内窥镜辅助与直视下经乳房下皱襞切口假体隆乳术临床效果对比

Comparing the clinical outcomes of endoscope-assisted and direct prosthetic augmentation mammaplasty through an inframammary fold incision

目的比较内窥镜辅助与直视下经乳房下皱襞切口假体隆乳术的临床效果。方法收集2021年6月至2022年10月于重庆华美整形外科医院采用内窥镜辅助经乳房下皱襞切口行假体隆乳术的小乳症患者临床资料,即内窥镜组;同时收集2015年6月至2021年5月在直视下进行手术的患者临床资料,即直视组,作为对照。分别记录2组患者手术时间、术后引流管留置时间、住院时间、术后1~3 d引流量;对患者切口愈合情况、乳房形态及并发症情况进行随访。应用SPSS 26.0软件处理数据,符合正态分布计量资料以±s表示,2组间比较采用t检验,计数资料以频数和(或)百分比表示,2组间比较采用Fisher精确概率检验,P<0.05表示差异有统计学意义。结果共纳入169例女性患者,年龄21~48岁,其中内窥镜组71例,直视组98例,2组患者年龄、体重指数、假体体积、术后随访时间分别比较,差异均无统计学意义(P均>0.05)。2组患者手术过程顺利,术后切口均一期愈合。内窥镜组手术时间为(123.5±13.5)min,稍长于直视组的(111.5±8.1)min(t=7.20,P<0.001);术后引流管留置时间为(2.6±0.7)d,明显短于直视组的(4.2±1.0)d(t=-11.58,P<0.001);住院时间为(2.8±0.8)d,明显短于直视组的(4.6±1.3)d(t=-10.33,P<0.001)。内窥镜组术后1~3 d双侧总引流量为(151.0±30.1)ml,明显少于直视组的(265.0±48.1)ml(t=-17.62,P<0.001)。术后12个月随访时,2组患者乳房形态和手感均较好,均无感染、假体破裂、移位或外露等情况,患者均对手术效果满意;内窥镜组患者包膜挛缩、乳头乳晕感觉减退和瘢痕增生的发生率为0.7%(1/138)、0.7%(1/138)和0(0/138),低于直视组的2.7%(5/188)、3.7%(7/188)和2.7%(5/188),但差异均无统计学意义(P均>0.05)。结论内窥镜辅助与直视下经乳房下皱襞切口假体隆乳术均能获得较满意的效果;在内窥镜辅助下比直视下手术用时稍长,但手术创伤小,缩短了术后引流管留置时间及住院时间,减少了术区出血量。

Objective To compare the clinical effects of endoscope-assisted and direct prosthetic augmentation mammaplasty through inframammary fold incisions.Methods The clinical data of patients who underwent prosthetic augmentation mammaplasty through inframammary fold incisions in Chongqing Huamei Plastic Surgery Hospital from June 2021 to October 2022 were collected.At the same time,the clinical data of patients who underwent the operation under direct vision from June 2015 to May 2021 were collected as control group.The operation time,postoperative drainage tube indwelling time,length of hospital stay and postoperative drainage volume within 1-3 days were recorded in the two groups,and the incision healing,breast morphology and complications were collected.The data were processed by SPSS 26.0 software,which accorded with the measurement data of normal distribution with Mean±SD,and t-test was used for comparison between the two groups.The data were presented as frequency and(or)percentage,and Fisher’s exact test was used for comparison between the two groups.When P<0.05,the difference was considered statistically significant.Results A total of 169 female patients aged 21-48 years old were enrolled,including 71 patients in the endoscope-assisted group and 98 patients in the direct group.There was no significant difference in age,body mass index,prosthesis volume and postoperative follow-up time between the two groups(P>0.05).The operation process of the two groups was smooth,and the incisions healed by first intention after the operation.The operation time in the endoscope-assisted group was(123.5±13.5)min,which was slightly longer than that in the direct group[(111.5±8.1)min](t=7.20,P<0.001),and the postoperative drainage tube indwelling time[(2.6±0.7)d)]was significantly shorter than that in the direct group[(4.2±1.0)d](t=-11.58,P<0.001).The length of hospital stay in the endoscope-assisted group[(2.8±0.8)d]was significantly shorter than that in the direct group[(4.6±1.3)d](t=-10.33,P<0.001).The total amount of bilateral drainage in the endoscope-assisted group was(151.0±30.1)ml on the 1st to 3rd day after the operation,which was significantly lower than that in the direct group[(265.0±48.1)ml](t=-17.62,P<0.001).During the follow-up for one year,the breast shape and hand feeling of the two groups were good,and there was no infection,prosthesis rupture,displacement or exposure.The patients were satisfied with the results of the operation.The rates of capsular contracture,nipple-areola hypoesthesia and scar hyperplasia in the endoscope-assisted group were 0.7%(1/138),0.7%(1/138)and 0(0/138),respectively,which were lower than those in the direct group[2.7%(5/188),3.7%(7/188)and 2.7%(5/188)],respectively,but the differences were not statistically significant(P>0.05).Conclusion Both endoscope-assisted and direct prosthetic augmentation mammaplasty through an inframammary fold incision can achieve satisfactory results.The operation time of endoscope-assisted augmentation mammaplasty is slightly longer than that under direct vision,but the surgical trauma of that is less,the postoperative drainage tube indwelling time and length of hospital stay are shortened,and the amount of bleeding in the operation area is reduced.