生理盐水充注式乳房假体的临床应用

为避免硅凝胶渗漏而导致的自身免疫性疾病，作者１９９４年３月～１９９５年８月应用上海威宁整形制品有限公司生产的生理盐水充注式乳房假体为４９例小乳症者做了隆乳术，其中２２例经６个月以上随访，结果令人满意。作者建议术中即时过度扩张后容量复原，可以获得良好的手感和自然的形态，国产生理盐水充注式乳房假体可作为隆乳术常规选择的假体     

充注式假体隆乳术后并发症13例分析

报告８６例国产充注式硅胶假体隆乳术后并发症１３例，为纤维包膜挛缩伴囊内细菌生长、假体破裂、囊内液慢性泄漏、包膜腔积液、胸部Ｘ线“液气平面”、心理失衡等６项，并分析了产生原因及防治方法。     

充注式乳房假体隆乳术的改进与体会

充注式乳房假体隆乳术在我国已较广泛开展，但其手术方式、麻醉方法和术中术后处理等方面，仍有许多可探讨之处。为此，作者对６１例１２１侧小乳症、轻度乳房萎缩、乳房下垂症等行充注式乳房假体隆乳术。术中采用腋顶皱襞切口，胸大肌下间隙置入，封闭式灌注加适量抗生素的生理盐水，放置负压引流术后穿紧身衣。改用肋间神经阻滞麻醉，加静脉内麻醉，效果良好、安全，受术者术后无痛苦记忆，使隆乳术更趋完善。６１例受术者中５５例外形满意、柔软、感觉良好，２例２侧乳头和乳房外侧象限有早期感觉减退，３例乳房假体位置偏高，１例因伴乳房下垂外形欠佳。作者认为，腋顶切口，封闭式灌注加有抗生素的生理盐水，术后引流及改良的麻醉方法，值得推荐。     

乳晕下缘切口行盐水充注式假体隆乳术

目的：探讨隆乳术中不损伤乳腺组织的相关问题。方法：采用乳晕下缘切口，胸大肌下腔隙盐水充注式假体隆乳。结果：２０例小乳症手术顺利，病人及手术医师均感满意，随访一年以上未出现并发症。结论：盐水充注式假体安全性高，乳晕下缘切口疤痕隐蔽，不损伤乳腺组织。手术损伤简便。     

经脐入路奥美定囊袋假体隆乳术

目的　探索假体隆乳的一种新方法。方法　用特制的手术器械 ,经脐入路 ,通过腹壁脂肪层向上分离 ,越过乳房下皱襞 ,在胸大肌下分离隆乳腔隙 ,采用奥美定假体隆乳。结果　临床应用 32例 ,随访 6个月 ,乳房外形满意 ,1例 1侧只乳房出现早期包膜挛缩。结论　与传统手术相比 ,切口更加隐蔽 ,胸部、腋窝处无切口瘢痕。与内窥镜下经脐隆乳术相比 ,方法简单 ,容易操作 ,值得推广     

经脐入路奥美定囊袋假体隆乳术

目的探索假体隆乳的一种新方法.方法用特制的手术器械,经脐入路,通过腹壁脂肪层向上分离,越过乳房下皱襞,在胸大肌下分离隆乳腔隙,采用奥美定假体隆乳.结果临床应用32例,随访6个月,乳房外形满意,1例1侧只乳房出现早期包膜挛缩.结论与传统手术相比,切口更加隐蔽,胸部、腋窝处无切口瘢痕.与内窥镜下经脐隆乳术相比,方法简单,容易操作,值得推广.     

经脐隆乳术

隆乳手术是女性常见的美容手术,最早开展于1899年,曾经尝试了多种方法,目前主要有注射式隆乳术（注射自体脂肪、聚丙烯酰胺水凝胶等）和假体置入隆乳术.而后者是国内外最常用的手术方法,切口通常选择在乳晕、乳房下皱襞或腋窝等处,在乳腺下或胸大肌下,形成腔隙,置入适当的人工乳房假体.但是这些手术方式有诸多的并发症,并能造成较为明显的乳房或腋窝的瘢痕,使患者和医师产生顾虑.随着内窥镜技术在整形外科的应用,经脐隆乳术也逐步发展起来,笔者对近十年来国外报道经脐隆乳术的文章,进行简要的综述.     

