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     

充注式绒毛状乳房假体的临床应用

为减少光滑面乳房假体隆乳术后纤维包囊挛缩的并发症,我院自1995年4月～1996年4月对12例隆乳患者采用充注式绒毛状乳房假体,其中8例随访6月以上获得了预期的效果。文中介绍了具体的操作方法,理论依据,优点及手术注意点。认为该类型假体为目前临床首选的乳房假体之一。     

国产充注式乳房假体62例应用报告

为了评估国产充注式乳房假体的临床效果，总结了１９９４年３月至１９９５年５月间手术的６２例１２３侧隆乳病例。假体由上海地区生产，容量２００～４５０ｍｌ，均置于胸大肌后间隙，术中假体作短暂性超定量注水，扩张周围组织。结果：１例假体因缝针误伤致术后乳房缩小，２例因伴乳房下垂欠满意，其余病例效果满意。３２例３个月随访时乳房外形对称，柔软，未见萎缩。认为，①国产充注式乳房假体的质量是好的。②术中假体短暂的超定量注水，扩张周围组织，优点明显，值得推荐。     

国产充注式乳房假体62例应用报告

为了评估国产充注式乳房假体的临床效果,总结了1994年3月至1995年5月间手术的62例123侧隆乳病例。假体由上海地区生产,容量200～450 ml,均置于胸大肌后间隙。术中假体作短暂性超定量注水,扩张周围组织。结果:1例假体因缝针误伤致术后乳房缩小,2例因伴乳房下垂欠满意,其余病例效果满意。32例3个月随访时乳房外形对称,柔软,未见萎缩。认为,①国产充注式乳房假体的质量是好的。②术中假体短暂的超定量注水,扩张周围组织,优点明显,值得推荐。     

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。     

充注式绒毛状乳房假体的临床应用

为减少光滑面乳房假体隆乳术后纤维包囊挛缩的并发症，我院自１９９５年４月￣１９９６年４月对１２例隆乳患者采用充注式绒毛状乳房假体。其中８例随访６月以上获得了预期的效果，文中介绍了具体的操作方法，理论依据，优点及手术注意点。认为该类型假体为目前临床首选的乳房假体之一。     

硅凝胶乳房假体隆乳术的改进与体会

为了最大可能减少隆乳术术后不良并发症,塑造一对逼真、美观、柔软、感觉良好的乳房,作者对隆乳术的各个步骤加以改进,使隆乳术更趋完善。45例受术者效果满意。作者认为改良的术前画线、术中分离、便携式持续负压引流、术后固定及按摩尤为重要,值得推广。     

改良双环法行乳房巨大肿瘤切除成形术

目的 探讨一种既能完整切除乳房巨大肿瘤,又能保持乳房功能和良好外形的手术方法 .方法 在传统双环法基础上,根据乳房肿瘤的大小及乳头下垂的程度,设计不同形状的外环及乳房外侧S形切口线,削除两环之间皮肤的表皮,沿乳房外侧S形切口线切开皮肤、皮下组织,直达瘤体包膜,沿包膜表面完整剥离肿瘤,可见遗留一个巨大的乳房皮下腔隙,充分利用去表皮的真皮脂肪瓣或真皮脂肪乳腺瓣填充肿瘤切除后的腔隙,重建乳房形态.结果 5例乳房巨大肿瘤,术后均维持了较好的形态和功能,无1例发生乳头乳晕感觉障碍和坏死,切口愈合良好.最长随诊2年,未见瘤体复发.结论 改良的双环法行乳房巨大肿瘤切除成形术,手术设计灵活,方法 简单,术后乳房外形良好,瘢痕轻,患者满意率高.     

Incidence of capsular contracture in silicone versus saline cosmetic augmentation mammoplasty: A meta-analysis

INTRODUCTION:

Capsular contracture after augmentation mammoplasty occurs at a rate of 15% to 45%. The purpose of the present study was to determine the effect of implant core type (silicone versus saline) on the rate of capsular contracture in augmentation mammoplasty.

METHODS:

A systematic review was conducted through a search of three electronic databases. Two reviewers independently scanned titles yielded by the search and identified potentially relevant papers. Inter-reviewer variability and the scientific quality of the articles were assessed. Meta-analysis was performed.

