雌激素硫酸转移酶在肥大乳房乳腺组织中的表达及意义

目的 探讨雌激素硫酸转移酶(estrogen sulftransferase,EST)在肥大乳房乳腺组织中的表达及其意义.方法 采用免疫组织化学EnVision二步法,检测EST在32例肥大乳房和15例正常体积乳房乳腺组织中的表达,以及不同类型肥大乳房(19例腺性肥大乳房和13例脂性肥大乳房)乳腺组织中EST的表达状况.结果 32例肥大乳房和15例正常体积乳房乳腺组织中EST阳性表达率分别为34.4%(11/32)和93.3%(14/15),组间比较差异有统计学意义(P＜0.01).EST在19例腺性和13例脂性肥大乳房乳腺组织中的阳性表达率分别为10.5%(2/19)和69.2%(9/13),组间比较差异有统计学意义(P＜0.01).结论 EST的表达减少或缺失,对肥大乳房的形成,尤其与腺性肥大乳房的关系较为密切.

Abstract：

Objective To investigate the expression of estrogen sulfotransferase (EST) in the mammary gland of hypertrophic breast and its significance. Methods EST expression in the mammary gland was detected by EnVision two step method of immunohistochemistry in 15 cases with normal breasts and 32 cases with hypertrophic breasts, including 19 gland-associated cases and 13 fat-associated cases.Results The positive expression rate of EST in mammary gland was 34.4% (11/32 ) in hypertrophic group and 93.3% (14/15) in normal group, showing a significant difference between the two groups(P ＜0.01 ). The positive expression rate of EST was 10.5% (2/19) in gland-associated group and 69. 2% (9/13) in fat-associated group, showing a significant difference between the two groups (P ＜ 0.01 ).Conclusions Decrease or deletion of EST in the mammary gland may be related to the development of hypertrophic breast, especially gland-associated hypertrophic breast.     

逆行桡侧小鱼际皮瓣修复手指软组织缺损

Objective To investigate the therapeutic effect of reverse radial hypothenar flap for finger soft tissue defect. Methods From Mar. 2006 to Mar. 2010, 13 cases (14fingers) with finger soft tissue defects were treated with reverse radial hypothenar flaps pedicled with ulnar palmar digital artery of little finger. The defects were 1.9 cm× 1. 5cm -4. 0 cm× 2. 0 cm in size. The flap size ranged from 1.5cm× 2.0 cm to 4. 0 cm × 2. 0 cm. Results All the flaps survived completely with primary healing both in donor and recipient area. 12 cases(13 fingers)were followed up for 1-3 years. The flaps color was similar to the unaffected fingers. Cicatricial contracture happened in one case due to contracture of palmar fascia.The two-point discrimination distance on flap was 3.2-5. 3mm. The active and passive movement of finger joints was evaluated as excellent in 12 fingers, good in one finger. There was no complaint about the feeling at the donor site. Two months after operation, all patients could go back to work. Conclusions The reverse radial hypothenar flap is very suitable for finger soft tissue defect with less morbidity to donor site.     

经乳晕切口治疗多种乳腺良性疾病的探讨

Objective To explore the indications, superiority and surgical technique of periareolar approach in the management of benign breast diseases. Methods 132 patients with benign breast disease (91 cases of Fibroadenoma, 12 cases of limited gland hyperplasia, 8 cases of cyst, 2 cases of benign phyllodes tumor and 6 cases of male gynecomastia) underwent operation through areolar incision. Results All patients were followed up for 1-10 months. 107 cases were satisfied with their treatment,19 cases were not quite satisfied with the relatively long incision, and 6 cases were not satisfied with the front incision. The one-month-later reexamination showed that 117 cases feel good and 15 cases had partial numbness of the nipple (15/132, 11.36%). All but two patients wound healing delayed because of local hematoma (2/132, 1.52%). Neither necrosis nor infection was found. Conclusions With the advantages of fewer complications and cosmetic effect, periareolar approach can be applied in management of various benign breast diseases. Factors such as indications, anatomical layer, postoperative molding, appropriate drainage, pressure dressing should be taken into consideration for the success of operation.     

