腔镜经乳晕双侧甲状腺手术83例临床观察

<正>近年来,腔镜技术广泛应用于甲状腺外科手术中,其手术入路及适应证选择也在不断变化。2010年5月至2013年12月沈阳市第五人民医院普外科实施83例腔镜经乳晕双侧甲状腺良性肿物切除手术。现报告如下。1资料与方法1.1一般资料共纳入83例病人,其中男性12例,女性71例;平均年龄37.6(21~65)岁。病人术前甲状腺功能检查正常,超声或CT检查提示双侧甲状腺肿物,肿物直径0.8~     

绕乳头基底乳晕纵切口结合肿胀麻醉隆乳术

目的：探讨绕乳头基底乳晕纵切口结合肿胀麻醉隆乳术的操作技巧及此方法的优点。方法：对我科39例腋下切口、15例乳房皱襞下切口、27例乳晕下缘弧形切口及35例绕乳头基底乳晕纵切口结合肿胀麻醉的116例隆乳患者的疗效及患者满意度进行比较。结果：采用绕乳头基底乳晕纵切口患者的疗效及满意度最高。结论：绕乳头基底乳晕纵切口结合肿胀麻醉是理想的隆乳术式,手术创伤小,切口隐蔽,易于操作,术后患者恢复快,形态好。     

内镜下胸乳晕径路甲状腺癌手术46例临床观察

目的 探讨内镜下胸乳晕径路甲状腺癌手术的安全性、有效性和可行性。方法 回顾性分析2011年4月—2015年8月46例内镜下胸乳晕径路甲状腺癌手术病例,对患者一般资料、手术方式及技巧、手术时间、出血量、引流时间、引流量和术后并发症等情况进行总结。结果 46例患者均顺利完成内镜下手术,其中选择腺叶及峡部切除术9例,一侧腺叶及峡部切除+对侧部分或大部切除术28例,全甲状腺切除术9例;中央区淋巴结清除术21例;结节平均最大直径为（1.63±0.75）cm;手术平均时间为（108.15±32.60）min;术中平均出血量为（34.46±18.42）ml;术后平均引流总量为（157.41±103.45）ml;术后平均引流时间为（3.52±0.94）天;术后3例出现一过性声嘶;术中皮肤烫伤和术后感染各1例;术后病理标本见甲状旁腺者9例,无永久性低钙抽搐病例;术后病理见中央区淋巴结转移8例;术中快速病理未能明确诊断4例,其中1例行开放二次手术;随访0~48月,期间未见肿瘤复发和转移病例。结论 内镜下胸乳晕径路甲状腺癌手术是可选择的手术方式,美容和近期效果满意,但病例选择和术中操作需谨慎。     

Prenatal testosterone exposure permanently masculinizes anogenital distance, nipple development, and reproductive tract morphology in female Sprague-Dawley rats.

In mammals, abnormal increases in fetal androgens disrupt normal development of the female phenotype. Due to the recent concern regarding environmental androgen-active chemicals, there is a need to identify sources of fetal androgen variation and sensitive developmental markers for androgenic activity in female rats. Anogenital distances (AGD), nipple retention, reproductive tract, and external genitalia are morphological parameters organized by prenatal androgens and are predictive of altered masculinized/defeminized phenotype in adult female mice and rats. The objectives of this study were to (1) characterize the natural prenatal androgen environment of rats including the magnitude of the intrauterine position (IUP) effect, (2) characterize the permanent effects of prenatal androgen exposure on female rats, and (3) determine the ability of AGD and areolas to predict these permanent androgenic alterations in female rats. Untreated male fetal rats had higher tissue testosterone (T) concentrations than females in the amniotic fluid, reproductive tract, gonad, and fetal body. The intrauterine position (IUP) of male and female fetuses did not affect T concentrations or AGD in male or female rats at gestational day (GD) 22. Female offspring exposed to 0, 1.5, and 2.5 mg/kg/day testosterone propionate (TP) on GDs 14-18 displayed increased AGD at postnatal day (PND) 2 and decreased nipples at PND 13 and as adults. TP-induced changes in neonatal AGD and infant areola number were reliable indicators of permanently altered adult phenotype in female rats. Further, females in the two high-dose groups displayed increased incidences of external genital malformations and the presence of prostatic tissue, not normally found in female rats.     

