摘要
目的探讨单孔腔镜皮下腺体切除术治疗男子乳腺发育症(gynecomastia,GYN)疗效以及术前评估腺体质量的方法。方法回顾性分析2023年8月—2024年2月收治且符合选择标准的65例GYN患者。患者年龄(30.8±7.9)岁,身体质量指数(body mass index,BMI)27.3(24.9,29.8)kg/m^(2)。乳房发育Simon分级:Ⅰ级8例、Ⅱa级32例、Ⅱb级21例、Ⅲ级4例。患者均接受双侧腋下单孔腔镜皮下腺体切除术。记录手术时间、术中出血量、术后双侧拔管时间、总住院时间及并发症发生情况,术后2个月以问卷调查行术后美容效果评分。术前测量BMI,站立位及平卧位胸乳距(sternal notch to nipple,SN-N)、乳头间距(nipple to nipple,N-N),计算两侧站立位与平卧位SN-N差值(ΔSN-N)、平卧位与站立位N-N差值(ΔN-N);术中称重切除腺体质量。比较不同Simon等级间腺体质量相关指标(BMI、ΔSN-N、ΔN-N);将腺体质量与BMI及对应侧别ΔSN-N、ΔN-N、Simon分级(Ⅰ、Ⅱa、Ⅱb、Ⅲ级分别赋值为1、2、3、4)进行Spearman相关分析以及多重线性回归分析。结果65例手术均顺利完成,手术时间75.0(60.0,90.0)min,术中出血量12.0(11.0,13.0)mL;双侧拔管时间为术后1.5(1.5,1.5)d;总住院时间3.0(3.0,3.0)d。术后发生胸壁皮下积血3例、乳头乳晕区麻木不适1例,其余患者均无术后出血、积液、感染、乳头乳晕坏死等并发症发生。术后2个月患者美容效果评分均为15分,非常满意。右侧ΔSN-N SimonⅠ级与Ⅱa级、Ⅱb级、Ⅲ级间比较,左侧ΔSN-N SimonⅠ级与Ⅱb级、Ⅲ级比较,差异均有统计学意义(P<0.05);其余级别间比较差异无统计学意义(P>0.05)。ΔN-N SimonⅡa级、Ⅱb级间比较,BMI SimonⅡb级、Ⅲ级间比较,差异均无统计学意义(P>0.05);其余级别间ΔN-N、BMI比较,差异均有统计学意义(P<0.05)。65例患者左、右侧腺体质量分别为69.0(52.1,104.0)g、73.0(56.0,94.0)g,差异无统计学意义(Z=−0.622,P=0.534);取右侧数据行相关性分析。相关性分析示右侧腺体质量与BMI及Simon分级、ΔSN-N、ΔN-N均成正相关(P<0.05)。多重线性回归分析示Simon分级对腺体质量有正向预测作用,回归方程如下:右侧腺体质量=5.541+32.115×Simon分级(R 2=0.354,P<0.001)。结论单孔腔镜皮下腺体切除术是治疗GYN的理想术式。BMI及Simon分级与GYN腺体质量密切相关,对于术前腺体质量评估有一定参考价值。
Objective To investigate the effectiveness of axillary single-site laparoscopic subcutaneous mastectomy in treatment of gynecomastia(GYN)and the assessment method of glandular mass before operation.Methods A clinical data of 65 GYN patients admitted between August 2023 and February 2024 and matched the selection criteria was retrospectively analyzed.The patients were(30.8±7.9)years old,with a body mass index(BMI)of 27.3(24.9,29.8)kg/m^(2).According to Simon’s grading criteria,the GYN was classified as gadeⅠin 8 cases,gradeⅡa in 32 cases,gradeⅡb in 21 cases,and gradeⅢin 4 cases.All patients underwent bilateral axillary single-site laparoscopic subcutaneous mastectomy.The operation time,intraoperative blood loss,postoperative bilateral extubation time,total length of hospital stay,and the occurrence of related complications were recorded.The cosmetic outcome score was assessed by questionnaire at 2 months after operation.Preoperative BMI,lying/standing sternal notch to nipple(SN-N),and lying/standing nipple to nipple(N-N)were measured.The differences in SN-N between standing and lying positions(ΔSN-N)and in N-N between lying and standing positions(ΔN-N)were calculated.The intraoperative resected glandular mass was recorded.The glandular mass-related indicators(BMI,ΔSN-N,ΔN-N)were compared between Simon grades.Spearman’s correlation analysis and multiple linear regression analysis of glandular mass with BMI andΔSN-N,ΔN-N and Simon grading(gradesⅠ,Ⅱa,Ⅱb,andⅢwere assigned values of 1,2,3,and 4,respectively)of the corresponding side.Results All operations were successfully completed with the operation time of 75.0(60.0,90.0)minutes,the intraoperative blood loss of 12.0(11.0,13.0)mL,and the bilateral extubation time of 1.5(1.5,1.5)days after operation.The total length of hospital stay was 3.0(3.0,3.0)days.Three cases of subcutaneous hematoma in the chest wall and 1 case of nipple areola numbness and discomfort occurred after operation,while the rest of the patients had no complication,such as postoperative haemorrhage,effusion,infection,and nipple areola necrosis.The subjective cosmetic scores were all 15 at 2 months after operation,which was very satisfactory.The differences inΔSN-N of right side between Simon gradeⅠand gradesⅡa,Ⅱb,Ⅲand inΔSN-N of left side between Simon gradeⅠand gradesⅡb,Ⅲwere significant(P<0.05),while the differences between the remaining grades were not significant(P>0.05).The differences inΔN-N between Simon gradeⅡa and gradeⅡb and in BMI between Simon gradeⅡb and gradeⅢwere not significant(P>0.05),while the differences between the remaining grades were significant(P<0.05).The glandular masses of left and right breasts in 65 patients were 69.0(52.1,104.0)g and 73.0(56.0,94.0)g,respectively;and the difference between left and right breasts was not significant(Z=−0.622,P=0.534).The data of the right breast was selected for correlation analysis.Correlation analysis showed that the right glandular mass was positive correlated with BMI and Simon grading,ΔSN-N,andΔN-N(P<0.05).Multiple linear regression analysis showed that Simon grading had a positive predictive effect on glandular mass,and the regression equation was as follows:right glandular mass=5.541+32.115×Simon grading(R 2=0.354,P<0.001).Conclusion Axillary single-site laparoscopic subcutaneous mastectomy is an ideal surgical procedure for the treatment of GYN.BMI and Simon grading are closely related to GYN glandular mass,and have certain reference value for preoperative glandular mass assessment.
作者
刘岩
李梦竹
胡扬喜
董星
孟化
刘宝胤
LIU Yan;LI Mengzhu;HU Yangxi;DONG Xing;MENG Hua;LIU Baoyin(Department of Gastrointestinal Metabolic Surgery,Zhengzhou Central Hospital Affiliated to Zhengzhou University,Zhengzhou Henan,450000,P.R.China;Department of Obstetrics and Gynaecology,Zhengzhou Central Hospital Affiliated to Zhengzhou University,Zhengzhou Henan,450000,P.R.China;Department of General Surgery&Obesity and Metabolic Disease Center,China-Japan Friendship Hospital,Beijing,100029,P.R.China)
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2024年第7期818-822,共5页
Chinese Journal of Reparative and Reconstructive Surgery