RESULTS:

Eighty-eight titles of potential relevance were selected from the 393 articles yielded by the search. Inter-rater agreement for selection of potentially relevant articles was 84% (κ=0.54). Four comparative studies were included in the analysis. Scientific quality scores of the included studies ranged from 5 of 14 to 9 of 14. Three of the four studies reported a higher rate of capsular contracture in patients with silicone implants. A combined odds ratio calculated on two of the studies found a 2.25-fold increased risk of capsular contracture in patients who received silicone implants. Eight series of patients who received cohesive gel silicone implants reported rates of capsular contracture from 0% to 13.6%.

CONCLUSIONS:

Higher rates of capsular contracture were found in patients who received silicone implants when compared with those who received saline implants. However, the scientific quality of the comparative studies to date on this subject is poor. Recent series evaluating cohesive gel implants report relatively low rates of capsular contracture. A randomized controlled trial comparing rates of capsular contracture in cohesive gel and saline implants is recommended.     

隆乳术后乳房肿块14例诊疗体会

目的 探讨隆乳术后乳房肿块的诊断及治疗。方法 总结我院2001—2006年收治的14例隆乳术后出现乳房肿块患者的临床资料。结果 8例为凝胶性假瘤,4例为纤维腺瘤,2例为乳癌。4例行穿刺抽液,8例行肿块切除,2例行乳癌改良根治术。结论 影像学检查方式以X线与MRI同时进行为最好,手术方式在不影响治疗效果的前提下选择对乳房的外形影响最少为佳。     

乳房假体大小与形态的选择

目的 探讨隆乳术中正确选择乳房假体大小与形态的方法.方法 通过502例隆乳术后乳房大小与形态的变化,并参考术前胸部各项测量参数,总结出选择合适的乳房假体大小与形态的方法.结果 术前胸廓的横径即H值是选择乳房假体横径的重要参数,以此推算出的乳房假体横径能满足乳间沟较明显及乳房外侧亦较丰满的要求.胸骨切迹中点S到乳头N的距离SN是选择水滴形乳房假体(解剖型乳房假体)高度的重要参数.假体直径和高度确定后,增大乳房体积主要靠增加假体突度实现.对于胸部扁平、比较消瘦者,水滴形假体是较好的选择.结论 术前胸廓的横径及乳房的大小等参数是选择乳房假体大小与形态的重要指标.圆形假体和水滴形假体具有各自的适应证.     

Evaluation of amniotic fluid as a skin graft storage media compared with RPMI and saline

We aimed to assess and compare the histological changes of grafts stored in Roswell Park Memorial Institute-1640 solution (RPMI), amniotic fluid (AF), and saline. Amniotic fluid which has abundant nutrients, proteins, and growth factors, and antimicrobial features may be an easily achievable and cheap alternative for the short term preservation of skin grafts. Discarded surgical skin pieces obtained from 15 trauma patients were divided into three groups as RPMI, AF, and saline. The specimens were evaluated at days 7, 14, 21, and 28 for histological alterations by a 3-point scoring scale. Histological scores in the grafts stored in amniotic fluid and RPMI were found significantly lower than those stored in saline (p < 0.01). No significant difference was detected between AF and RPMI stored grafts. AF may be a good alternative for skin graft preservation as demonstrated by histological changes. New studies with multiple AF donators and repeated experiments will be worthwhile. Besides, restrictions of some ethical and legal issues for AF use should be solved.     

The semi-permeability of silicone: a saline-filled breast implant with intraluminal and pericapsular Aspergillus flavus.

Fungal infection of breast implants is a rare complication. Growth of fungi within the lumen of saline-filled implants has previously been demonstrated in laboratory studies, however, clinical infections are rare. We report a case of Aspergillus flavus growth within and around a saline-filled breast implant that was inserted 18 months previously. This was successfully treated with implant removal and wound irrigation. Possible routes of microbial contamination as well as survival mechanisms of organisms within saline-filled implants are discussed. This case re-iterates that the silicone envelope of a saline-filled implant is selectively permeable and we believe this is instrumental in facilitating intraluminal microbial growth. This also emphasises the importance of stringent asepsis when dealing with saline-filled breast implants including avoiding contamination of the saline filling fluid.