乳晕内下缘弧形切口皮内缝合治疗男性乳房肥大症

目的:探讨通过乳晕内下缘弧形切口切除增生乳腺组织,并采用皮内缝合治疗男性乳房肥大症的手术方法和临床效果。方法:回顾性分析5年来采用局部浸润麻醉或基础麻醉+局部浸润麻醉,在乳晕内下缘取弧形切口切除肥大增生乳腺组织,保留乳头下方的部分乳腺组织垫,治疗59例,76侧男性乳房肥大症的临床资料。结果:59例,76侧男性乳房肥大症患者,经治疗后手术效果确切,血运障碍发生少,术后患者胸部平坦,无凹陷,乳头无异常感觉,外形满意,切口隐蔽,切口痕迹不明显。结论:采用乳晕内下缘弧形切口皮内缝合治疗男性乳房肥大症能有效去除多余的腺体和脂肪组织,创伤小,恢复快,减少了术后乳头乳晕血运障碍的发生,无感觉障碍,而且切口隐蔽,瘢痕细小,是治疗男性乳房肥大症的良好手术方法。     

乳晕内上方月牙形切口结合脂肪抽吸治疗中度男性乳房肥大症

目的:探讨通过乳晕内上方"月牙形"切口切除增生乳腺组织,并结合脂肪抽吸治疗中度男性乳房肥大症的手术方法和临床效果。方法:在乳晕内上方设计"月牙形"切口,结合负压脂肪抽吸,在去除增生乳腺组织和堆积脂肪的同时,纠正向外下方移位的乳头乳晕位置。结果:本组共12例,20侧,Si mon分级2b以上男性乳房肥大患者,经本方法治疗,手术效果确切,在去除增生乳腺及脂肪组织的同时,向外下方移位的乳头乳晕位置亦得以纠正,1例1侧术后出现血肿,经妥善处理后痊愈。结论:采取乳晕内上方"月牙形"切口结合脂肪抽吸的方法治疗男性乳房肥大,即可有效去除多余的腺体和脂肪组织,又可以纠正外下方移位的乳头乳晕位置,术后乳头乳晕血供良好,感觉正常,是安全有效的方法。     

吸脂联合乳晕下缘弧形切口治疗男性乳房肥大症

目的：总结肿胀麻醉脂肪抽吸联合乳晕下缘弧形切口腺体部分切除术治疗男性乳房肥大症的临床疗效,探寻治疗男性乳房肥大症的微创手术方法。方法：2005年1月-2014年12月,对68例136侧男性乳房肥大症患者实行了肿胀麻醉脂肪抽吸联合乳晕下弧形切口腺体部分切除术,切除增生肥大乳腺组织100～300g。结果：除2例患者出现皮下血肿,后经手术清除积血、止血、加压引流好转痊愈;全部均未发生乳头、乳晕缺血、坏死等并发症。经过6～24个月的随访,乳房外形良好,患者满意。结论：吸脂联合乳晕下缘弧形切口腺体部分切除术具有手术损伤轻、出血量少、安全性高、切口痕迹不明显、乳头乳晕无变形、恢复快、患者满意度高等优点,是目前治疗男性乳房肥大症的有效方法。     

保留乳头的男性乳腺增生切除术的体会

男性乳腺增生亦称为男性乳房肥大症。对于经中西药治疗无好转者,外科传统行包括乳头、乳晕在内的全乳腺切除。此术式,青壮年患者,尤其是未婚者,颇不愿接受。为此,我们自1980年采用了保留乳头、乳晕的全乳腺切除术,经过10例观察,效果良好,现报告如下:一般资料年龄:20~41岁。未婚8例,已婚之例。皆为单侧。增生乳腺小者约3x3em,大者ioxl心em,"1乙均sx义m。10例中仅l例在术后第二天发生血肿,取出血肿后治愈。本10例经近期(最短斗个月)观察,无l例发生乳头、乳晕、皮肤、皮缘坏死及切口感染。     

内镜乳晕小切口男性乳房肥大矫正术

目的探索减少男性乳房肥大整形术后瘢痕,使乳房切除更加精确,更有利于塑形,避免出血、血肿及支配乳头、乳晕感觉神经的损伤。方法对16例患者在内镜监视下,采用乳晕旁2~3.5cm切口,切除肥大的男性乳腺腺体组织,对于以脂肪增生为主者,先行肿胀吸脂术,后在内镜监视下进行残余肥大腺体切除。切除乳腺体组织量单侧为100~320g,平均为130g;吸脂量为20~130ml,平均为68ml,无血肿,切除组织病理检查为脂肪组织及腺体组织。结果术后无血肿,无皮肤坏死,乳头及皮肤的感觉良好,均获随访观察,时间为手术后5个月至3年,无复发。结论内镜外科技术能缩小乳晕切口,避免损伤乳头、乳晕,利于离乳晕较远范围的乳腺组织切除及乳房重新塑形,为男性乳房肥大矫正的一种良好选择。     

