聚丙烯酰胺水凝胶注射式隆胸术后不同切口手术取除治疗临床分析

Clinical analysis of different incisions about remove the polyacrylamide hydrogel from breast

目的统计分析本院收治的聚丙烯酰胺水凝胶(polyacrylamide hydrogel,PAHG)取除术后患者不同手术切口症状缓解情况及术后瘢痕情况,为后续临床治疗提供临床经验。方法收集2013年1月1日——2019年11月30日重庆医科大学附属第一医院医疗美容科/烧伤科收治的PAHG取出术患者共41例,82只乳房,均为女性。收集分析基线资料,根据手术方式分为直视下乳房下皱壁切口组(A组)17例、直视下乳晕下半环切口组(B组)24例,比较两种术式术后彩超评估注射物清除率、并发症(疼痛、包块、移位)、瘢痕情况及满意度,并进行统计学分析(Mann-Whitney U检验、卡方检验及Fisher精确检验)。结果41例患者中,PAHG取除术后并发症发生率A组(58.8%)低于B组(64.7%),两组率的比较无统计学差异(χ^(²)=0.168,P=0.628);术后疼痛缓解率A组(88.9%)低于B组(90.0%),包块消除率A组(25.0%)低于B组(45.5%),移位消除率A组(100.0%)高于B组(75.0%);手术满意度评分中位数A组(97分)高于B组(80分);自身外观满意度评分中位数A组(80分)等于B组(80分);术后症状缓解率及满意度评分均无统计学意义(P_(疼痛)=1.000,P_(包块)=0.633,P_(移位)=1.000,P_(手术)=0.515,P_(外观)=0.758);术后瘢痕采用温哥华评分量表评分,A组中位数(4.000)高于B组中位数(1.000),差异有统计学意义(P=0.000)。结论1.聚丙烯酰胺水凝胶长期植入人体后可导致局部不同程度的免疫应答反应,故针对此类患者,应及时尽早取出注射物,避免进一步对组织造成不良影响;两种手术入路(A组、B组)在术后并发症、症状缓解率、对于自身及手术满意度,术后彩超残留率方面均无统计学差异,但在术后瘢痕评分中,A组明显高于B组,故更推荐乳晕下缘切口为手术入路。

Objective In order to provide clinical experience for subsequent clinical treatment,the symptom relief and postoperative scar of patients with polyacrylamide hydrogel removal of breast admitted to our hospital were statistically analyzed.Methods From January 1,2013 to November 30,2019,41 patients with 82 breasts were enrolled in the Department of Plastic Surgery/Burn of the First Affiliated Hospital of Chongqing Medical University for PAHG removal.Analysis of baseline information collection,according to the operation method is divided into direct wrinkle wall under the breast incision group(group A)17 cases,looking directly at half ring under areola incision group(B group)24 cases,comparing two operation injection clearance,postoperative complications(pain,scleroma,shift),scarring and satisfaction,and statistical analysis(the Mann-Whitney U test,chi-square,and Fisher's exact test).Results In 41 patients,the incidence of postoperative complications in group A(58.8%)was lower than that in group B(64.7%),and there was no statistical difference between the two groups(χ^(2)=0.168.P=0.628).The postoperative pain relief rate of group A(88.9%)was lower than that of group B(90.0%).Scleroma elimination rate in group A(25.0%)than group B(45.5%),shift to eliminate rate in group A(100.0%)than group B(75.0%).The median surgical satisfaction score of group A(97 points)was higher than that of group B(80 points).The median self-appearance satisfaction score of group A(80 points)was equal to that of group B(80 points);Postoperative symptom relief rate and satisfaction score were not statistically significant(P _(pain)=1.000,P_(mass)=0.633,P_(displacement)=1.000,P_(operation)=0.515,P_(appearance)=0.758).Postoperative scar was scored by Vancouver scoring scale,and the median of group A(4.000)was higher than that of group B(1.000),and the difference was statistically significant(P=0.000).Conclusions Long-term implantation of polyacrylamide hydrogel in the human body can lead to different degrees of local immune response,so for such patients,the injection should be removed as soon as possible,to avoid further adverse effects on the tissue.There were no statistical differences between the two surgical approaches(group A and group B)in postoperative complications,symptom remission rate,self-satisfaction and surgical satisfaction,and postoperative color ultrasound residual rate.However,in postoperative scar score,group A was significantly higher than group B,so the incision at the half ring under areola was more recommended as the surgical approach.