硅胶囊假体隆乳术并发症

应用硅胶假体的隆乳术在我国普遍开展，各种并发症也屡有报道，手术医生应掌握该方面的相关知识及并发症的防治方法，以使受术者的痛苦减少到最低程度。过去的十年里在我科共施行１１５例硅胶假体隆乳术，发生并发症９例，主要包括血肿、积液、假体破裂、位置不正。血肿和积液早期都会引起局部疼痛且有并发感染的可能，应尽早引流血肿和积液。假体破裂的诊断很重要，最常用的方法是Ｂ超，但以ＭＲＩ最为准确。位置不正可通过准确的分离腔隙和有效的包扎固定得以预防。与硅胶假体隆乳术相关的自身免疫性疾病越来越引起关注，１５例硅凝胶乳房假体的受术者的免疫功能检查，ＩｇＧ，ＩｇＭ及Ｃ３增高提示硅胶做为一种异物长期存在体内引起非特异性免疫活动增强，但这方面尚需做进一步的临床与实验研究证实。     

不同类型乳房假体隆乳术后并发症的临床分析

目的 统计不同类型的乳房假体置人人体后，远期并发症发生的几率，并分析其原因。方法 总结1993年至2002年间假体隆乳573例，随访到手术方法相同、假体放置位置相同、同一医生组手术的隆乳妇女427例共852只乳房，使用4种不同类型乳房假体：毛面硅凝胶、光面硅凝胶、毛面生理盐水充注式、光面生理盐水充注式乳房假体。出现的远期并发症有纤维包膜挛缩、假体破裂渗漏、疼痛移位等，对各种假体并发症发生率进行统计分析，比较各类假体的优劣。结果 427例852只中803只效果满意，无明显并发症，占94．24％。发生并发症者42例49只乳房，占5．76％。并发症中乳房硬化属Baker‘s分级Ⅲ～Ⅳ级的有26只，缩小变形24只，移位疼痛10只，经手术取出发现假体破裂渗漏的有30只。其中纤维包膜挛缩引起乳房硬化多发生于硅凝胶假体，假体渗漏引起乳房缩小变形多发生于生理盐水充注式假体；假体在体内放置时间越长，发生并发症的几率越高。结论 经统计学处理发现，光面生理盐水假体并发症明显少于光面硅凝胶假体，毛面硅凝胶假体和毛面生理盐水假体并发症发生率没有明显差异。49只有不同并发症的乳房假体中有30只假体破裂渗漏，占61．22％，假体破裂渗漏后又容易引发其它并发症，说明假体质量的提高是减少并发症的关键，长期留置体内假体的老化是目前的难题。     

Subpectoral-transaxillary method of breast augmentation in orientals

Many Oriental patients are very flat-chested and the scar at the site of prosthesis insertion tends to become conspicuous. The author has been using a method combining the transaxillary and subpectoral approaches since 1979 in 47 patients. There are still some problems in this method to be worked out, but the physical stature of the Japanese seems to be suited to this method. This seems to be the reason for the author's success in breast augmentation in Japanese patients. If the indications are evaluated properly, this combined method will be worthy and useful to Orientals in general.     

假体隆乳术后形态不佳的矫治

目的探讨假体置入隆乳术后形态不佳的原因和矫治方法。方法根据临床表现将乳房不佳分为5种类型：圆球型、上部膨隆型、下坠型、单侧双乳型及不规则型。通过松解纤维囊、纤维囊折叠缝合、重新分离隆乳腔隙、更换假体、乳房悬吊术等方法，进行矫治再次隆乳术。结果经过至少6个月随访观察，本组106例均获得了满意的手术效果。结论隆乳术后乳房形态不佳主要与假体体积过大、腔隙分离不到位、假体移位、乳房下皱襞过度分离、纤维囊挛缩及引流、包扎位置不当等因素有关，针对不同原因实施相应的手术方法矫治，能够获得满意的手术效果。     

Breast cancer after breast augmentation with silicone implants

Background: Although epidemiological studies have failed to demonstrate an increased incidence of breast cancer in women who had undergone prior prosthetic augmentation mammoplasty (PAM), it has been reported that when breast cancer arises in this group it presents mostly in a palpable form and at a more advanced stage. This is thought to be secondary to suboptimal mammographic evaluation caused by the masking effect of the implant. This study was undertaken to determine, in our experience, whether breast cancer arising in women who had undergone PAM could be detected in a prepalpable form by mammography and whether it presented at a more advanced stage as compared with nonaugmented women with breast cancer. Methods: The charts of 22 patients, treated by at least one of the authors, in whom 23 breast cancers developed after PAM (group A) were retrospectively reviewed. The comparison groups consisted of 611 nonaugmented patients who underwent 636 procedure for the treatment of primary breast cancer at our institution (group B) and the surveillance, epidemiology, and end results (SEER) data (group C). Parameters studied were mode of detection, tumor size, axillary lymph node involvement, and histopathology. Results: No significant differences between the groups were found in mean tumor size (group A vs. group B), the incidence of preinvasive cancer (group A vs. group B), or axillary lymph node involvement (group A vs. group B and group A vs. group C). Breast-preserving surgery was performed significantly less in augmented patients (group A vs. group B). Conclusion: We conclude that prepalpable and preinvasive breast cancer can be detected in the PAM patient by mammography and that the stage of presentation in this group is not significantly different than in nonaugmented patients. Total mastectomy is preferred over breast-preserving procedures for the treatment of breast cancer in the PAM patient. Presented at the 46th Annual Cancer Symposium of The Society of Surgical Oncology, Los Angeles, March 18–21, 1993.     