脂肪抽吸联合乳晕切口腺体切除治疗青春期男性乳房肥大症

目的 探讨脂肪抽吸联合乳晕切口腺体切除治疗青春期男性乳房肥大症的临床疗效.方法 43例男性乳房肥大患者,年龄14～36岁,脂肪型15例,脂肪、腺体混合型28例.均先采用肿胀麻醉乳晕小切口脂肪抽吸术,吸除大部分脂肪后,延长切口至1.0～1 5 cm,切除乳晕下及乳晕周围乳核区乳腺组织,再次通过抽吸调整过渡区的平滑整齐,术后加压包扎,7d拆线.结果 术后无1例发生乳头乳晕坏死,切口瘢痕不明显.最长随访时间3年,乳房外形良好,未见复发.结论 脂肪抽吸联合乳晕切口腺体切除法治疗男性乳房肥大,具有操作简易、出血少、康复快、美学效果佳等优点,值得临床推广.     

垂直切口上蒂法治疗乳房肥大的临床效果研究

目的:探讨垂直切口上蒂法治疗乳房肥大的临床效果。方法:2017年5月-2019年6月,采用垂直切口上蒂法治疗乳房肥大56例(112侧),根据术前设计去除蒂部表皮,切除多余的皮肤及乳腺组织,自下而上对合内外侧乳腺,V-Y推进乳头乳晕复合瓣至适当位置,固定乳头乳晕后,逐层缝合。结果:术后随访6～18个月,40例患者对术后乳房形态,对称性及瘢痕满意;6例(8侧)出现了皮下脂肪液化,切口延期愈合;10例(12侧)切口出现瘢痕增生,患者基本满意。结论:对于乳房肥大患者,术前根据乳房肥大下垂程度设计乳头的位置,术中在减小乳房体积前提下,确保乳头乳晕血运,最大程度保留乳头乳晕感觉及乳房的泌乳功能,尽可能减少术后切口瘢痕及恢复双侧乳房的良好外形和对称性。     

脂肪抽吸加乳晕小切口治疗男性乳房肥大症

目的　探讨男性乳房肥大症的治疗方法及脂肪抽吸加乳晕小切口治疗男性乳房肥大症的手术效果。方法　于肥大乳房区域皮下脂肪层注射肿胀麻醉液 ,采用负压吸脂法吸出该区内的脂肪组织及部分乳腺组织 ,使其与周边衔接自然 ,胸部平整为止。经抽吸 ,乳头下方残留的乳腺组织与其下方呈网状疏松连接 ,极易被分离 ,于乳晕缘做 2cm切口 ,分离并切除残余的乳腺组织。与以往的治疗方法对比 ,讨论了本法的优点 ,提出了术中操作要点及注意事项 ,明确了本手术的适应证。结果　采用此方法为 2 2例男性乳房肥大症患者治疗 ,吸出脂肪组织 3 2 0～ 680ml,切除乳腺组织 3 0～ 15 0 g ,伤口Ⅰ期愈合 ,术后胸部平整 ,切口瘢痕不明显 ,效果满意。 结论　本方法出血量小 ,安全性大 ,操作简单 ,易于掌握 ,适用于治疗脂肪型及脂肪腺体型男性乳房肥大症     

吸脂法乳房皮下腺体全切术治疗男性乳腺发育症

目的：探讨吸脂法皮下腺体全切术治疗男性乳房发育症的临床价值及美容效果。方法2012年3月-2014年3月对13例男性乳房发育症行吸脂法皮下腺体全切术。在乳房肥大区域皮下脂肪层注射脂肪裂解液,乳晕旁取1．0 cm切口,采用负压吸脂,抽吸该区域内的脂肪组织,经小切口逐条切除增生肥大的乳腺组织,术毕生物胶粘合切口。结果单侧手术时间40-100 min,平均70 min;出血量20-50 ml,平均30 ml。2例皮下少量积液,其中1例局部血肿,经反复抽吸3 d后愈合。术后住院时间平均2．8 d（2-5 d）。切口隐匿,无明显瘢痕,一期愈合,无乳头、乳晕坏死,胸部曲线平坦、自然,无凹凸不平感。8例随访3个月,外形均比较满意,乳头形态正常,3例术后乳头乳晕麻木,3个月后感觉恢复正常。结论吸脂法皮下腺体全切术治疗男性乳房发育症,操作简单,安全,美容效果满意。     