逆行桡侧小鱼际皮瓣修复手指软组织缺损

Objective To investigate the therapeutic effect of reverse radial hypothenar flap for finger soft tissue defect. Methods From Mar. 2006 to Mar. 2010, 13 cases (14fingers) with finger soft tissue defects were treated with reverse radial hypothenar flaps pedicled with ulnar palmar digital artery of little finger. The defects were 1.9 cm× 1. 5cm -4. 0 cm× 2. 0 cm in size. The flap size ranged from 1.5cm× 2.0 cm to 4. 0 cm × 2. 0 cm. Results All the flaps survived completely with primary healing both in donor and recipient area. 12 cases(13 fingers)were followed up for 1-3 years. The flaps color was similar to the unaffected fingers. Cicatricial contracture happened in one case due to contracture of palmar fascia.The two-point discrimination distance on flap was 3.2-5. 3mm. The active and passive movement of finger joints was evaluated as excellent in 12 fingers, good in one finger. There was no complaint about the feeling at the donor site. Two months after operation, all patients could go back to work. Conclusions The reverse radial hypothenar flap is very suitable for finger soft tissue defect with less morbidity to donor site.     

Superomedial pedicle reduction mammaplasty based on Würinger's horizontal septum

Objective To discuss the surgical techniques and efficacy of a new method of breast treatment of hypermastia. Methods From January 2009 to February 2011, a series of 15 patients underwent a new technique for reduction mammaplasty. This technique involved a superomedial pedicle nipple-areolar complex (NAC). Results In our series, the resection weight per breast was (522. 9±218.3) g and the new nipple-to-sternal-notch distance was (21.7± 1.74) cm postoperatively. Mean nipple elevation was 8. 5cm (range, 4-16 cm). There were no hematoma and partial or complete NAC necroses occurred in our series. Minimal wound dehiscence occurred in one case ( 6.7 % ). Thirteen patients were followed up for 6 to 18 months. NAC sensibilities were comparable before and after operation, and good breast shapes were produced in all cases. Conclusion The superomedial pedicle technique provides good results with respect to NAC viability and sensibility, breast contour and last superomedial fullness.     

Superomedial pedicle reduction mammaplasty based on Würinger's horizontal septum

Objective To discuss the surgical techniques and efficacy of a new method of breast treatment of hypermastia. Methods From January 2009 to February 2011, a series of 15 patients underwent a new technique for reduction mammaplasty. This technique involved a superomedial pedicle nipple-areolar complex (NAC). Results In our series, the resection weight per breast was (522. 9±218.3) g and the new nipple-to-sternal-notch distance was (21.7± 1.74) cm postoperatively. Mean nipple elevation was 8. 5cm (range, 4-16 cm). There were no hematoma and partial or complete NAC necroses occurred in our series. Minimal wound dehiscence occurred in one case ( 6.7 % ). Thirteen patients were followed up for 6 to 18 months. NAC sensibilities were comparable before and after operation, and good breast shapes were produced in all cases. Conclusion The superomedial pedicle technique provides good results with respect to NAC viability and sensibility, breast contour and last superomedial fullness.     

Accurate Application of the Levator Palpebrae Superioris Anterior Migration and Shortening Technique in Blepharoptosis Correction Surgery

Background Accurate preoperative evaluation of the levator palpebrae superioris(LPS)strength is required for specific calculation of anterior migration or shortening.This information serves as a surgical reference for more accurate correction of ptosis.Methods Between June 2017 and June 2019,155 eyes of 97 patients were studied.Patients were divided into the following 3 groups based on the ptosis degree:mild(28 cases),moderate(53 cases),and severe(16 cases).The LPS strength was evaluated preoperatively and used to calculate LPS anterior migration and shortening.The LPS aponeurosis and Müller’s muscle(L-M)complex was separated from the upper margin of the tarsal plate to the calculated height according to the levator muscle suspension system retention approach.The complex was subsequently fixed to the planned tarsal plate location.The upper eyelid margin(UEM)height,eyelid morphology,eyelid closure,eye symmetry,exposure keratitis status,and patient satisfaction were evaluated at 1 week and at 1 and 6 months postoperatively.Results In all cases,the UEM positions were normal,and only patients with severe ptosis exhibited lagophthalmos in the early posterative period.Six months postoperatively,13%of eyes in the severe group had residual ptosis;all mild and moderate cases exhibited good surgical outcomes.The eyelids closed well with no exposure keratitis.All patients were satisfied with the eyelid contour.Conclusions Accurate LPS anterior migration and aponeurosis shortening can eliminate various factors affecting surgical blepharoptosis treatment.These procedures not only reduce operation time but also enhance the stability of postoperative correction.     

