脂肪抽吸联合微创切口腺体切除治疗男性乳房发育:加减平衡及经验  

Liposuction Combined with Mini-invasive Mammary Gland Resection for Gynecomastia:Experience of Balance Technique

作　　者：黄一雄[1] 周碧玉 周帆 陈蕊[1] HUANG Yi-xiong;ZHOU Bi-yu;ZHOU Fan;CHEN Rui(Department of Plastic Surgery,Renji Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200217,China)

机构地区：[1]上海交通大学医学院附属仁济医院整形外科,上海200217

出　　处：《中国现代手术学杂志》2022年第5期347-350,共4页Chinese Journal of Modern Operative Surgery

摘　　要：目的总结脂肪抽吸与再调整技术结合微创切口腺体切除治疗男性乳腺发育(gynecomastia,GYN)的经验与效果。方法回顾性分析2018年6月至2021年3月收治的55例GYN患者的临床资料,单侧20例,双侧35例,Simon分级:Ⅱa级35例(58侧),Ⅱb级9例(13侧),Ⅲa级11例(19侧)。行经乳晕切口脂肪抽吸联合微创切口腺体组织切除治疗,术中进行胸部乳晕切口设计,肿胀分离,负压抽吸,腺体周围脂肪再调整固定,腺体组织最大化切除。记录患者手术时间、切除量、出血量、引流管放置时间、引流量、并发症与随访满意度。结果本组手术时间平均(75±11)min,脂肪抽吸量平均(150±55)mL,腺体切除量为(270±68)g,引流量平均(25±15)mL,引流管留置时间平均(2.0±0.5)d,切口均一期愈合。术后均获随访,随访时间平均(23.0±1.5)月。术后并发症12例(16侧):术后早期胸部皮肤瘀斑6例10侧(11.11%),均在术后2周内完全吸收,未出现血肿、血清肿;乳头乳晕感觉麻木6例6侧(6.67%),恢复时间平均(3.2±2.5)月,无明显乳头中央区凹陷畸形和乳头内陷。患者满意度评分平均(4.02±0.6)分。结论脂肪抽吸联合微创切口腺体切除治疗GYN可达到较好的手术效果。脂肪肿胀抽吸、分离和术中脂肪再调整可有效避免术后胸部凹陷高低起伏,肿胀水分离技术是有效避免术中出血和保证分离完整的手段,运用整形外科技术能提高患者的满意度。Objective To assess the experience and effect of liposuction and readjustment technique combined with mini-invasive glandular tissue resection in the treatment of gynecomastia(GYN).Methods The clinical data of 55 GYN patients admitted from June 2018 to March 2021 were analyzed retrospectively,including 20 of unilateral GYN and 35 of bilateral GYN.Simon classification revealed 35 cases(58 sides)ofⅡa,9 cases(13 sides)ofⅡb and 11 cases(19 sides)ofⅢa.All cases were performed swelling separation,negative pressure suction,gland-surrounding fat readjustment and fixation,and maximal glandular tissue resection by breast areola incision.The operation duration,resection volume,bleeding volume,drainage tube retention time,drainage volume,complications and satisfaction degree were observed.Results The operation was accomplished successfully in all 55 patients with(75±11)min of operation duration,(150±55)mL of liposuction volume,(270±68)g of resection volume,(25±15)mL of drainage volume,(2.0±0.5)d of drainage tube retention time.All cases were followed up for(23.0±1.5)months averagely.Postoperative complications were found in 12 cases(16 laterals):early ecchymosis of chest skin was in 6 cases(10 laterals,11.11%),and which were completely absorbed without hematoma and seroma in 2 weeks after the operation;numb of nipple areola was in 6 cases(6 laterals,6.67%),and restored in(3.2±2.5)months.There was no obvious depression of nipple central area and inversion of nipple.The satisfaction score of patients ranged from 3.2 to 9.2 with an average of(4.02±0.6).Conclusions Liposuction combined with min-invasive mastectomy is an effective method for GYN.The technique of fat swelling-separation and suction and intra-operative fat readjustment can avoid dents and unevenness of chest after the surgery.Swelling liquid separation technique can avoid bleeding effectively and ensure separation completely during the operation.And application of plastic surgery would improve the satisfaction degree of GYN patients.

关 键 词：男性乳房发育症 肿胀分离技术 脂肪抽吸 脂肪再调整 乳腺切除术 

分 类 号：R655.8[医药卫生—外科学]