改良双环法与垂直双蒂法巨乳缩小术的临床研究

发布时间：2019-04-07 16:35

【摘要】：目的:探讨改良双环法与垂直双蒂法两种巨乳缩小术的临床应用效果。方法:回顾分析2000年1月至2014年6月我院收治的乳房肥大症患者34例,平均年龄(38.76±6.40)岁,其中改良双环法巨乳缩小术18例,设为观察组;垂直双蒂法巨乳缩小术16例,设为对照组,术后均随访6个月~1年。评价术后效果:患者术前症状的改善、患者术后满意度(术后乳房整体外形、乳头乳晕外形及位置、乳头乳晕感觉、瘢痕情况等)、医师对术后乳房评价、术中切除组织量、术前术后乳房形态(包括乳头至锁骨中点的距离、两乳头间距、乳晕直径、过乳头胸围)的测量、术后并发症等。结果:两组患者症状均明显缓解,乳房体积明显减小。观察组术后乳头和乳晕上方乳腺组织在胸大肌筋膜上的悬吊使得乳房看起来挺拔、圆润、自然,术后瘢痕少而隐蔽,术后仅出现1例切口愈合不良,2例术后乳晕扩大;对照组患者乳房外形饱满、挺拔,但术后瘢痕较明显,并且出现2例切口部分裂开,2例脂肪液化,4例术后乳房瘢痕明显增生。医师对术后乳房评价与患者满意度相符合,术后乳房整体外形及乳头乳晕外形患者满意度上两组无明显差异,而乳头乳晕感觉及瘢痕满意度上观察组明显高于对照组,观察组在乳头乳晕上移距离约(7.98±1.70)cm,切除组织量平均达到(596.61±152.43)g,与对照组相仿。并发症的发生率观察组明显少于对照组。结论:垂直双蒂法巨乳缩小术设计精确但较复杂,血供充分,组织切除量大,但术后留有倒T瘢痕,且乳头乳晕感觉迟钝,适用于中重度及超重度乳房肥大且对瘢痕要求不高的患者。改良双环法巨乳缩小术可以有效减小乳房体积,且不影响血供及乳房塑形,可广泛应用于轻、中、重度乳房肥大患者,术后保留乳头乳晕感觉,且瘢痕小而隐蔽,因此对于瘢痕要求高的患者,改良双环法巨乳缩小术优于垂直双蒂法巨乳缩小术。
[Abstract]:Objective: to investigate the clinical effect of modified double-loop and vertical double-pedicle mammoplasty. Methods: 34 patients with breast hypertrophy from January 2000 to June 2014 were retrospectively analyzed. The mean age was (38.76 卤6.40) years old. Among them, 18 cases were treated with modified double-ring mammoplasty and were set up as observation group. A total of 16 cases of vertical double pedicle mammoplasty were set up as control group. All patients were followed up for 6 months to 1 year. Evaluation of postoperative effects: improvement of preoperative symptoms, postoperative satisfaction (overall breast shape, nipple areola shape and position, nipple areola sensation, scar condition, etc.), evaluation of postoperative breast by physicians, amount of tissue removed during operation, Preoperative and postoperative breast morphology (including the distance between the nipple and the midpoint of clavicle, the distance between the nipples, the diameter of the areola, the diameter of the nipple and the chest circumference of the nipple), postoperative complications, etc. Results: the symptoms of the two groups were relieved obviously, and the breast volume was obviously reduced. In the observation group, the suspension of the breast tissue above the nipple and areola on the fascia of the major pectoral muscle made the breast look stiff, round, natural, few and hidden scar after operation, only 1 case had bad wound healing after operation, and 2 cases had enlarged areola after operation. In the control group, the breast was full and erect, but the postoperative scar was obvious, and there were 2 cases with partial laceration of incision, 2 cases with fat liquefaction and 4 cases with obvious hyperplasia of breast scar after operation. There was no significant difference in the overall breast shape and the nipple areola appearance between the two groups, but the feeling of nipple areola and scar satisfaction in the observation group were significantly higher than those in the control group, and there was no significant difference in the overall breast shape and the nipple areola appearance between the two groups. The average amount of resected tissue in the observation group was (596.61 卤152.43) g at the distance from (7.98 卤1.70) cm, to the nipple areola, which was similar to that in the control group. The incidence of complications was significantly lower in the observation group than in the control group. Conclusion: the design of vertical double pedicle giant mammoplasty is accurate but complex, the blood supply is sufficient, the amount of tissue resection is large, but the inverted T scar is left after operation, and the sense of areola of nipple is dull. It is suitable for patients with moderate to severe breast hypertrophy and low demand for scar. Modified double-ring mammoplasty can effectively reduce breast volume without affecting blood supply and breast shaping, and can be widely used in patients with mild, moderate, or severe breast hypertrophy, and postoperative preservation of nipple areola sensation, and scar is small and concealed. Therefore, for patients with high scar requirements, the modified double-loop macromastectomy is superior to the vertical double-pedicle macromastectomy.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R655.8

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