个月满意度情况。采用χ~2检验比较2组术后近期(2周内)并发症情况的差别,采用t检验比较2组手术时间、微创旋切刀切取次数、术中出血量、术后6个月满意度情况的差别。结果手术时间A组为(51.55±7.67)min,B组为(34.55±5.75)min,组间比较,差异有统计学意义(t=5.880,P<0.001);微创旋切刀切取次数A组为(122.91±19.10)次,B组为(48.83±9.91)次,组间比较,差异有统计学意义(t=11.519,P<0.001);术中出血量A组为(33.64±9.98)ml,B组为(30.45±9.08)ml,组间比较,差异无统计学意义(t=0.782,P=0.443);术后2周内A组出现9例皮下积液,B组出现5例皮下积液,组间比较,差异无统计学意义(χ~2=0.693,P=0.405),给予注射器抽吸、加压包扎后好转;A组出现7例局部皮下血肿,吸收后好转,B组未出现皮下出血,组间比较,差异有统计学意义(P=0.014)。术后随访6个月满意度分别为:双侧对称性满意度A组(7.18±1.25)分,B组(8.25±0.87)分,组间比较,差异有统计学意义(t=-2.361,P=0.030);术区皮肤及乳头感觉满意度A组(7.55±1.27)分,B组(7.67±1.30)分,组间比较,差异无统计学意义(t=-0.202,P=0.842);患者整体自我满意度A组(7.09±1.38)分,B组(8.42±1.24)分,组间比较,差异有统计学意义(t=-2.420,P=0.025)。结论抽脂联合微创旋切术治疗男性乳腺发育症具有手术时间短、术后并发症较少、患者满意度高的优势,有较好的临床应用价值。

Objective To investigate the clinical outcome of minimally invasive biopsy combined with liposuction in treatment of gynecomastia. Methods It was a retrospective study. Totally 100 cases of gynecomastia treated in the Department of Breast Surgery, People＇s Hospital of Zhengzhou University from January 2014 to December 2015 were analyzed according to inclusion and exclusion criteria. The patients were divided into two groups： group A （n = 54） and group B （n = 46 ） according to the operation methods. In group A, the patients underwent minimally invasive biopsy to excise mammary gland. In group B, vacuum liposuction was firstly given to remove excess fatty tissue, then minimally invasive biopsy to remove glandular tissue. The operation time, times of minimally invasive excisions, intraoperative blood loss, postoperative complications （2 weeks） and patients＇ satisfaction within postoperative 6 months were recorded. χ2 test was used to comparepostoperative complications between two groups and t test was used to compare the operation time, times of minimally invasive excisions, intraoperative blood loss and patients＇ satisfaction within postoperative 6 months. Results The operation time was （ 51.55 ± 7.67 ） min in group A and （ 34. 55 ± 5.75 ） min in group B, indicating a significant difference （ t = 5. 880, P〈0. 001 ）. The times of minimally invasive excisions was （ 122. 91±19. 10 ） in group A and （ 48. 83 ± 9. 91 ） in group B, indicating a significant difference （ t = 11.519, P〈0. 001 ）. The intraoperative blood loss was （33.64±9.98）ml in group A and（30. 45±9.08）ml in group B, indicating no significant difference （ t = 0. 782, P = 0. 443 ）. Within postoperative 2 weeks, nine patients in group A and five patients in group B had subcutaneous fluid, which was relieved after syringe aspiration and pressure dressing, and the two groups showed no significant difference （χ2 = 0. 693,P = 0. 405 ）. Seven patients in group A had local hematoma, which was improved after absorption, while none in group B was observed with local hematoma, suggesting a significant difference （ P = 0. 014 ）. In 6-month follow-up, the score in bilateral symmetry satisfaction was （7. 18 ± 1.25） in group A and （8.25 ± 0. 87） in group B, suggesting a significant difference （t =-2. 361 ,P= 0. 030） ; the score in satisfaction to skin and nipple sensation in surgical field was （7. 55 ± 1.27 ） in group A and （7.67 ± 1.30） in group B, suggesting no significant difference （ t = -0. 202, P=0. 842） ; the score in overall satisfaction was （7.09 ± 1.38） in group A and （8. 42± 1.24） in group B, suggesting a significant difference （ t = - 2. 420, P = 0. 025 ）. Conclusion The combination of minimally invasive biopsy and liposuetion in treatment of gynecomastia has the advantages of short operative time, less postoperative complications, high patients＇ satisfaction and favorable clinical outcome.