经腋窝人路内镜辅助双平面法解剖型假体隆乳术

目的 探讨应用内镜辅助技术,经腋窝人路双平面法硅凝胶假体隆乳术的可行性,并对手术操作经验进行总结.方法 手术在全麻下进行.切口位于双侧腋窝皮肤自然皱褶处,长约4cm.以常规方法剥离胸大肌后间隙,在10 mm-30°内镜辅助下,剪离断部分胸大肌.通过腋窝切口植 入毛面解剖型硅凝胶乳房假体,常规留置负压引流3-5 d.结果 临床应用79例,术后随访时间6～12个月,与单纯胸大肌后假体隆乳患者相比,本组患者术后疼痛程度明显较轻,外形更为自然,手 术效果满意,无包膜挛缩、血肿、瘢痕增生及感染等并发症出现.结论 在内镜辅助下,可以经腋窝入路完成双平面法硅凝胶假体植入隆乳术.该方法将乳腺后间隙假体隆乳术及胸大肌后间隙假体隆乳术的优点相结合,切口隐蔽.在双平面法隆乳术中,当患者要求采用隐蔽切口时,应用该技术是非常合适的选择.     

Autoinflation of saline-filled inflatable breast implants

Spontaneous autoinflation of saline-filled breast implants is a rare phenomenon; only 20 cases have been reported in the world literature. Over the past seven years, three patients have presented with significant unilateral autoinflation of their smooth, single-lumen, round, saline-filled implants. This developed at various times: progressively over 23 years with a Simaplast implant; between the ninth and 10th year after augmentation with a leaflet valve implant; and slowly over the first four years with a leaflet valve implant. The etiology of the autoinflation was shown to be different for the two types of implants. The Simaplast implant had likely been injected with a hypertonic filling solution – one that was twice as concentrated as ‘normal saline’. This would have created an osmotic gradient, which would have facilitated autoexpansion by diffusion. The implant solution remained clear and transparent. In addition, there were no detectable levels of glucose, uric acid or albumin in the fluid. By contrast, auto-inflation of the leaflet valve implants likely resulted from mechanical alterations of the valve mechanism. This type of implant is known to have a high deflation rate, with frequent partial deflations. It is interesting that one of the patients with the leaflet valve implants presented with an autoexpansion on one side and a partial deflation on the other side. Both implants were from the same lot number. The same mechanism that caused partial deflations may have also allowed fluid from the implant pocket to pass through the valve into the lumen of these implants. This could allow glucose, protein and cellular elements to enter into the lumen (these would not pass through an intact elastomeric shell) which would create an osmotic gradient, allowing water to enter the elastomeric shell by diffusion. The fluid in these leaflet valve implants was brownish yellow, very viscous and turbid. It contained elevated levels of glucose and uric acid which would not have passed through the elastomeric shell. Over the past 10 years, four different theories have been proposed in an attempt to explain the etiology of autoinflation. However, the findings of the present study indicate that there are only two mechanisms – a hypertonic filling solution and alterations of the valve mechanism.     

Complications with homologous fat grafts in breast augmentation surgery

The most common complications in breast augmentation surgery with homologous fat grafts obtained from fresh cadavers are presented, showing subsequent surgical procedures to reconstruct the breasts of such patients through use of silicone prostheses and muscle flaps from the latissimus dorsi.     

PAHG注射隆乳术前评估

目的　探讨PAHG注射隆乳术前乳房局部条件的评估指标 ,严格掌握适应证和提高术后效果的预见性。方法　回顾 1432例注射PAHG隆乳术患者术前乳房局部检查结果 ,着重从腺体、基质、脂肪和皮肤等方面进行综合分析并与术后隆乳效果进行相关性分析比较。结果　术前评估与术后隆乳效果评价的相应符合率A优 =88.79%A良 =5 6 .46 %A中 =83.15 %A差 =6 1.90 % ;整体符合率B =72 .5 8% ,并依据此方法设计了注射PAHG隆乳术前乳房局部条件评分评估方案。结论　PAHG注射隆乳术前评估可较准确地预见术后效果 ,为临床实践提供相对客观的参考指标 ,从而避免发生一些不必要的并发症和纠纷 ,对临床实践有一定的指导意义     

隆乳术乳房假体容积的测算

以往隆乳术选择植入假体容积，常常仅凭经验、目测作粗略估算。为使手术效果既符合公认的美学要求，又能满足病人期望，希望找到一种较精确的计算乳房假体容积的方法。将近年来接受隆乳术病人的术前、术后乳房体表相关测量指标、乳房体积及假体容积等有关数据，经ＧＲＡＦＴＯＯＬ软件进行处理、分析，获得隆乳术病人术前、术后身高与胸围的关系曲线；术后胸围与术后双侧乳房总体积的关系曲线及回归方程。根据回归方程计算，再结合病人的身高、术前的胸围、乳房体积以及自己对术后乳房大小的要求，即可较精确地测算出植入假体的容积。这一计算方法，通过大量临床病例的验证，获得了满意的效果。