摘要
目的评价分体式内镜腋窝入路高位双平面隆乳术的安全性、可靠性和有效性，探索提高腋窝入路内镜操作效率和手术效果的内镜操作技术，以及内镜下形成双平面安全有效的方法。方法采用与传统内镜辅助腋窝入路双平面隆乳术不同的新技术方法：①高位双平面技术，离断胸大肌的位置在原乳房下皱襞上方1．5cm，使双平面形成后乳房假体下极处于远侧胸大肌的深面，用拉钩将胸大肌近侧断端外侧端分离至乳头水平，形成高位双平面。②分体式内镜操作技术，设计制作了专用拉钩，采用拉钩与内镜分离的分体式操作方式，助手持拉钩，主刀医生一手持内镜，一手持电刀进行腔隙分离。③精准定位技术，通过定向针刺引导镜下剥离，使分离边界与体表设计线准确重合一致。结果采用该术式共完成1106例隆乳术，其中405例随访1年以上纳入本回顾性研究。随访时间12～60个月，平均24．3个月。平均手术时间为（1．47±0．46）h，平均拔除引流管时间是术后（4．23±0．51）d。围手术期并发症发生率为0．99％，包括术中出血变更切口1例、术中气胸1例、术后早期出血2例。远期并发症包括：Ⅲ级包膜挛缩6例（1．48％）、乳头乳晕感觉障碍或减退21例（5．20％）、可触及假体14例（3．46％）、假体移位3例（0．74％）、假体旋转2例（0．49％），再次手术10例，总再次手术率为2．47％。未出现感染、血肿、血清肿、窗帘征、双泡畸形等并发症。结论高位双平面技术不仅可以弥补传统双平面方法下极组织覆盖不足的问题，大大减少下极易触及假体的现象，而且可以解除近侧胸大肌与原有下皱襞的关系，有效地解决腋窝入路无法进行Ⅱ、Ⅲ型双平面操作的问题，减少了术后窗帘征和双泡畸形等并发症的风险。分体式内镜器械与操作技术，操作灵活便捷，结合精准定位技术，可以实现腔隙的精准分离，新的乳房下皱襞定位准确，并发症率低，虽然学习曲线较长，却十分值得学习和推广，是安全可控、效果确切的隆乳方式。
Objective To evaluate the safety, reliability and effectiveness of ＂ free style endoscopic technique＂ assisted transaxillary high level dual plane breast augmentation; To explore endoscopic techniques that can achieve higher efficiency and better result ; To discover a safe and effective method for dual plane dissection with the help of endoscopy. Methods Using new endoscopic techniques to perform transaxillary dual plane breast augmentation： ① High level dual plane technique, the muscle division line is about 1.5 cm higher than the original inferior mammary fold, the cephalic side of the muscle is retracted to the lower border of the areola with a special retractor to form a high level dual plane cavity, thus the upper and lower portion of the implant would be covered by pectorilis major muscle, while the rest of the implant was partially under breast parenchyma. ② ＂ Free style endoscopic techniques＂, the endoscopy and retractor are not fixed to each other, thus the space is exposed by an assistant with a new designed special retractor, while the operator is concentrate on dissecting with endoscopy in one hand and long tipped bowie in the other hand. ③ Accurate navigate technique, define the dissection border by acupuncture via skin in a 90 degree angle, thus to make the dissection right as preoperative design. Results There were 1 106 cases underwent this kind of surgery, while 405 of them, whose minimum follow up were 12 months were included in this retrospective study. The follow up period ranged from 12 -60 months, the average follow up period is 24.3 months. The average operation time is （ 1.47 ± 0.46） h, the average drainage removal time is （4.23 ± 0. 51 ） d after surgery. The perioperative complication rate is 0.99%, including an incision site change caused by intraoperative bleeding, 1 case of pneumothorax, 2 cases of bleeding after surgery. Long period complication including： 6 cases （ 1.48% ）Ⅲ grade capsular contracture, 21 cases （5.20%） of nipple-areola sensation disorders, implant palpable occurred in 14 case （3.46%） , 3 cases （0.74%） implant malposition, 2 cases （0.49%） implant distortion, the total reoperation rate is 2.47%. There was no infection, hematoma, seroma, curtain deformity, double bubble deformity occurred in our study. Conclusions The high level dual plane techniques not only can solve the deficient soft tissue coverage problem thus to lower the rate of implant palpability, but also can relieve the relationship of the pectorilis major muscle and the inframammary fold（IMF） , offering an option to replace 1] and II1 type of dual plane techniques, decrease the risk of curtain deformity and double bubble deformity. The free style endoscopic techniques are very flexible and efficient, with the help of accurate navigate technique, it can archive an accurate cavity dissection, accurate and definite IMF, and a lower complication rate. Though the learning curve is relatively longer, it is really a safe and effective breast augmentation method worthwhile to learn and spread.
出处
《中华整形外科杂志》
CSCD
北大核心
2017年第5期321-328,共8页
Chinese Journal of Plastic Surgery
关键词
隆乳术
内镜
双平面
乳房假体
Breast augmentation
Endoscopes
Dual plane
Breast implant
