内窥镜辅助下腋窝入路隆乳术的临床体会

目的：为了减少在常规隆乳术中由于分离时存在视觉误区而对组织造成损伤,进而引起术中出血症状,探究在内镜辅助下腋窝入路隆乳术的,临床可能性及优势。方法：选择2009年1月-2011年1月来我院就医者52例,所有病例均进行双侧腋窝入路隆乳,观察患者术中出血情况以及隆乳效果分析。结果：52例患者中,38例患者48h内两侧引流量小于20ml,13例患者48h两侧引流量小于30ml,只有1例患者48h两侧引流量大于30ml,在进行完引流后术后的5天内拔管。术后常规抗生素应用3日后无感染、出血等并发症出现。乳房形态优美自然,活动度良好,出现包膜挛缩11例,6例患者出现术后乳头乳晕感觉异常,术后1月后均恢复正常。结论：内窥镜辅助下腋窝入路隆乳手术,创伤小、并发症少、恢复快、效果好。但也有许多的局限性,如乳房下皱襞较薄弱的患者,如何在内窥镜下进行脱细胞真皮片加强,如何解决在腋下切口进行腔内缝合固定的问题等等,还需进一步的研究与探讨。     

腋窝与乳晕切口乳腺后间隙隆乳术对比体会

目的:探讨腋窝入路与乳晕入路行乳腺后间隙假体隆乳术的优缺点.方法:选取腋窝入路与乳晕入路行乳腺后间隙假体隆乳术患者各30例,对比其优缺点.结果:两种手术方式,术后乳房形态、手感、乳房活动度无明显差别.结论:腋窝入路的乳腺后间隙假体隆乳术,无乳腺导管损伤的风险,无乳晕瘢痕,对于难以接受乳晕切口的患者来说,是一个良好的手术方式     

内窥镜辅助腋下切口隆乳术的应用体会

目的:探讨应用内窥镜辅助,在腋下切口假体隆乳术中的临床应用与操作体会。方法:自2010年10月~2012年10月应用内窥镜辅助隆乳20例,40侧。手术均行腋下切口,内窥镜辅助,胸大肌下分离置入假体或胸大肌筋膜间分离置入假体。结果:20例均随访1年以上,一例一侧包膜挛缩变硬,再次内窥镜辅助经腋下切口切开包膜组织,扩大腔隙,重新置入假体,,术后恢复好。其余术后乳房形态良好,外形及手感好,无血肿及感染等并发症发生。结论:采用内窥镜辅助下,手术在直视下进行,安全性高,手术创伤小,出血少,术后包膜挛缩发生率低,是值得推广的辅助技术。     

内镜辅助下腋窝切口乳腺后间隙隆乳术

目的 减少常规隆乳术中因盲视分离对组织的损伤及术中出血,探讨在内镜辅助下经腋窝切口行乳腺后间隙隆乳术的可能性.方法 2005年以来,在内镜下经腋窝切口行乳腺后间隙隆乳术27例,术中出血显著减小,并大为减轻钝性分离的创伤.结果 27例术后除1例发生切口部分愈合不良外,均无血肿、血清肿及感染发生.16例术后随访6个月～1年,1例发生Baker分级Ⅱ度假体纤维包膜囊挛缩硬化,其余手感良好,外形满意.结论 内镜下隆乳术可降低对麻醉的要求,有效控制术中出血,减少术中创伤,便于置入假体的准确定位,减轻术后疼痛.     

硅胶假体隆乳术矫正乳腺萎缩伴轻度下垂

目的:一次性完成隆乳并同时矫正乳房轻度下垂。方法:经腋窝切口将乳房假体置入胸大肌后间隙。结果:28例乳腺萎缩伴乳房轻度下垂患者术后乳房及乳头形态位置良好,乳头感觉及勃起正常。结论:经腋窝切口隆乳术能同时矫正下垂乳房,创伤小,瘢痕隐蔽,效果稳定可靠。     