乳晕边缘切口及压力封闭残腔技术在乳腺良性肿块切除术中的应用

目的：探讨在乳腺良性肿块切除术中应用乳晕边缘切口及压力封闭残腔技术的疗效。方法方便选取80例于2013年4月―2014年4月期间在该院行局部手术的乳腺良性肿块患者,根据残腔处理的不同分为缝闭腺体残腔组(A组﹚和压力封闭残腔组(B组﹚,均行乳腺良性肿块切除术,观察两组临床疗效、满意度、乳房外形变化率及术后1、2 d时VAS评分情况。结果两组切口愈合率差异无统计学意义,但B组满意度较A组显著要高(P<0.05﹚,分别为97.5%、82.5%,而乳房外形变化率显著低于A组(P<0.05﹚,分别为2.5%、15.0%;同时两组术后1、2 d时VAS评分比较差异无统计学意义(P>0.05﹚,术后3 d时B组VAS评分显著低于A组(P<0.05﹚,分别为(2.13±0.35﹚分、(2.62±0.39﹚分,差异均有统计学意义。结论在乳腺良性肿块切除术中应用乳晕边缘切口及压力封闭残腔技术可取得显著疗效,具有推广价值。     

乳腺良性肿瘤经乳晕弧形切口切除术与传统术式的临床比较

目的：研究并对比在乳腺良性肿瘤患者的手术治疗中使用经乳晕弧形切口切除术与传统术式的效果。方法方便收集齐齐哈尔市第一医院乳腺科2013年8月—2015年9月收治的乳腺良性肿瘤患者共120例,根据平行、单盲、随机对照的设计原则分为对照组(60例)和观察组(60例),对照组接受传统术式,观察组则经乳晕弧形切口行切除术,将两组患者的瘢痕可接受率、双乳基本对称率、乳头乳晕正常率进行观察和对比。结果观察组的瘢痕可接受率为95.0%,明显高于对照组的(66.7%,χ2=15.545,P=0.000);观察组的双乳基本对称率为93.3%,显著高于对照组的71.7%(χ2=9.755,P=0.002);观察组的乳头乳晕正常率为88.3%,与对照组的90.0%相比,差异无统计学意义(χ2=0.086,P=0.769)。结论在乳腺良性肿瘤患者的治疗过程中,经乳晕弧形切口切除术能够有显著降低术后瘢痕的发生率,保持患者乳房的美观,值得推广应用。     

Bigger Bust No Longer on Trend: Malaysians Prefer Moderation in Ideal Female Breast Augmentation

Background It is important to correctly determine the ideal female breast anatomy and aesthetic proportions in order to prepare for surgery and establish its goals. Leaving the preference to the operating surgeons alone might leave unsatisfactory results, which especially leads to reoperation, quite often in the aspect of breast dimension. Methods This study was conducted using an online graphic questionnaire. We attempted to seek male and female perspectives toward their preferred ideal female breast size for breast augmentation, in order to provide up-to-date data to assist breast surgeons in attaining satisfactory surgical results. Results Sixty males and 67 females participated in the study comprising Asian major ethnicities of Malay, Chinese, and Indian. Universally, 46.6% of men and 53.5% of women preferred 30 mm diameter for the most ideal nipple-areola complex (NAC) size. For the perfect bust, they generally favored size C and D cup (37.8% and 38.5%, respectively). Conclusion The majority of women seek natural breast beauty and the longing for an oversized look appears to have infiltrated practice but these assumptions have finally been challenged by these findings.     

聚丙烯酰胺水凝胶注射隆乳术后取出方法探讨

目的:探讨聚丙烯酰胺水凝胶注射隆乳术后的不同取出方法的临床效果差异。方法:回顾性分析本院2008年5月～2012年7月共收治聚丙烯酰胺水凝胶注射隆乳术后并发症患者39例的临床资料,其中20例患者接受经乳房皱襞下肿胀吸脂术治疗(A组),19例患者接受经乳晕切口开放式清除术治疗(B组),对两组患者的手术时间、Ⅰ期愈合情况、聚丙烯酰胺水凝胶残留、术后并发症及患者满意度进行比较。结果:两组手术时间分别为1.5±0.3h和2.6±0.4h,A组最短(P<0.05),Ⅰ期愈合率差异不显著(P>0.05),两组在术后PAHG残留方面差异显著(P<0.05)A组10例残留明显,B组仅1例残留明显。结论:聚丙烯酰胺水凝胶注射隆乳术后两种取出方法各具特色,其中抽吸术操作简单、创伤小,但PAHG残留较多,乳晕切口开放式清除PAHG清除较为彻底,临床上应根据具体适应症合理选择。