超声检测乳房假体状况对隆乳术后包膜挛缩手术方式选择的临床意义  

Cinical implication of US-implant strategy for surgical intervention selection in capsular contracture af- ter augmentation mammoplasty

作　　者：程宁新[1] 邓慧[2] 吴戴红[3] 钟红[3] 张小曼[3] 丁小邦[2] 

机构地区：[1]广东药学院附属第一医院整形外科,广州510080 [2]广州医学院附属市一人民医院整形外科 [3]广东药学院附属第一医院功能科,广州510080

出　　处：《中华医学美学美容杂志》2008年第1期11-14,共4页Chinese Journal of Medical Aesthetics and Cosmetology

摘　　要：目的 评估在硅凝胶乳房假体置入后并发严重包膜挛缩时进行超声检查对手术方式选择的临床意义。方法 将51例（89侧）手术治疗的硅凝胶假体隆乳术后并发严重包膜挛缩（Baker Ⅲ-Ⅳ级）者，按术前是否接受超声检查分为超声组和非超声组。超声组25例（45侧）假体置入年限均≥5年的受术者，接受包膜顶部或全部切除术。非超声组26例（44侧）采用包膜切开松解术或包膜旷（留）置术，假体置入年限≥5年的占53．8％（14／26）。结果 89个乳房假体手术中发现假体破裂或渗漏的55个，发生率为61．7％。超声组手术证实假体破裂或渗漏的达到86．7％（39／45），超声诊断手术符合率92．1％（35／38），术后6个月随访包膜挛缩复发率为5．3％（2／38）。非超声组经手术证实的假体破裂或渗漏率为36．4％（16／44），术后6个月随访包膜挛缩复发率为25．9％（7／27）。两组的假体破裂或渗漏的手术符合率和术后包膜挛缩复发率差别有统计学意义（P〈0．001和P〈0．05）。结论超声检查有助于包膜挛缩的评估、假体破裂或渗漏的诊断和手术治疗方式的选择。严重包膜挛缩者，置入5年以上的乳房假体破裂或渗漏率明显增加。建议在严重包膜挛缩者的超声诊断提示乳房假体破裂或渗漏时应用包膜切除术，以提高治疗效果和降低术后复发。Objective To assess the value of ultrasonography （US） -implant in selection of surgical intervention for the treatment of severe capsular contracture （ Baker Ⅲ-Ⅳ ） after breast augmentation. Methods The operations were performed to treat the severe capsular contracture after augmentation mammoplasty with silicone gel-filled implants in 51 patients. The peroperative ultrasound examination was performed in 25 cases （ US group） with implants over 5 years and the upper part or total capsulectomy was taken. Other 26 cases without US examination （non-US group） were treated with open capsulotomy or capsular retention, in which only 53.8 % were with implants over 5 years. Results A total of 89 breast implants were explanted and rupture/ leakage prostheses were found in 55 implants （61.7 % ）. In non-US group, the rupture/leakage rate of surgical finding was 36.4 % （16/44） and the recurrence rate was 25.9 % （7/27）. The rupture/leakage rate of surgical finding and recurrence rate in US-group were 86.7 % （39/45） and 5.3 % （2/38）, the US-surgical positive rate of rupture/leakage prostheses was 92.1% （31/38）, respectively. Conclusion US is a reliable tool to implant rupture/leakage diagnosis and clinical evaluation of capsular contracture. When rupture/leakage implant is detected by ultrasonography, the capsulectomy is recommended as an effective and optional surgical approach.

关 键 词：超声检查 乳房假体 包膜挛缩 包膜切除术 隆乳术 

分 类 号：R655.8[医药卫生—外科学]