内镜下经腋路双平面隆乳术的应用解剖研究

目的 对女性新鲜尸体的乳房及胸大、小肌附着点,血管支配和联合腱膜等进行局部解剖学观察,为内镜下经腋路双平面隆乳术提供解剖学基础.方法 解剖并观察成年女性新鲜人体标本,精准识别乳腺,胸大、小肌的相对位置关系,重要神经、血管的走行以及与周围肌肉的腱膜连接,测量胸骨体的宽度.模拟再现手术过程,并阐明手术要点.结果 ①胸小肌外缘在胸大肌外缘后下方,其后间隙较疏松,有较密集的神经、血管分支.②胸大肌的肋部与腹直肌腱膜、腹外斜肌腱膜及前锯肌筋膜均有较致密的联合.③胸骨体中下2/3的平均宽度 （3.0±0.5）cm.结论 ①经腋路极易误入胸小肌后间隙,分离易损伤血管造成出血.②双平面腔隙内侧缘间距安全距离至少为3.0cm.③胸大肌的肋部与其他比邻肌肉腱膜的连接较致密,在直视下才能确切离断松解,使肌肉回缩形成真正的双平面假体放置腔隙,维持乳腺-胸大肌-假体三者的动力关系平衡.④内窥镜辅助在经腋路双平面隆乳术中是必要的.     

经腋窝入路内窥镜辅助隆乳术的创新与进展

假体隆乳术已经成为我国女性最受欢迎的美容手术之一。但在假体隆乳术广泛开展的同时,手术效果不佳以及各种并发症的出现等问题也随之凸显出来。“追求安全、稳定、持久的美学效果,最大程度地减少手术风险,严格控制并发症”成为当今隆乳术的目标。因此,如何对手术技术不断改进和创新,以获得更加精细的美学效果和减少并发症的发生成为整形外科医师关注的焦点。笔者从以下3个方面简要介绍内窥镜辅助隆乳技术的优势、发展和技术要点。     

乳腺良性病变术后并发Mondor病27例报道

目的探讨Mondor病的发病原因及诊治方法。方法结合相关文献对15年来收治的1012例乳腺良性病变术后并发Mondor病的27例患者的临床资料，进行病因和临床表现分析，总结有效的诊治方法。结果27例患者均为女性，与乳腺手术有关，主要表现为术侧胸腹壁皮下痛性条索状物，质硬韧，长度不等。3例随诊观察治愈，19例服用强的松和非甾体类消炎镇痛药治愈，3例经局部封闭治愈，2例经手术切除治愈。结论乳腺手术创伤可能是Mondor病发病的主要原因，根据病史临床表现诊断不难，但需排除恶变。     

腋下切口全程内窥镜隆乳术的临床体会

目的:探讨经腋下切口全程运用内窥镜隆乳术的临床体会和手术方法。方法:本科室于2012年3月~2013年10月间应用内窥镜经腋下切口隆乳手术64例(128侧),54例行胸大肌下分离腔隙植入假体,10例行乳腺下分离腔隙植入假体,均全程运用内窥镜隆乳设备。结果:64例手术患者经复诊和随访至少6个月,未发现包膜挛缩变硬案例,2例术后短期出现乳房外侧皮肤麻木感,术后半年感觉恢复正常;1例慢性疼痛两周后恢复,其余伤口均Ⅰ期愈合,无二次手术,无血肿感染等并发症,双侧乳房外形对称圆润,手感柔软。结论:腋下切口全程内窥镜隆乳术,切口瘢痕隐蔽,避免在术中盲视下操作、减少术中血管神经的误伤,便于分离、止血、通过技术改良能达到创伤更小,恢复更快,达到效果更满意的目的,值得推广应用。     

内窥镜辅助隆乳术

目的 养活常规隆乳术盲视下操作分离假体置入腔隙而赞成的创伤,提高隆乳术效果,探讨内镜在隆乳术中的应用。方法 自1996年5月起在内窥镜辅助下行胸大肌下置入腔隙的分离,止血及肌肉,筋膜的剥离,切割,17例置入假体34个,其中经腋切口7例,乳晕旁切口9例,乳房下皱臂切口1例。结果 应用内间辅助进行隆乳术可以减少组织损伤,经乳晕旁切口可以更直接和准确地分离和切割胸大肌内下份起点,腹直肌前鞘和腹外斜肌筋膜,形成分离彻底的置入腔隙和良好的乳房下皱襞形态,防止乳房假体上移及位置不正,术后无出血,感染等并发症,10例术后经随访3－12月,均无包膜挛缩,外形及手感良好,结论 内窥镜 乳术对置入腔分离,止血彻底,可减少血肿,感染等并发症,降低包膜挛缩的发生率,有助于获得良好的手术效果。     

