经腋窝切口入路内窥镜辅助下行假体隆乳术

The Mammoplasty Augmentation through Axillary Incision Posterior in Endoscopic Assistant

目的:比较经腋路内窥镜辅助下和盲视下行假体隆乳的临床效果。方法:选择2014年1月-2017年5月于本院隆乳就医者120例(240侧乳房)为研究对象,其中内窥镜辅助下隆乳46例(92侧)为实验组,盲视下隆乳74例(148侧)为对照组。术前常规选择假体,设计剥离范围;实验组在直视下电凝剥离胸大肌后间隙,离断胸大肌下缘起点;对照组用剥离铲剥离胸大肌后间隙,尽量顿性离断胸大肌下缘;常规置入假体。比较两组手术时间、术中出血量、术后引流量、伤口愈合情况、乳头感觉、就医者满意度及术后1年Ⅲ/Ⅳ包膜挛缩发生率等。结果:两组就医者切口均达甲级愈合,术后双乳形态、对称性等无明显差别,未出现严重不良反应。实验组出现1例乳头双侧或单侧感觉迟钝(占2.2%),对照组出现3例乳头感觉减退(占4.0%),差异具有统计学意义(P<0.01);均在术后3~6个月恢复正常。实验组平均手术时间、术后1d引流量及去除引流装置时间均高于对照组,而术中平均出血量显著低于对照组,差异有统计学意义(P<0.05);术后1年实验组满意率为97.8%(45/46)明显高于对照组的83.8%(62/74),差异有统计学意义(P<0.05)。实验组术后1年发生单侧或双侧Ⅲ/Ⅳ包膜挛缩者2例(4.3%),对照组6例(8.1%),前者明显低于后者(P<0.01)。结论:内窥镜辅助腋路下行假体隆乳较传统腋路盲视下假体隆乳具有腔隙剥离精准、止血彻底、双平面形成完全、并发症少和手术满意度高等优势,是临床上经腋路假体隆乳的优先选择。

Objective To compare the clinical effects of prosthetic mammoplasty augmentation by endoscopic assistant(endoscopic axillary approach)and blindsight surgery via axillary.Methods 120 cases(240 sides of breast)for mammoplasty augmentation in our hospital from January 2014 to May 2017 were selected as the research object.46 cases(92 sides)with endoscopic assistant as the experimental group,74 cases(148 sides)with blindsight surgery as the control group.The prosthesis was selected according to the standard and the range of space for implant was designed.The experimental group was performed under direct vision,and electrocoagulation was used to separate the inferior space of the pectoralis major,the origin inferior edge of the pectoralis major was cut off.The control group,the inferior space of the pectoralis major muscle was stripped with a stripping shovel,and the inferior edge of the pectoralis major muscle was cut off as far as possible.The prosthesis were routinely implanted.The operation time,operative bleeding amount,postoperative drainage,wound healing,nipple sensation,case satisfaction and incidence of capsular contracture III/IV one year after operation between the two groups were compared respectively.Results The incision in Two groups of patients were healed,the breasts shape in two sides was no significant difference,and there were no serious adverse reactions.In the experimental group,there were 1 cases of bilateral or unilateral sensory dullness of the nipples(2.2%),3 cases(4.0%)in the control group,the difference was statistically significant(P<0.01).All were restored to normal in 3-6 months after the operation.The average operative time,postoperative 1d drainage volume and drainage time in the experimental group were higher than those in the control group,while the average blood loss during operation was significantly lower than that in the control group,the difference was statistically significant(P<0.05).The satisfaction rate of the experimental group was 97.8%,which was significantly higher than that of the control group(83.8%,62/74)in 1 years after the operation(P<0.05).There were 2 cases(4.3%)of unilateral or bilateral in the experimental group,and 6 cases(8.1%)in the control group(P<0.05).Conclusion Endoscope assistant transaxillary prosthetic mammoplasty augmentation would have some advantages such as lacunar stripping precision,hemostasis,double plane formation completely,reducing complications and the same as satisfaction compared with traditional transaxillary blindsight surgery.It suggested that transaxillary prosthetic mammoplasty augmentation is clinically preferred by endoscopic assistant.