腋下单孔乳腔镜双侧乳腺腺体切除治疗男子乳腺发育

Axillary Single-site Laparoscopic Bilateral Mastectomy for the Treatment of Gynaecomastia

目的探讨腋下单孔乳腔镜双侧乳腺腺体切除治疗男子乳腺发育(gynecomastia,GYN)的临床疗效。方法2023年8~10月我院对31例GYN行腋下单孔乳腔镜双侧乳腺切除术。取腋窝处2~2.5 cm切口,于腺体前后间隙进行溶脂、吸脂,冷刀离断皮下Cooper韧带,乳腔镜下完成腺体切除,术区置管引流。结果31例均成功完成腋下单孔乳腔镜双侧乳腺切除术,手术时间中位数70(60,90)min,术中出血量(12.6±2.3)ml。拔除双侧引流管时间(1.5±0.2)d,住院时间(3.0±0.5)d。切除腺体质量:右侧(66.1±25.9)g,左侧中位数67.7(42.0,87.0)g。术后经乳头胸围、乳头间距、双侧胸乳距、乳头中线距、乳头高度与术前比较差异均有统计学意义(P<0.05)。术后经乳头胸围缩短(6.52±3.12)cm;乳头间距缩短(2.46±1.53)cm;右侧乳头高度上移中位数0.82(0.17,1.47)cm;左侧乳头高度上移中位数0.87(0.00,1.40)cm。术后双侧乳头位置对称,两侧乳头中线距及乳头高度差异均无统计学意义(P>0.05)。术后1例发生右侧乳头乳晕区麻木不适,术后2个月症状基本缓解;1例术后左侧胸壁皮下积血,经乳晕小切口置管冲洗引流后治愈;余29例无术后出血、积液、感染、乳头乳晕坏死等并发症。术后2个月患者美容效果主观自评非常满意(均为15分)。结论腋下单孔乳腔镜双侧乳腺腺体切除治疗GYN安全、有效,可临床推广。

Objective To investigate the therapeutic effect of axillary single-site laparoscopic mastectomy in the treatment of gynecomastia.Methods From August to October of 2023,axillary single-site laparoscopic bilateral mastectomy was conducted in 31 patients with gynaecomastia.A 2-2.5 cm incision in the axilla was made,followed by lipolysis and liposuction in the anterior and posterior glandular spaces.After scalpel dissection of the subcutaneous Cooper’s ligament,laparoscopic mastectomy was completed,with placement of a drainage tube in the area of the operation.Results The axillary single-site laparoscopic bilateral mastectomy was successfully completed in all the 31 cases.The median operating time was 70(60,90)min,the intraoperative hemorrhage was(12.6±2.3)ml,the time to remove bilateral drainages was(1.5±0.2)d,and the duration of hospitalization was(3.0±0.5)d.The weight of resected mammary gland was(66.1±25.9)g on the right side and 67.7(42.0,87.0)g on the left side.The differences in postoperative chest circumference,nipple to nipple distance,bilateral sternal notch to nipple distance,nipple to midline distance,and nipple height were statistically significant when compared with the preoperative period(P<0.05).Postoperative reduction in chest circumference was(6.52±3.12)cm,the distance between nipples reduced by(2.46±1.53)cm,the right nipple height shifted upwards by 0.82(0.17,1.47)cm,and the left nipple height shifted upwards by 0.87(0.00,1.40)cm.The bilateral nipple position was symmetry postoperatively.There was no statistically significant difference in the bilateral nipple to midline distance and height difference values(P>0.05).Numbness and discomfort in the area of the right nipple and areola occurred after surgery in 1 case,and the symptoms were largely resolved 2 months after surgery.Subcutaneous hemorrhage on the left chest wall occurred postoperatively in 1 case and was resolved by placing a tube through a small incision in the areola to irrigate and drain.No postoperative complications such as hemorrhages,effusions,infections,or nipple-areola necrosis occurred in the remaining 29 cases.Patients’subjective self-assessment of cosmetic results 2 months after surgery was very satisfactory(all were 15 points).Conclusion Axillary single-site laparoscopic mastectomy is a safe and effective treatment for gynecomastia,which is of high value for promotion.