Encor真空负压旋切系统在乳腺良性肿物切除术中的应用

目的探讨超声引导下Encor真空负压旋切系统对乳腺良性肿物切除术中的应用价值。方法 2010年7月～2011年7月采用超声定位引导,利用Encor真空负压旋切系统（美国强生公司Model CART01型）对119例391个乳腺良性肿物进行切除,术后加压包扎48 h。切除标本常规行快速石蜡病理检查。结果 117例389个乳腺良性肿物被完全切除,1例肿物少量残留,1例手术失败改传统开放性手术。术后病理诊断：乳腺纤维腺瘤276个,纤维腺瘤伴导管内乳头状瘤25个,乳腺导管扩张性症68个,导管内乳头状瘤14个,上皮非典型增生6个,乳腺腺病2个。术中大量出血（10～30 ml）6例,术后血肿3例,皮下瘀斑11例。119例术后随访3～15个月,平均8个月,血肿、瘀斑消失,乳房外形正常,1例残余肿瘤无明显变化,余118例未发现病灶残留、复发。结论应用超声引导Encor真空负压旋切系统切除乳腺良性肿物效果好,微创优势明显,操作简单、安全,对乳腺良性肿物可完全切除,值得推广。     

Transaxillary Breast Augmentation: Two Breast Cancer Patients with Successful Sentinel Lymph Node Diagnosis

In recent years, some surgeons have been warned of possible problems with sentinel lymph node diagnosis (SLND) for patients who have undergone transaxillary breast augmentation (TBA), although no scientific studies support this warning. The authors report two additional cases of breast cancer in which the SLND was successfully performed for patients with previous TBA. The surgical anatomy of the axilla, the groups of lymph nodes, and a personal way of performing TBA are described. Five other reports concerning the same issue are thoroughly discussed. Four of these are clinical in vivo reports, and one is a cadaver study. The four in vivo studies and what we are reporting now clearly demonstrate that what was said regarding possible problems in the SLND after TBA was not founded on clinical research and contradicts these five clinical findings.     

Subfascial Transaxillary Breast Augmentation Without Endoscopic Assistance: Technical Aspects and Outcome

Background Although transaxillary breast augmentation (TBA) is a well-studied procedure, few previous reports exist concerning the subfascial technique, especially without endoscopic assistance. This study aimed to analyze the feasibility of the technique after breast augmentation in terms of its indication, surgical technique, limitations, and clinical outcome. Methods For this study, 42 patients underwent TBA without endoscopic assistance. The technique was indicated for patients with breasts of small or moderate volume without ptosis, patients who wanted no breast scars, and patients who had a poorly defined inframammary fold. The mean follow-up period was 16 months. Implant and incision approach complications were evaluated. Information on patient satisfaction was collected. Results A total of 14 complications occurred in 42 patients, all of them minor. Axillary incision–related complications occurred in 26% of the patients, as represented by a late axillary subcutaneous band (119%), sensory loss in the inner aspect of the arm (71%), and a hypertrophic scar and small wound dehiscence (71%). No patient presented with capsular contracture, visible rippling, or infection. Most of the patients (93%) were either very satisfied or satisfied with their result, and none regretted the surgery. Conclusion The TBA procedure without endoscopic assistance is a simple and reliable technique for breast augmentation. Most of the complications in this study were minor and predictable. They did not interfere with the aesthetic outcome nor the normal postoperative recovery. With TBA, success depends on patient selection as well as careful intra- and postoperative management.     

乳外微小切口乳腺良性实体肿瘤切除术对提高术后乳房美容效果的临床研究

目的 观察乳外微小切口乳腺良性实体肿瘤切除术的疗效及对术后乳房美容效果的影响。方法 选取2021年6月-2022年6月我院收治的56例乳腺良性实体肿瘤患者为研究对象,采用随机数字表法分为对 照组和观察组,各28例。对照组采用传统大切口,观察组采用乳外微小切口切除术,比较两组临床手术指 标、并发症发生情况及乳房美容满意度评分。结果 观察组手术时间、手术切口、术中出血量、切口愈合时 间均优于对照组（P＜0.05）;观察组并发症总发生率为7.14%,低于对照组的17.86%（P＜0.05）;观察组 乳房外形、对称性、瘢痕满意度评分均高于对照组（P＜0.05）。结论 乳外微小切口乳腺良性实体肿瘤切 除术可减小创伤程度,缩短手术时间,减少术中出血量,促进切口愈合,美容效果及患者满意度均较高, 是一种安全有效的治疗方案,值得临床应用。     

