单孔全腔镜皮下乳房切除术治疗WiesmanⅡ型男子乳房发育

Application of Single-port Endoscopic Subcutaneous Mastectomy for WiesmanⅡType Gynecomastia

目的探讨单孔全腔镜皮下乳房切除术治疗WiesmanⅡ型男子乳腺发育的可行性和安全性。方法2017年1月~2018年11月对15例WiesmanⅡ型男子乳腺发育行经侧胸壁单孔腔镜皮下乳房切除术。彩超辅助下于皮下及乳腺腺体表面注射亚甲蓝混合利多卡因凝胶以标记患侧乳房边缘。取侧胸壁切口,置入单孔套管穿刺器,超声刀沿乳腺腺体后间隙剥离腺体,分离至胸大肌边缘时置入扇形嵌上挑腺体继续分离,直至环周亚甲蓝利多卡因凝胶全部显露。可弯曲五叶钳挑开皮瓣分离乳腺前间隙,完整切除患侧乳腺组织,自切口缓慢旋转取出标本。结果15例均在腔镜下顺利完成,无中转开放手术。手术时间90~155 min,(115.9±19.0)min;出血量10~22 ml,(15.5±3.8)ml。住院时间5~9 d,(6.4±1.2)d。术后病理:男子乳腺发育。所有患者乳房切口均一期愈合。1例术后乳头乳晕麻木,3个月后感觉逐渐恢复正常。15例术后3个月根据自制满意度评分表(0~10分)进行满意度评价,评分为8~10分,平均9.1分。15例随访6~12个月(平均7.8月),患侧无明显瘢痕,双侧乳房外形基本对称,曲线自然,患者对术后乳房外形及对称性感觉满意。结论单孔全腔镜皮下乳房切除术治疗WiesmanⅡ型男子乳腺发育安全可行,患者满意度高。

Objective To investigate the safety and feasibility of single-port endoscopic subcutaneous mastectomy for WiesmanⅡtype gynecomastia.Methods From January 2017 to November 2018,15 patients with WiesmanⅡtype gynecomastia were treated.Single-port endoscopic subcutaneous mastectomy through lateral chest wall was performed.Methylene blue mixed lidocaine gel was injected on the surface of the breast and gland under the assistance of color Doppler ultrasound to mark the edge of the affected breast.The side chest wall incision was used to insert the single-port sheath puncture.The gland was dissected along the posterior space of the mammary gland by ultrasonic scalpel and was separated to the edge of pectoralis major with insertion into the fan-shaped gland to continue operation until the peripheral blue methyl blue lidocaine gel was exposed.The anterior space of mammary gland was separated and the breast tissue of the affected side was excised completely by using the flexible five leaf forceps.The specimen was slowly rotated and removed from the incision.Results All the 15 cases were successfully completed under endoscopy without conversion to open surgery.The operation time was 90-155 min,with an average of(115.9±19.0)min.The blood loss waS10-22 ml,with an average of(15.5±3.8)ml.The length of hospital stay ranged from 5 to 9 days,with an average of(6.4±1.2)d.Postoperative pathology showed gynecomastia.All the patients healed in the first stage.The sensation of nipple and areola gradually returned to normal after 3 months in one patient.Three months after the operation,all the patients were evaluated according to the self-made satisfaction scale(0-10 points),and the score was 8-10 points,with an average of 9.1 points.The 15 patients were followed up for 6-12 months(mean,7.8 months).There was no obvious scar on the affected side.Bilateral breasts were basically symmetrical,and the curve was natural.The patients were satisfied with the shape and symmetry of breasts after operation.Conclusion It is safe and reliable to apply single-port endoscopic subcutaneaus mastectomy for gynecomastia.