双干型静脉皮瓣在撕脱性断指再植中的应用

Objective To report the application and results of venous flap with double vein trunks in replantation of degloved fingers.Methods From March 2007 to June 2009, 6 cases of soft tissue defect in the degloved finger were replanted with venous flap with double vein trunks.The interval between injury and operation was 30 minutes to 8 hours.All fingers were replanted by arterialized free venous flap from the ipsilateral forearm with double vein trunks.The flap was 1.8 cm×1.8 cm to 2.2 cm× 5.8 cm in size.The donor site was directly closed.Results Primary wound healing was observed in all 6 cases postoperatively.All the replanted fingers survived completely.In 5 cases the venous flaps survived uneventfully.In 1 case there was partial superficial necrosis of the flap which healed with conservative management.Postoperative follow-up ranged from 6 to 24 months.The flaps and fingers had good circulation, good texture and color match.According to the criteria for functional assessment of amputated finger issued by the Chinese Hand Surgery Society, the results were graded as excellent in4cases, goodin 1 case, andfairin 1 case.Theoverall excellent rate was 82.5%.Conclusion Replantation of degloved finger with fransfer of venous flap with double vein trunks is capable of repairing pulp soft tissue defect and maximizing the restoration of finger appearance and function.     

双干型静脉皮瓣在撕脱性断指再植中的应用

Objective To report the application and results of venous flap with double vein trunks in replantation of degloved fingers.Methods From March 2007 to June 2009, 6 cases of soft tissue defect in the degloved finger were replanted with venous flap with double vein trunks.The interval between injury and operation was 30 minutes to 8 hours.All fingers were replanted by arterialized free venous flap from the ipsilateral forearm with double vein trunks.The flap was 1.8 cm×1.8 cm to 2.2 cm× 5.8 cm in size.The donor site was directly closed.Results Primary wound healing was observed in all 6 cases postoperatively.All the replanted fingers survived completely.In 5 cases the venous flaps survived uneventfully.In 1 case there was partial superficial necrosis of the flap which healed with conservative management.Postoperative follow-up ranged from 6 to 24 months.The flaps and fingers had good circulation, good texture and color match.According to the criteria for functional assessment of amputated finger issued by the Chinese Hand Surgery Society, the results were graded as excellent in4cases, goodin 1 case, andfairin 1 case.Theoverall excellent rate was 82.5%.Conclusion Replantation of degloved finger with fransfer of venous flap with double vein trunks is capable of repairing pulp soft tissue defect and maximizing the restoration of finger appearance and function.     

青春期乳房肥大症乳腺组织中芳香化酶P450 mRNA的表达

Objective To investigate the expression status of the P450arom mRNA in breast tissue of pubertal mammary hypertrophy and then explore the possible etiology of pubertal mammary hypertrophy. Methods 15 patients were selected for pubertal mammary hypertrophy group. Breast hypertrophy tissue specimens were collected from the gland excised during reduction mammaplasty. 15 patients with pathologically simple fibroadenoma were used as another control group. Patient approval of participation in this study was obtained preoperatively. The expression of P450arom mRNA was detected by RT-PCR in all the cases above. Results There was no significant difference between the pubertal mammary hypertrophy groups and normal groups on the expression rates of P450arom mRNA. But among the positive cases, the expression of P450arom mRNA within breast tissue were 0.202±0.048 in pubertal mammary hypertrophy group; and 0.159±0.068 in normal group. There was significant difference between the pubertal mammary hypertrophy and normal groups (P < 0.05). Conclusion The expression of P450arom mBNA in pubertal mammary hypertrophy are significantly higher than in normal mammary glandular tissue. The pubertal mammary hypertrophy may be related to the expression status of P450arom mRNA within breast tissue.     

应用乳腺旋转瓣固定矫正轻中度乳房下垂

目的:介绍采用乳房外下象限乳腺旋转瓣固定矫正轻中度乳房下垂的方法和经验。方法:经乳晕周缘"双环形"切口,去除内外环之间的表皮。在皮下脂肪组织与腺体之间广泛分离。在乳房下方正中垂直剖开乳腺,并向外侧分离,形成乳房外下象限乳腺瓣,并向内上方旋转固定,缩小乳房基底,重塑乳房外形,并上提下垂的乳头乳晕复合体。伴有明显乳腺萎缩者,同期或Ⅱ期行胸大肌下假体隆乳术。结果:2011年2月~2013年12月采用该方法共治疗轻中度乳房下垂19例,无血肿、感染、乳头乳晕坏死等并发症发生,术后随访1~2年,无乳房下垂复发,乳房下垂明显矫正,双乳对称,外形良好。切口瘢痕呈环线状,乳头乳晕感觉功能正常。结论:乳腺旋转瓣固定法结合了"双环法"和"垂直法"两种技术的优势,对轻中度乳房下垂的治疗,提供了一种新的思路和方法。     