超声引导下Vacora旋切术在乳腺多发良性疾病中的应用

目的探讨超声引导下真空辅助旋切系统(Vacora旋切系统)在乳腺多发(一侧乳腺病灶≥3个)良性病灶治疗中的应用价值。方法 2009年2月~2010年6月应用真空辅助旋切系统(美国巴德公司Vacora系统)对17例经B超检查发现直径≤3 cm的79个良性乳房肿瘤进行实时超声引导旋切,术后2 d,2个月及6个月对患者行超声随访,并将手术区超声图像与术前病灶图像进行对比分析,观察有无血肿,肿瘤残留及美容效果。结果所有乳腺多发病灶均准确并完整切除,经病理诊断均为良性。17例随访1~16个月,平均7.6月,1例术后14 d复查可见血肿形成,术后2个月血肿完全消失;1例术后3个月复查发现残留,继续跟踪随访;所有患者皮肤切口愈合良好,无明显切口瘢痕。结论超声引导下Vacora旋切系统对乳腺多发良性病灶切除效果好,具有美观、微创、安全、并发症少等优点。     

微型高频针状电极在软腭粘膜良性病变切除中的应用

目的 探讨微型高频针状电极在软腭粘膜良性病变切除中的应用价值。方法 选取2017年1月-2020年1月我院收治的软腭粘膜良性病变患者28例作为研究对象,随机分为试验组16例及对照组12例。试验组使用微型高频针状电极进行手术,对照组使用常规电极进行手术。比较两组软腭肿物的手术切除时间、并发症发生情况以及疼痛评分。结果 试验组手术时间短于对照组,差异有统计学意义（P ＜0.05）;两组术后出血以及复发率比较,差异无统计学意义（P ＞0.05）;试验组术后第1、3、7天疼痛评分均低于对照组,差异有统计学意义（P ＜0.05）。结论 微型高频针状电极在软腭粘膜良性病变切除中的应用效果较好,能够缩短手术时间,减少术后并发症,减轻患者疼痛感,值得临床应用。     

Safety, Complications, and Satisfaction of Patients Undergoing Submuscular Breast Augmentation via the Inframammary and Endoscopic Transaxillary Approach

Background Since its introduction, augmentation mammaplasty has gained widespread popularity, as demonstrated by the fact that an estimated 2 million women in the United States have received implants. During recent decades, several surgical approaches have evolved in terms of implant placement or site of access to the surgical plane. Debate has existed concerning the questionable superiority of a particular technique for achievement of optimal results. Thus, the inframammary approach, an established and widely accepted technique for breast augmentation, and endoscopically assisted transaxillary breast augmentation were retrospectively compared in terms of safety and aesthetic outcome, as measured, respectively, by the rate of postoperative complications and patient satisfaction. Methods This study analyzed 78 patients undergoing augmentation mammaplasty between 1997 and 2004. Only patients seeking primary augmentation mammaplasty solely for aesthetic reasons were included in the study. Previously performed breast surgery and simultaneously conducted ipsilateral mastopexy were among the exclusion criteria. Patient satisfaction was assessed using the client satisfaction questionnaire (CSQ-8) because of its easy applicability. Results The complication rate was low in both patient subsets, thus confirming the safety of the transaxillary approach, as compared with the more common submammary technique. However, a higher level of satisfaction was detected in the former patient group, indicating a more favorable aesthetic outcome with the transaxillary augmentation mammaplasty. Conclusion Endoscopically assisted transaxillary augmentation mammaplasty is a safe method with predictable results associated with a high level of patient satisfaction. If applied in the setting of appropriate indications, it is an excellent tool for use with patients who prefer to have an incision at a distant site.     

Implications of Transaxillary Breast Augmentation: Lifetime Probability of Breast Cancer Development and Sentinel Node Mapping Interference

After the “fifth-generation” breast implants with ultracohesive silicone gel technology are introduced, the Food and Drug Administration (FDA) will sooner or later retire the ban on the use of these devices in the United States. When this happens, the plastic surgery community must be prepared to face a massive demand for reoperations to change saline-filled breast implants because cohesive gel devices have the potential to provide a more natural breast shape, to minimize the risk of postoperative rippling, and to provide a greater degree of safety if the implant loses its integrity. Despite these advantages and extensive use throughout the rest of the world during the ban in the United States, silicone implants also have disadvantages. One drawback is that transaxillary breast augmentation with more “rigid” gel-filled implants may produce trauma to the armpit, may interfere with sentinel node mapping for breast cancer treatment, and may have future medicolegal implications.