内窥镜辅助假体隆乳的术前精确设计和术中精准控制

唐新辉　李京　刘英　王杰　彭正春　宋茂启

[摘要]目的：探讨内窥镜辅助假体隆乳手术，术前精确设计和术中精准控制的方法、技巧和作用。方法：采用笔者提出的“十一精确设计法”，进行乳房假体选择和术前画线设计;术中全程用内窥镜进行精准控制，直视下剥离胸大肌后间隙，用针头穿刺精准定位剥离边缘;内窥镜直视下精准形成“高位双平面”。结果：2015年2月-2018年12月，采用此方法共完成内窥镜辅助假体隆乳1 658例，术后早期出血3例。隨访6～24个月，Ⅲ级包膜挛缩8例，可触及假体边缘感21例，假体移位2例，无感染、血肿、血清肿、窗帘征、双泡畸形、Ⅳ级包膜挛缩等并发症发生。结论：假体隆乳术前精确设计，术中在内窥镜直视下精准控制，是保证内窥镜辅助假体隆乳取得良好效果的有效方法，是精准可控的假体隆乳方式，值得在临床上推广应用。

[关键词]内窥镜;隆乳术;乳房假体;双平面法;胸大肌;并发症

[中图分类号]R622    [文献标志码]A    [文章编号]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

随着微创、精准治疗理念的兴起，内窥镜技术被广泛引入到假体隆乳手术中[1-6]。“追求安全、稳定、持久的美学效果，最大程度地减少手术风险，严格控制并发症”成为当今隆乳术的目标[7]。对于任何手术而言，术前的精确设计和术中精准控制，都是实现这一目标的良好方法。2015年2月-2018年12月，采用笔者提出的“十一精确设计法”，进行乳房假体选择和术前画线设计;术中全程运用内窥镜直视下剥离胸大肌后间隙，用针头穿刺精准定位剥离边缘;内窥镜直视下精准形成“高位双平面”。共计完成内窥镜辅助假体隆乳1 658例，效果良好，具体报道如下。

1  临床资料

本组患者共计1 658例（3 316侧），女性，年龄19～60岁。初次手术患者1 612例，二次修复手术者46例。术前检查身体健康，排除乳腺炎、乳腺肿瘤等疾病。二次修复手术者是原来曾行腋窝切口假体隆乳，假体位置不佳或者形状不良的患者，此类患者不接受乳晕切口或下皱襞切口修复。本组患者全部使用毛面假体，其中使用圆形假体171例，解剖形假体1 487例。假体体积180～400ml。