脂肪抽吸加乳晕小切口治疗男性乳房肥大症

目的探讨男性乳房肥大症的治疗方法及脂肪抽吸加乳晕小切口治疗男性乳房肥大症的手术效果.方法于肥大乳房区域皮下脂肪层注射肿胀麻醉液,采用负压吸脂法吸出该区内的脂肪组织及部分乳腺组织,使其与周边衔接自然,胸部平整为止.经抽吸,乳头下方残留的乳腺组织与其下方呈网状疏松连接,极易被分离,于乳晕缘做2?cm切口,分离并切除残余的乳腺组织.与以往的治疗方法对比,讨论了本法的优点,提出了术中操作要点及注意事项,明确了本手术的适应证.结果采用此方法为22例男性乳房肥大症患者治疗,吸出脂肪组织320～680?ml,切除乳腺组织30～150?g,伤口Ⅰ期愈合,术后胸部平整,切口瘢痕不明显,效果满意.结论本方法出血量小,安全性大,操作简单,易于掌握,适用于治疗脂肪型及脂肪腺体型男性乳房肥大症.     

超声引导下微创旋切术治疗男性乳房肥大症

目的探讨B超引导下Mammotome微创旋切系统在男性乳房肥大症微创手术中的应用价值.方法B超引导下利用Mammotome对10例17处男性乳房肥大症行微创旋切切除术.结果乳房肿块均被Mammotome微创旋切切除,每处平均旋切28次(25～47次).手术时间15～40 min,平均30 min.皮肤切口仅3～4 mm,术后1周2例出现轻度皮下瘀斑,1例出现局部小血肿.10例随访6～8周,临床及B超复查均无异常.结论B超引导下Mammotome微创旋切系统行男性乳房肥大症切除术,操作简易,创伤小,切除彻底,值得临床推广.     

The surgical management of high-grade gynecomastia

It is now well accepted that low grades of gynecomastia are best treated with liposuction alone. However, the surgical management of the high-grade gynecomastia (Simon's grade III) has remained problematic because both liposuction and conventional subcutaneous mastectomy (without skin excision) have frequently resulted in significant residual skin redundancy, requiring a second operation for skin resection. Our preferred approach to high-grade gynecomastia has been the single-stage subcutaneous mastectomy and circumareolar concentric skin reduction with deepithelialization. However, in the rare case of tubular breast deformity in the male and also in patients with gynecomastia who underwent massive weight loss, simple mastectomy and free nipple graft is performed. Therefore, these 2 groups of patients will be excluded from the current series. Twenty-four consecutive males with high-grade gynecomastia were reviewed. All patients underwent subcutaneous mastectomy with concentric skin resection. There were no major complications such as infection, hematoma, seroma, or nipple-areola complex necrosis. The main disadvantage of the technique was the mild residual skin redundancy, which was noted in all 24 patients. This redundancy, however, was never severe enough to require a secondary procedure, and all patients were satisfied with the final result.     

应用肿胀麻醉技术微创小切口治疗中重度男性乳房发育症

目的：寻找一种切口小、创伤小的治疗中重度男性乳房发育的手术方法。方法：应用肿胀麻醉技术,在局麻下作男性发育乳房的脂肪抽吸,同时取乳晕缘小切口切除增生肥大的腺体。结果：21例男性乳房发育患者肥大的乳房减小,切口瘢痕小且隐蔽。随访6～60月,无复发。结论：对于中重度男性乳房发育症,应用肿胀麻醉技术微创小切口出血少、切口小、创伤小,是一种治疗该病的理想的手术方法。     

Surgical treatment of gynecomastia: complications and outcomes

ABSTRACT: Gynecomastia is defined as the benign enlargement of the male breast. Multiple surgical options have been used to improve outcomes. The aim of this study was to analyze the surgical approaches to the treatment of gynecomastia and their outcomes over a 10-year period. All patients undergoing surgical correction of gynecomastia in our department between 2000 and 2010 were included for retrospective evaluation. The data were analyzed for etiology, stage of gynecomastia, surgical technique, complications, risk factors, and revision rate. The surgical result was evaluated with self-assessment questionnaires. A total of 41 patients with 75 operations were included. Techniques included subcutaneous mastectomy alone or with additional ultrasound-assisted liposuction (UAL) and isolated UAL. The surgical revision rate for all patients was 4.8%. The skin-sparing procedure gave good surgical results in grade IIb and grade III gynecomastia with low revision and complication rates. The self-assessment report revealed a good level of overall satisfaction and improvement in self-confidence (average scores 9.4 and 9.2, respectively, on a 10-point scale). The treatment of gynecomastia requires an individualized approach. Subcutaneous mastectomy combined with UAL could be used as the first choice for surgical treatment of grade II and III gynecomastia.     

