改良内上蒂倒T形切口乳房缩小上提术  

Modified superomedial pedicle technique for reduction mammaplasty with inverted T-shaped incision

作　　者：杨开 王先成[1] 孙杨[1] 熊祥[1] 孟宪熙 李文波 易忠杰 赵弘历 乔治华 Yang Kai;Wang Xiancheng;Sun Yang;Xiong Xiang;Meng Xianxi;Li Wenbo;Yi Zhongjie;Zhao Hongli;Qiao Zhihua(Department of Plastic and Aesthetic(Burn)Surgery,Second Xiangya Hospital,Central South University,Changsha 410011,China)

机构地区：[1]中南大学湘雅二医院整形美容(烧伤)外科,长沙410011

出　　处：《中华整形外科杂志》2024年第5期491-498,共8页Chinese Journal of Plastic Surgery

基　　金：国家自然科学基金(82272283)。

摘　　要：目的探讨改良内上蒂倒T形切口乳房缩小上提术的临床效果。方法回顾性分析2021年3月至2023年3月于中南大学湘雅二医院整形美容(烧伤)外科,采用改良内上蒂倒T形切口完成的乳房缩小上提术患者的临床资料。术前使用手持多普勒超声血流探测仪探查并标记胸廓内动脉第2~4穿支血管的穿出点,根据穿支位置设计含至少2条穿支的内上蒂,蒂部宽度为6 cm左右;术中将蒂部向外上方旋转,将乳头乳晕复合体(NAC)向上移位,塑造较饱满的乳房上极,下皱襞处切除多余皮肤形成倒T形切口。术后对NAC血运情况、乳房形态及并发症发生情况进行观察和随访。应用Canfield Mirror 7.1.1软件通过侧位照片测量术前和术后6个月左、右侧乳房形态数据,包括乳房总面积、乳房最大突出度、乳房上极突出度、乳房下极高度、乳头提升高度5个指标;采用BREAST-Q量表调查患者术前和术后6~12个月乳房满意度、社会心理健康度、性健康度及身体健康度,每个维度总分均为0~100分,分数越高满意度和健康度越高。应用SPSS 28.0软件对数据进行分析,正态分布计量资料以±s表示,术前和术后乳房形态数据(前4个指标)、BREAST-Q量表评分比较采用配对t检验,P<0.05为差异有统计学意义。结果共纳入56例女性患者,年龄(32.0±6.7)岁,体重指数(29.1±5.7)kg/m^(2)。术前多普勒超声血流探测仪探查显示,所有患者均未出现内上蒂穿支缺如和明显变异的情况。术中去除乳房体积为890~1800 ml,平均1250 ml,内上蒂平均宽度为5.4 cm(4.0~7.0 cm)。术后随访时间(13.3±2.5)个月,所有患者NAC血供佳,乳房形态良好,患者对手术效果均非常满意。术后有1例发生切口周围血清肿,3个月内自然缓解;2例切口轻微裂开,经换药后愈合良好;其余患者均恢复较好,无皮瓣坏死、血肿等并发症发生。乳房形态数据比较结果:术后左、右侧乳房总面积均小于术前(Objective To explore the clinical efficacy of modified superomedial pedicle technique using an inverted T-shaped incision for reduction mammaplasty and mastopexy.Methods A retrospective analysis was conducted on clinical data of patients who underwent modified superomedial pedicle technique for breast reduction surgery with inverted T-shaped incision between March 2021 and March 2023 at the Department of Plastic and Aesthetic(Burn)Surgery,Second Xiangya Hospital of Central South University.Preoperatively,a handheld Doppler ultrasound blood flow detector was used to detect and mark the exit points of the 2nd to 4th perforating vessels of the internal thoracic artery,and a superomedial pedicle containing at least two perforators was designed based on the perforator locations,with a pedicle width generally about 6 cm.Intraoperatively,the pedicle was rotated superolaterally,moving the nipple-areola complex(NAC)upwards to construct a fuller upper pole of the breast and removing excess skin in the lower fold to form a inverted T-shaped incision.Postoperatively,the blood supply of the NAC,breast morphology,and incidence of complications were observed and followed up.Canfield Mirror 7.1.1 software was utilized to measure pre-and post-operative breast morphology data from lateral photographs at 6 months,including total breast area,maximum breast protrusion,upper pole protrusion,lower pole height,and nipple elevation height.The BREAST-Q questionnaire was used to survey patient satisfaction with breast appearance,psychosocial well-being,sexual well-being,and physical health before surgery and 6-12 months after surgery,with each dimension scoring 0-100 points,where higher scores indicate greater satisfaction and health.SPSS 28.0 software was used for data analysis,with normally distributed measurement data expressed as Mean±SD,and paired t-test was applied for comparisons of pre-and post-operative breast morphology data(the first 4 indicators)and BREAST-Q scores,with P<0.05 considered statistically significant.Results A tot

关 键 词：乳房成形术 超声检查 多普勒 脉冲 胸廓内动脉 穿支皮瓣 内上蒂法 乳房缩小成形术 

分 类 号：R655.8[医药卫生—外科学]