改良双环法乳房下垂矫正术

目的:介绍改良双环法行乳房悬吊术的方法和经验。方法:采用传统的双环法环乳晕切口,切除双环间表皮,在皮肤与上半乳腺的腺体表面之间剥离,去除上半腺体后松弛的浅筋膜深层,上提腺体至正常位置并固定于深筋膜,同时进行腺体的适当折叠塑形或置入乳房假体增加丰满程度。结果:共行轻、中度下垂28例(4例为单侧下垂),其中悬吊加假体隆乳9例;腺体瓣交叉缝合悬吊塑形19例。术后乳房外形改善满意,乳头、乳晕感觉良好,效果持久。结论:本手术方法安全易行,组织损伤小,瘢痕不明显,是矫治轻、中度乳房下垂的一种比较理想的方法。     

双环复合组织筋膜瓣法矫正乳房下垂的临床应用

目的 探讨应用双环复合组织筋膜瓣法行乳房悬吊术矫治乳房轻、中度下垂的方法及临床效果.方法 在传统的双环形切口乳房缩小整形术的基础上,在皮肤与乳腺的腺体表面间行广泛剥离后,应用蒂在乳腺上半象限的筋膜瓣垂直下拉,缝合固定于下半象限的乳腺与胸大肌之间,并将乳晕内外环的真皮行荷包缝合,术后将乳房塑形包扎.结果 应用双环复合组织筋膜瓣行乳房悬吊术的方法矫治乳房下垂20例,患者均Ⅰ期愈合,无乳头、乳晕坏死.所有患者术后随访6~12个月,乳晕周围皮肤皱褶基本消失,乳房外形美观持久,乳头、乳晕感觉良好,效果满意.结论 改良手术方法技术简便易行,组织损伤小,瘢痕不明显,是矫治轻、中度乳房下垂的一种比较理想的方法,值得推广应用.     

乳腺瓣悬吊加假体置入矫正中重度乳房萎缩下垂

目的:介绍采用乳腺瓣悬吊,并在胸大肌后间隙置入硅凝胶假体矫正中重度乳房萎缩下垂的方法和经验。方法:经乳晕周缘"双环形"切口,去除内外环之间的表皮。在皮下脂肪组织与腺体之间广泛分离。在乳腺上部形成4～5cm宽的纵向乳腺瓣,横向切断乳腺瓣,上提缝合固定以悬吊乳房。胸大肌后间隙置入硅凝胶假体。将去表皮的真皮帽边缘与乳腺基部缝合,并固定在胸壁上,重塑乳房外形。结果:2005年1月～2009年6月采用该方法共治疗28例中重度乳房萎缩下垂的患者,无血肿、感染、乳头乳晕坏死等并发症发生。术后随访1～4年,乳房丰满挺拔,萎缩下垂得到矫正,切口瘢痕呈环线状,乳头乳晕感觉功能正常。结论:该术式在增大乳房体积的同时提升下垂的乳房,对中重度乳房萎缩下垂患者可作为一种理想的整形方法。     

改良双环法乳房悬吊术

目的 介绍改良双环法行乳房悬吊术的方法和经验。方法 采用传统的双环法乳房悬吊术切口，在皮肤与乳腺的腺体表面之间行广泛剥离后。在乳腺的下半象限正中将腺体垂直切开，将形成的两部分乳腺复合组织瓣向内上及外上方向旋转后互相交叉重叠缝合固定成形。并将乳晕内外环的真皮行荷包缝合。术后将乳房塑形包扎。结果 采用本方法矫治轻、中度乳房下垂者共8例16侧。术后乳房外形美观持久，乳头、乳晕感觉良好，效果满意。结论 本手术方法简便易行．组织损伤小．瘢痕不明显．是矫治轻、中度乳房下垂的一种比较理想的方法。     

