内镜辅助下乳腺良性病变切除同期行双平面假体隆乳术的临床应用

Clinical application of dual plane breast augmentation after the resection of the breast lesions under endoscope

目的探讨内镜辅助下腋窝入路乳腺良性病变切除同期行双平面隆乳术的临床应用,并总结手术要点。方法自2013年5月至2017年10月,对我院整形科和乳腺外科收治的29例乳腺良性病变患者,根据患者的情况,标记切除乳腺良性病变的范围,设计经腋窝拟置入假体所需剥离的范围,选择适宜假体。在内镜辅助下用电刀剥离植入腔隙,应用穿刺引导技术定位乳腺病变并切除,同期行双平面假体隆乳术。结果本组29例患者均顺利完成手术,手术时间为(153.4±22.7)min;术中出血量为(45.2±4.3) ml;术后引流量为(4.6±0.6) d;单侧乳腺引流量为(227.2±24.6) ml。术后门诊随访1～12个月,均无乳头、乳晕感觉异常。1例患者出现局部腺体轻度凹陷。其余患者乳腺外形丰满圆润,手感柔软,活动度好,无包膜挛缩、假体移位、双侧不对称及双峰乳形等并发症。结论对于合并乳腺良性病变的患者,经腋窝入路在内镜辅助下建立双平面植入腔,切除乳腺病变后再行隆乳术,手术方案安全可行,瘢痕隐蔽,可获得良好的手术效果。

Objective To investigate the clinical application of dual plane breast augmentation after the resection of the breast lesions under endoscope through a transaxillary incision.Methods 29 patients aged from 23 to 42 were received the operation.According to the patient’s condition,we marked the extent of breast lesion removal,designed the range of the needed dissection to implant the prosthesis,and chose suitable prosthesis.The space were separated with electroscalpel under endoscope through a 4 cm transverse incision in the axilla.Benign breast lesions were removed by position with the puncture guiding technique.Silicone implants were placed through the axillary incision.The vacuum drainage was used for 3~6 days.Results All patients were successfully operated and had no uncontrolled bleeding during operation.The operative time was(153.4±22.7)min,blood loss was(45.2±4.3)ml,postoperative drainage was(4.6±0.6)d,unilateral breast drainage was(227.2±24.6)ml.Patients were followed up for 12 months,no significant nipple and areola sensory loss.1 cases appeared mild local dent on the surface of the breast.The rest cases of breast shape plump mellow,soft,good activity,no capsular contracture,prosthesis displacement,bimodal breast shape and other complications.Conclusion For this kind of patients,dual plane breast augmentation was performed after the resection of the benign breast lesions under endoscope through a transaxillary incision was safe and feasible.