超声联合MRI在男性乳房发育症治疗中的应用价值  

Value of ultrasound combined with MRI in the treatment of gynecomastia

作　　者：贾琳娇 范盼红 王文康 胡文笳 李海婷 王若岩 张志远 高佳茹 张斌 李文涛 JIA Linjiao;FAN Panhong;WANG Wenkang;HU Wenjia;LI Haiting;WANG Ruoyan;ZHANG Zhiyuan;GAO Jiaru;ZHANG Bin;LI Wentao(Department of Breast Surgery,Henan Provincial People's Hospital,Zhengzhou University People's Hospital,Zhengzhou,Henan 450003,China;Department of Pathology,Henan Provincial People's Hospital,Zhengzhou University People's Hospital,Zhengzhou,Henan 450003,China;Department of Breast Surgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan 450052,China;Department of Ultrasound,Henan Provincial People's Hospital,Zhengzhou University People's Hospital,Zhengzhou,Henan 450003,China;Department of Medical Imaging,Henan Provincial People's Hospital,Zhengzhou University People's Hospital,Zhengzhou,Henan 450003,China)

机构地区：[1]河南省人民医院乳腺外科、郑州大学人民医院,河南郑州450003 [2]河南省人民医院病理科、郑州大学人民医院,河南郑州450003 [3]郑州大学第一附属医院乳腺外科,河南郑州450052 [4]河南省人民医院超声科、郑州大学人民医院,河南郑州450003 [5]河南省人民医院影像科、郑州大学人民医院,河南郑州450003

出　　处：《中华实用诊断与治疗杂志》2025年第3期257-262,共6页Journal of Chinese Practical Diagnosis and Therapy

摘　　要：目的 探讨超声联合MRI在男性乳房发育症(GM)、手术方案制订中的应用价值。方法 2014年1月—2024年1月河南省人民医院诊治GM患者149例,均行手术治疗,并进行随访。149例术前行乳腺超声检查,评估乳头下方皮肤层至胸肌浅面软组织腺体层厚度。其中102例术前行乳腺MRI检查,测量乳腺脂肪组织体积(GAT)、全部乳房组织体积(TGT),计算GAT/TGT并进行Cohen分型,其中单纯腺体型10例(GAT/TGT<0.3),脂肪腺体型59例(GAT/TGT 0.3~0.6),单纯脂肪型33例(GAT/TGT>0.6)。149例根据乳腺超声测量结果和/或Cohen分型制订手术方案。7例单纯脂肪型且乳头下方皮肤层至胸肌浅面软组织腺体层厚度<0.6 cm者行溶脂抽脂术,26例单纯脂肪型且乳头下方皮肤层至胸肌浅面软组织腺体层厚度≥0.6 cm、59例脂肪腺体型者行腔镜辅助溶脂抽脂+腺体切除术,10例单纯腺体型、47例术前未行MRI但乳头下方皮肤层至胸肌浅面软组织腺体层厚度≥0.6 cm者行开放/腔镜辅助保留乳头乳晕的大部分腺体切除术。术后标本均送组织病理检查。结果 149例手术均一期愈合,均未出现明显疼痛,未发生血肿、血清肿等并发症。术后胸部体积较术前明显减小、外形有不同程度改善,未出现明显瘢痕残留、明显台阶感及双乳不对称现象。1例术后乳晕表面出现轻度坏死,经解除局部压迫及换药后好转。术后组织病理示149例乳腺组织呈不同程度的腺管扩张及纤维脂肪组织增生,缺乏小叶和腺泡结构。随访至2024年6月,失访6例,143例均未复发,无乳头乳晕感觉异常,外观满意。结论 GM患者根据术前超声测量的乳头下方皮肤层至胸肌浅面软组织腺体层厚度联合MRI测量的GAT/TGT制订手术方案,可取得良好的美容效果,避免术后并发症。Objective To investigate the application value of ultrasound combined with MRI in the surgical planning for gynecomastia(GM).Methods From January 2014 to January 2024,149 patients with GM treated in Henan Provincial People's Hospital underwent surgical treatment and were followed up.All patients underwent preoperative breast ultrasound to assess the thickness of the soft tissue glandular layer from the skin beneath the nipple to the superficial surface of the pectoralis major muscle,among whom 102 patients underwent preoperative breast MRI to measure the glandular adipose tissue volume(GAT)and total glandular tissue volume(TGT),and the GAT/TGT ratio was calculated for Cohen classification.Among them,there were 10 patients with pure glandular type(GAT/TGT:<0.3),59 patients with glandular-adipose type(GAT/TGT:0.3-0.6),and 33 patients with pure adipose type(GAT/TGT:>0.6).Surgical approaches were determined for all 149 patients based on breast ultrasound measurements and/or Cohen classification.Liposuction was performed in 7 pure adipose type patients with the soft tissue glandular layer thickness of<0.6 cm.Endoscopic-assisted liposuction with glandular excision was performed in 26 pure adipose type patients with the soft tissue glandular layer thickness of≥0.6 cm,and in 59 glandular-adipose type patients.Open or endoscopic-assisted partial glandular excision with nipple-areola preservation was performed in 10 pure glandular type patients and 47 patients who did not undergo preoperative MRI but had a soft tissue glandular layer thickness of 0.6 cm.All surgical specimens were sent for histopathological examination.Results All 149 patients achieved primary healing with no obvious pain and complications such as hematoma and seroma.Postoperative chest volume was significantly reduced compared to preoperative volume,and the appearance was improved to varying degrees.No significant scarring,step-off deformity,or breast asymmetry was observed.One patient developed mild necrosis of the areolar surface postoperatively,which

关 键 词：男性乳房发育症 MRI成像 超声 手术方案 

分 类 号：R655.8[医药卫生—外科学]