Mastopexy utilizing a dermoglandular hammock flap

BackgroundMany procedures have been described in the search for the ideal mastopexy technique, ranging from simple cutaneous reduction, with or without glandular remodelling, to the use of dermal flaps fixed to the pectoral fascia, or even the use of silicone mesh or sheets.ObjectiveWe describe a technique that uses a dermoglandular hammock flap to achieve optimal position and shape of the breast; well located, good quality scars that are as short as possible; and satisfactory early- and long-term results.MethodsA superior pedicle dermoglandular flap was raised from the lower pole of the breast and transposed to the upper pole. The flap is fixed like a hammock to the pectoral fascia and the wedge-shaped donor defect is closed by approximation and fixation of the medial and lateral pillars with absorbable sutures, thus releasing the tension in the skin suture line.ResultsTwenty-eight patients aged 19 to 58 years underwent the procedure. Adequate shape and projection were achieved in all cases. Partial dehiscence of the suture line developed in 1 patient. The scar quality was excellent, except in 2 cases in which some degree of temporary hypertrophy occurred.ConclusionsIn our experience with this technique, we obtained satisfactory position and shape; good quality, well-placed scars; long-lasting results; and preservation of the patient's ability to breast feed. The technique is simple to perform and is indicated in cases of moderate ptosis.     

真皮乳腺组织瓣悬吊纠正乳房下垂

目的 应用真皮乳腺组织瓣悬吊纠正乳房下垂.方法 本组共6例乳房下垂病人,采用乳晕周围双环切口,在新乳标记点处斜向下方切开腺体组织使乳房下部形成包含双环之间真皮的乳腺组织瓣,将组织瓣向上牵拉覆盖乳腺上部并悬吊固定于胸肌筋膜.组织瓣切取根据乳房下垂程度及组织量多少而定,同时要确保组织瓣血液循环.结果 6例病人均获得满意的乳房外形.结论 该方法是目前比较理想的纠正乳房下垂的方法     

腓骨瓣联合小腿外侧皮瓣修复颌面缺损

目的 探讨腓骨瓣联合小腿外侧皮瓣修复口腔颌面软、硬组织缺损的临床疗效.方法 以腓动、静脉为血管蒂腓骨瓣联合小腿外侧皮瓣进行颌面部软、硬组织缺损修复,腓骨用于修复颌骨缺损,小腿外侧皮瓣主要用于修复口底、牙龈、咽侧、颊以及腭部的软组织缺损.结果 2005年3月至2007年3月,共治疗26例,其中修复恶性肿瘤术后缺损25例,双侧上颌骨缺失1例.术中组织瓣制备顺利,没有出现伤及腓骨血管以及小腿外侧皮瓣的穿支血管的现象.所有移植组织瓣全部成活.其中有1例术后12 h出现吻合动脉危象,经抢救成活;1例术后24 h出现静脉吻合危象,静脉血栓形成,经手术探查,重新吻合静脉后,抢救成功.术后随访6个月至2年,修复区外形满意,患者能从事正常的社会活动.结论 腓骨瓣联合小腿外侧皮瓣修复口腔颌面部复合组织缺损效果较好.可作为首选方法.     

假体置入联合乳腺瓣固定矫正筒状乳房畸形

目的：介绍采用乳腺底面放射状切开固定,同期在胸大肌后间隙置入硅凝胶假体,矫正伴有乳腺发育不良的筒状乳房畸形的方法和经验。方法：经乳房下皱襞切口,乳腺底面放射状切开,形成4个乳腺瓣,向下固定于胸大肌筋膜上,胸大肌后间隙置入硅凝胶假体。结果：2002年1月～2010年12月采用该方法共治疗3例伴有乳腺发育不良的筒状乳房畸形的患者,无血肿、感染、乳头乳晕坏死等并发症发生。术后随访1～3年,乳房丰满挺拔,畸形得到矫正,乳头乳晕感觉功能正常。结论：该术式在增大乳房体积的同时矫正筒状乳房畸形,对伴有乳腺发育不良的筒状乳房畸形患者可作为一种理想的整形方法。     

Modification of “Periwinkleshell operation” for involution and ptosis of the breasts

Summary Involution and ptosis of the breast may follow gestation or dietary weight loss. Whenever possible the breast tissue is reshaped by resecting the skin over its inferior part, detaching the fixation of the glandular tissue medially and laterally, and dividing it centrally to create two mammary gland flaps. The lateral flap is fixed medially to the base of the medial flap and vice versa. In this way the breast tissue assumes a conical form with only minimal to moderate recurrence of ptosis and flatness. If necessary, an augmentation mammoplasty with a prosthesis can be carried out in a second operation 3 to 4 months later.