倒T切口轴型三蒂法缩乳术在治疗中重度乳房肥大及巨乳症中的临床应用  

Clinical application of inverted T-incision and axial three-pedicle breast reduction in the treatment of moderate to severe breast hypertrophy and macromastia

作　　者：李娟[1,2] 冯玉[1] 张栋林 刘芳[4] 刘珍坊[4] 周娇 覃湘泉 刘馨然 邱梦雪 杨焕佐 杜正贵 LI Juan;FENG Yu;ZHANG Donglin;LIU Fang;LIU Zhenfang;ZHOU Jiao;QIN Xiangquan;LIU Xinran;QIU Mengxue;YANG Huanzuo;DU Zhenggui(Department of Breast Surgery,West China Hospital,West China School of Medicine,Sichuan University,Chengdu 610041,China;Department of Breast Surgery,Sichuan Academy of Medical Sciences·Sichuan Province People's Hospital,Chengdu 610072,China;Department of General Surgery,the Fourth People's Hospital of Sichuan Province,Chengdu 610016,China;Department of General Surgery,West China Longquan Hospital Sichuan University,Chengdu 610100,China;Breast Disease Research Center,West China Hospital,West China School of Medicine,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学临床医学院华西医院乳腺外科,四川成都610041 [2]四川省医学科学院·四川省人民医院乳腺外科,四川成都610072 [3]四川省第四人民医院普通外科,四川成都610016 [4]四川大学华西龙泉分院普通外科,四川成都610100 [5]四川大学临床医学院华西医院乳腺疾病研究中心,四川成都610041

出　　处：《中国普通外科杂志》2022年第5期559-568,共10页China Journal of General Surgery

基　　金：四川省科学技术厅科技计划基金资助项目(2020YFS0199,2021YFS0104)。

摘　　要：背景与目的乳房缩小整形术(缩乳术)是治疗乳房肥大和巨乳症的有效方法,缩乳术手术方式多样,手术成功的关键是保留乳头乳晕(NAC)血供和感觉及术后良好的乳房外形。笔者团队前期在倒T切口基础上,开创了一种轴型三蒂法缩乳术,在乳腺癌伴生理性乳房肥大和/或中重度乳房下垂患者中取得满意效果。本研究进一步评价该方法在中重度生理性乳房肥大及巨乳症患者中应用效果。方法收集2017年1月─2021年3月在四川大学临床医学院华西医院乳腺外科、四川省第四人民医院、四川大学华西龙泉分院对中重度乳房肥大及巨乳症患者、采用倒T切口行三蒂法缩乳术患者的临床资料。统计术后并发症(NAC坏死、T形切口裂开、蜂窝组织炎、出血、皮瓣坏死、脂肪液化)发生情况,患者使用BREAST-Q量表“Reduction/Mastopexy”模块对缩乳前后乳房满意度、生理机能、社会心理健康以及性生理健康方面进行自评。结果共纳入28例患者(53个乳房),患者平均年龄为(33.7±6.8)岁,平均BMI为(25.8±3.2)kg/m^(2)。术前E罩杯2例,FF罩杯2例,G罩杯4例,GG罩杯7例,H罩杯13例,术中左、右乳切除腺体平均重量为993.5 g、1017.7 g,左右乳头分别提高(14.4±3.7)cm、(14.5±3.4)cm,术后B罩杯10例,C罩杯15例,D罩杯3例。术后总并发症发生率为7.5%,1例(1.9%)出现T型交界处创面裂开,1例(1.9%)发生乳房蜂窝组织炎,1例(1.9%)发生脂肪液化。所有患者术后NAC均得到保留,仅1例(1.9%)患者发生NAC色素减退。中位随访时间24(1~36)个月,患者术前对乳房满意度评分为15.5±8.2,术后1、3、6个月与1、2、3年对乳房满意度评分分别为32.2±4.8、42.6±7.5、52.7±8.0、52.7±8.5、56.9±8.0、60.8±5.1,术后评分均明显高于术前(均P<0.05)。术后各时间点社会心理健康、生理机能评分均高于术前(均P<0.05),性生理健康评分除了术后第1个月外,其余时间点评分均高于术前(PBackground and Aims Reduction mammaplasty(breast reduction surgery)is effective method for the treatment of breast hypertrophy and macromastia.There are a variety of surgical options for breast reduction,and the principal criteria for surgical success are the preservation of blood supply and sensation of the nipple-areola complex(NAC)as well as satisfactory postoperative breast appearance.The authors'team previously developed an axial three-pedicle breast reduction technique based on an inverted T-incision,and satisfactory results were obtained in breast cancer patients with concomitant breast hyperytophy and/or moderate to severe breast ptosis.This study was performed further evaluate the application efficacy of this method in patients with moderate to severe physiological breast hypertrophy or macromastia.Methods The clinical data of patients with moderate to severe breast hypertrophy or macromastia who underwent inverted-T incision and axial three-pedicle breast reduction between January 2017 and March 2021 in the Department of Breast Surgery,West China Hospital of Sichuan University,Fourth People's Hospital of Sichuan University and Longquan Branch of West China,Sichuan University were collected.The incidence of postoperative complications(NAC necrosis,T-incision dehiscence,cellulitis,hemorrhage,skin flap necrosis,and fat liquefaction)was recorded.The treatment outcomes were determined by self-assessment of the breast satisfaction,physical well-being,psychosocial well-being and sexual well-being of the patients in the BREAST-Q reduction/mastopexy module before and after breast reduction.Results A total of 28 patients(53 breasts)were included.Of the patients,the average age was(33.7±6.8)years old,and the average BMI was(25.8±3.2)kg/m^(2).The breast cup size was E in 2 cases,FF in 2 cases,G in 4 cases,GG in 7 cases and H in 13 cases before operation.The average tissue resection weight for the left and right breast was 993.5 g and 1017.7 g,and the elevation distance for the left and right nipple was(14.4±3.7)

关 键 词：乳房成形术 乳房肥大 巨乳症 手术后并发症 

分 类 号：R655.8[医药卫生—外科学]