单孔腔镜技术治疗男性乳腺发育症的临床价值

Clinical value of single hole endoscopic technique in the treatment of gynecomastia

目的探讨经腋窝单孔法腔镜皮下腺体切除术治疗男性乳腺发育症的临床效果,为男性乳腺发育症的治疗提供参考。方法回顾性分析2021年8月—2023年4月在上海交通大学医学院附属第一人民医院南院乳腺甲状腺外科行经腋窝单孔法腔镜皮下腺体切除术的男性乳腺发育症的13例患者的手术资料。对手术美容效果、手术时间、术中出血量、术后引流管保留时间、并发症、肢体活动恢复时间进行评价。结果13例患者的经腋窝单孔法腔镜皮下腺体切除术均成功实施,手术时间0.5~4.5 h,平均1.5 h,引流管拔除时间7~14 d,平均10 d。1例出现一侧乳头部分发黑,经局部处理后好转;1例发生血清肿,经反复抽液后愈合;1例患侧上肢皮下气肿,自行吸收。术后随访美容效果评分平均为14.5分,患者主观评价都很满意。结论经腋窝单孔腔镜技术治疗男性乳腺发育症比常规开放手术更能获得满意的美容效果,但该术式有一定的并发症发生可能,需要术者有一定的腔镜手术经验,并不断积累和改进,以减少并发症的发生,提高患者满意度,为男性乳腺发育症的治疗提供指导。

Objective To investigate the clinical effect of endoscopic subcutaneous gland resection via axillary single hole method in the treatment of gynecomastia,in order to provide reference for the treatment of gynecomastia.Methods From August 2021 to April 2023,the surgical data of 13 cases with gynecomastia in the Department of Breast and Thyroid Surgery in the South Compound of First People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine who underwent endoscopic subcutaneous gland resection via axillary single hole method were retrospectively analyzed.The cosmetic effect,operation time,intraoperative blood loss,postoperative drainage tube retention time,complications and limb movement recovery time were evaluated.Results All the 13 patients were successfully underwent endoscopic subcutaneous gland resection via axillary single hole method.The operation time was 0.5-4.5 hours,with an average of 1.5 hours,and the drainage tube extraction time was 7-14 days,with an average of 10 days.One case had partial blackening of one side of the nipple,which was improved after local treatment;1 case had serum swelling,which healed after repeated drainage;and 1 case had subcutaneous emphysema on the upper limb of the affected side,which was absorbed by itself.The average score of cosmetic effect of postoperative follow-up was 14.5 points,and the subjective evaluations of the patients were very satisfactory.Conclusion Compared with conventional open surgery,axillary single hole endoscopic technique could achieve satisfactory cosmetic effect in the treatment of gynecomastia,but there was a certain possibility of complications in this operation.It was necessary for the operator to have a certain experience of endoscopic surgery,and to accumulate and improve continuously,in order to reduce the occurrence of complications,improve the satisfaction degree of patients,provide guidance for the treatment of gynecomastia.