腔镜奥美定取出联合或不联合即刻胸肌前假体植入隆胸疗效比较  

Effectiveness comparison of endoscopic removal of injectable Amazingel with/without immediate prepectoral implant-based breast augmentation

作　　者：钟家媛 杨焕佐 谢妍妍 梁法清[1,2] 冯玉 张栋林[3] 杜正贵[1,2] CHUNG Kawun;YANG Huanzuo;XIE Yanyan;LIANG Faqing;FENG Yu;ZHANG Donglin;DU Zhenggui(Department of General Surgery,West China Hospital,Sichuan University,Chengdu Sichuan,610041,P.R.China;Breast Center,West China Hospital,Sichuan University,Chengdu Sichuan,610041,P.R.China;Department of General Surgery,the Fourth People’s Hospital of Sichuan Province,Chengdu Sichuan,610020,P.R.China)

机构地区：[1]四川大学华西医院普通外科,成都610041 [2]四川大学华西医院乳腺疾病中心,成都610041 [3]四川省第四人民医院普外科,成都610020

出　　处：《中国修复重建外科杂志》2024年第7期807-812,共6页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨腔镜奥美定取出联合或不联合即刻胸肌前假体植入隆胸的手术方法、早期安全性及美容学效果。方法回顾分析2020年4月—2024年1月收治且符合选择标准的25例行腔镜奥美定取出联合或不联合即刻胸肌前假体植入隆胸术的患者临床资料。患者年龄33~73岁,平均50.4岁;身体质量指数16.8~26.6 kg/m^(2),平均21.5 kg/m^(2)。均为双侧注射奥美定,初次注射至该次手术时间17~26年,平均21.4年。早期安全性通过术后早期并发症发生率进行评估,早期美容学效果采用术后3个月Harris评分(包括乳房外形满意度、感觉满意度、弹性满意度)进行评估。结果单纯行奥美定取出9例(A组),奥美定取出联合即刻胸肌前假体植入隆胸16例(B组)。术中取出奥美定808~1285 mL,平均1050.7 mL;取出包膜质量36~169 g,平均103.6 g;均使用毛面解剖型假体,大小315~355 mL,中位大小345 mL。手术时间95~395 min,平均194.2 min;手术费用0.8~9.1万元,平均3.3万元。患者均获随访,随访时间3.0~48.1个月,中位时间22.7个月。术中因电刀操作导致皮肤烫伤1例,术后自然愈合,无皮瓣坏死;术后3个月内均未发生术区出血、切口裂开、皮下积气、皮瓣坏死等并发症;随访期间均未出现假体轮廓显现、波纹征、包膜挛缩等不良情况;术后1年复查发现2例患者有少量奥美定残留。术后3个月采用Harris评分评定早期美容学效果,A组乳房外形满意度、感觉满意度、弹性满意度均低于B组,但两组差异无统计学意义(P>0.05)。结论腔镜奥美定取出联合或不联合胸肌前假体植入隆胸术,术后早期均安全可靠,且具有良好的美容学效果;对于符合适应证的患者建议在奥美定取出后联合即刻假体植入隆胸术,重塑乳房外形。Objective To explore the surgical technique and preliminary safety and aesthetic results of endoscopic removal of injectable Amazingel with/without immediate prepectoral implant-based breast augmentation for patients.Methods The clinical data of 25 patients who underwent endoscopic removal of injectable Amazingel with/without immediate prepectoral implant-based breast augmentation between April 2020 and January 2024 and met the selection criteria was retrospective analysed.The patients’age ranged from 33 to 73 years,with a mean of 50.4 years,and the body mass index ranged from 16.8 to 26.6 kg/m^(2),with a mean of 21.5 kg/m^(2).They were all bilaterally injected with Amazingel,and the time between initial injections and surgery ranged from 17 to 26 years,with a mean of 21.4 years.Early safety was evaluated by the incidence of early postoperative complications,and early aesthetic results were evaluated using Harris scores(including breast shape satisfaction,sensation satisfaction,and elasticity satisfaction)at 3 months after operation.Results There were 9 cases underwent Amazingel removal(group A)and 16 cases underwent Amazingel removal with immediate prepectoral implant-based breast augmentation(group B).Intraoperative removal of Amazingel ranged from 808 to 1285 mL,with a mean of 1050.7 mL;the mass of the capsule removed ranged from 36 to 169 g,with a mean of 103.6 g;and a gross anatomical prosthesis was used with a median size of 345 mL(range,315-355 mL).The operation time ranged from 95 to 395 minutes,with a mean of 194.2 minutes;and the cost of the procedure ranged from 8000 to 91000 yuan,with a mean of 33000 yuan.Patients had a median follow-up time of 22.7 months(range,3.0-48.1 months).There was 1 case of intraoperative skin burn due to the operation of the electric scalpel,which healed naturally after operation without flap necrosis.There was no adverse conditions such as prosthesis outline showing,ripple sign,and capsular contracture during follow-up;a small amount of Amazingel residue was found in 2 pat

关 键 词：乳腺腔镜 奥美定 胸肌前假体植入隆胸 包膜 

分 类 号：R655.8[医药卫生—外科学]