唐新輝　李京　劉英　王杰　彭正春　宋茂啟

[摘要]目的：探討內(nèi)窺鏡輔助假體隆乳手術(shù)，術(shù)前精確設(shè)計(jì)和術(shù)中精準(zhǔn)控制的方法、技巧和作用。方法：采用筆者提出的“十一精確設(shè)計(jì)法”，進(jìn)行乳房假體選擇和術(shù)前畫線設(shè)計(jì);術(shù)中全程用內(nèi)窺鏡進(jìn)行精準(zhǔn)控制，直視下剝離胸大肌后間隙，用針頭穿刺精準(zhǔn)定位剝離邊緣;內(nèi)窺鏡直視下精準(zhǔn)形成“高位雙平面”。結(jié)果：2015年2月-2018年12月，采用此方法共完成內(nèi)窺鏡輔助假體隆乳1 658例，術(shù)后早期出血3例。隨訪6～24個(gè)月，Ⅲ級(jí)包膜攣縮8例，可觸及假體邊緣感21例，假體移位2例，無(wú)感染、血腫、血清腫、窗簾征、雙泡畸形、Ⅳ級(jí)包膜攣縮等并發(fā)癥發(fā)生。結(jié)論：假體隆乳術(shù)前精確設(shè)計(jì)，術(shù)中在內(nèi)窺鏡直視下精準(zhǔn)控制，是保證內(nèi)窺鏡輔助假體隆乳取得良好效果的有效方法，是精準(zhǔn)可控的假體隆乳方式，值得在臨床上推廣應(yīng)用。

[關(guān)鍵詞]內(nèi)窺鏡;隆乳術(shù);乳房假體;雙平面法;胸大肌;并發(fā)癥

[中圖分類號(hào)]R622? ? [文獻(xiàn)標(biāo)志碼]A? ? [文章編號(hào)]1008-6455（2019）10-0001-03

Abstract： Objective? To explore the methods， skills and functions of precise preoperative design and precise intraoperative control in endoscope-assisted augmentation mammoplasty. Methods? Eleven precise design methods proposed by the author were used to select breast prostheses and draw lines before operation. During the whole operation， the endoscope was used for precise control. The posterior space of the pectoralis major muscle was peeled off under direct vision， and the peeling edge was accurately positioned by needle puncture. The “high position double plane”was accurately formed under the direct vision of endoscope. Results? From February 2015 to December 2018， 1 658 cases of endoscope-assisted augmentation mammoplasty were completed by this method， early bleeding occurred in 3 cases. Following up for 6～24 months， there were 8 cases of grade Ⅲ capsular contracture， 21 cases of palpable marginal sensation and 2 cases of prosthesis displacement. No complications such as infection， hematoma， seroma， curtain sign， double vesicle deformity and grade Ⅳ capsular contracture occurred. Conclusion? Precise design before augmentation mammoplasty and precise control during operation under endoscopy are effective methods to ensure good results of augmentation mammoplasty assisted by endoscope. It is a precise and controllable method of augmentation mammoplasty， and it is worth popularizing and applying in clinic.

Key words： endoscope; augmentation mammoplasty; breast implant; dual-plane technique; pectoralis major; complications

隨著微創(chuàng)、精準(zhǔn)治療理念的興起，內(nèi)窺鏡技術(shù)被廣泛引入到假體隆乳手術(shù)中[1-6]?！白非蟀踩?、穩(wěn)定、持久的美學(xué)效果，最大程度地減少手術(shù)風(fēng)險(xiǎn)，嚴(yán)格控制并發(fā)癥”成為當(dāng)今隆乳術(shù)的目標(biāo)[7]。對(duì)于任何手術(shù)而言，術(shù)前的精確設(shè)計(jì)和術(shù)中精準(zhǔn)控制，都是實(shí)現(xiàn)這一目標(biāo)的良好方法。2015年2月-2018年12月，采用筆者提出的“十一精確設(shè)計(jì)法”，進(jìn)行乳房假體選擇和術(shù)前畫線設(shè)計(jì);術(shù)中全程運(yùn)用內(nèi)窺鏡直視下剝離胸大肌后間隙，用針頭穿刺精準(zhǔn)定位剝離邊緣;內(nèi)窺鏡直視下精準(zhǔn)形成“高位雙平面”。共計(jì)完成內(nèi)窺鏡輔助假體隆乳1 658例，效果良好，具體報(bào)道如下。

1? 臨床資料

本組患者共計(jì)1 658例（3 316側(cè)），女性，年齡19～60歲。初次手術(shù)患者1 612例，二次修復(fù)手術(shù)者46例。術(shù)前檢查身體健康，排除乳腺炎、乳腺腫瘤等疾病。二次修復(fù)手術(shù)者是原來(lái)曾行腋窩切口假體隆乳，假體位置不佳或者形狀不良的患者，此類患者不接受乳暈切口或下皺襞切口修復(fù)。本組患者全部使用毛面假體，其中使用圓形假體171例，解剖形假體1 487例。假體體積180～400ml。