���׷�ǻ��Ƥ�������г��������������ٷ���֢�ٴ���ֵ����

??Value of single-site laparoscopic subcutaneous mastectomy for gynecomastia WANG Zi-han,CHEN Zhi-cheng,GE Zhi-cheng,et al. Department of General Surgery??Beijing Friendship Hospital??Capital Medical University??Beijing 100050??China
Corresponding author: QU Xiang, E-mail:cqx3968@sina.com
WANG Zi-han and CHEN Zhi-cheng are the first authors who contributed equally to the article
Abstract Objective To discuss the treatment effect in gynecomastia with single-site laparoscopic subcutaneous mastectomy. Methods From March 2017 to August 2017??clinical data of 5 patients with gynecomastia underwent single-site laparoscopic subcutaneous mastectomy (1 patient was unilateral affected??others were bilateral, total 9 cases) in Department of General Surgery??Beijing Friendship Hospital??Capital Medical University. The aesthetic and patient satisfaction results, operative time, postoperative drainage and complications were evaluated. Results All operations were successful. The average score of cosmetic effect was 15 after 6 months, and the subjective evaluation of the patients was very satisfactory. Subcutaneous hydrops or hematoma??papilla and areola necrosis or other complications did not occur after surgery. Conclusion Compared with the conventional operations, single-site laparoscopic subcutaneous mastectomy for gynecomastia may be a better method for cosmetic effect which is worthy of further study.     

锐性吸脂针腋皱襞入路肿胀抽吸法治疗男性乳房发育症

目的:改良目前治疗男性乳房发育症的手术方法,观察其效果。方法:术前应用高频超声探头选择脂肪和乳腺组织均有增生的男性乳房发育症患者18例,以腋皱襞前端为入路,单纯应用锐性吸脂针对增大的乳房进行肿胀抽吸治疗,吸出物送病理学检查。结果:乳房胸部塑形良好,无血肿、乳头乳晕感觉障碍等并发症。胸部无手术痕迹残留。随访3～18月无复发。病理检查结果显示吸出物中有增生的乳腺组织,病理特点符合男性乳腺发育症。结论:对于脂肪和乳腺组织均有增生的男性乳房发育症,锐性吸脂针腋皱襞入路单纯肿胀抽吸术是一种可选的有效手术方法。     

YL-1型颅内血肿粉碎仪对高血压脑出血的微创治疗

目的探讨微创治疗高血压脑出血的临床效果。方法根据CT定位，使用YL-1型颅内血肿粉碎仪对颅内血肿碎吸引流。结果治疗36例，存活出院34例，死亡2例。结论微创治疗高血压脑出血，操作简便、安全，疗效好，费用低，是对高血压脑出血治疗的有效的治疗方法。     

Indications for and results of surgical therapy for male gynecomastia.

BACKGROUND: The objective of our study was to analyze factors determining diagnostic versus cosmetic indication and postoperative results in the treatment of gynecomastia. PATIENTS AND METHODS: Data from 100 patients and 141 breasts were analyzed retrospectively, and reevaluated by questionnaire (n = 81) and clinical examination (n = 33). Except for 2 patients, all underwent subcutaneous mastectomy through various incisions. RESULTS: Diagnostic surgery was exclusively performed in unilateral, nodular gynecomastia being preferentially of grade I. Higher grade, bilateral gynecomastia led mainly to cosmetic surgery. Minor complications (skin retraction, hypertrophic scars, hypesthesia, skin redundancy) occurred in 53% of patients and significantly more often in grade III or II gynecomastia. Each incision was preferentially associated with specific sequelae. However, 86% of patients were satisfied with surgical results. CONCLUSIONS: Laterality, consistency, grade, and age at onset of symptoms determine surgical indication. Despite the high number of sequelae due to preoperative grade and selected incision, most patients are satisfied with postoperative results.