【摘要】：目的：選取常用乳房縮小術(shù)術(shù)式中的兩種術(shù)式：雙環(huán)形切口真皮帽法巨乳縮小整形術(shù)和垂直切口垂直雙蒂瓣法巨乳縮小整形術(shù),在手術(shù)方法、術(shù)后效果及術(shù)后滿意度等方面進(jìn)行對(duì)比研究,分析兩種術(shù)式術(shù)后并發(fā)癥的發(fā)生原因及如何處理預(yù)防。方法：選取乳房肥大癥患者相關(guān)病例30例,年齡26-44歲,已婚已育20例,未婚未生育10例。將30例患者分為A、B兩組,分別應(yīng)用上述兩種術(shù)式進(jìn)行對(duì)比分析,A組15例患者應(yīng)用雙環(huán)形切口真皮帽法巨乳縮小整形術(shù);B組15例患者應(yīng)用垂直切口雙蒂瓣法巨乳縮小整形術(shù)。根據(jù)患者的術(shù)前臨床癥狀資料和乳房數(shù)據(jù)進(jìn)行術(shù)前設(shè)計(jì),術(shù)中按照術(shù)前設(shè)計(jì)精準(zhǔn)操作,認(rèn)真做好術(shù)后護(hù)理、觀察,及時(shí)發(fā)現(xiàn)處理并發(fā)癥。觀察兩組術(shù)前設(shè)計(jì)、術(shù)中操作、術(shù)后乳房形態(tài)、并發(fā)癥及切口瘢痕以及術(shù)后恢復(fù)情況。結(jié)果：A組15例應(yīng)用雙環(huán)切口真皮帽法巨乳縮小整形術(shù)的患者中,術(shù)后3例單側(cè)乳暈局部出現(xiàn)水泡,變黑,經(jīng)及時(shí)處理數(shù)日后好轉(zhuǎn)、恢復(fù)。4例出現(xiàn)切口瘢痕增生,術(shù)后患者切口因荷包縫合所到切口皺褶明顯,未出現(xiàn)脂肪液化,血清腫,血腫等并發(fā)癥。術(shù)后6-12個(gè)月隨訪,患者雙側(cè)乳房形態(tài)基本對(duì)稱,乳房充盈、飽滿,乳頭乳暈感覺良好,切口瘢痕恢復(fù)良好,個(gè)別有瘢痕增生現(xiàn)象的患者在術(shù)后6個(gè)月后瘢痕增生現(xiàn)象也逐漸好轉(zhuǎn)。術(shù)后雙乳手感自然,乳暈邊緣切口皺褶紋理瘢痕逐漸減輕、松懈。術(shù)前出現(xiàn)的因乳房過大和過重所產(chǎn)生的癥狀被良好的改善。患者的生活質(zhì)量得以明顯提高,最初的設(shè)計(jì)形態(tài)決定最后的手術(shù)效果。乳腺組織去除的多少?zèng)Q定術(shù)后乳房的大小。B組15例應(yīng)用垂直切口垂直雙蒂瓣法巨乳縮小整形的患者術(shù),出現(xiàn)術(shù)后切口延遲愈合1例,出現(xiàn)三角尖瓣皮膚壞死1例,出現(xiàn)切口瘢痕增生1例,兩組術(shù)式中均未出現(xiàn)脂肪液化,血清腫,血腫等并發(fā)癥。在術(shù)后6-12個(gè)月進(jìn)行了術(shù)后隨訪,患者雙側(cè)乳房形態(tài)大致對(duì)稱,乳房充盈、飽滿,乳頭乳暈感覺良好,切口瘢痕恢復(fù)良好,個(gè)別患者在術(shù)后3個(gè)月有瘢痕增生現(xiàn)象,在給予注射瘢痕軟化藥物后逐漸好轉(zhuǎn)。術(shù)后雙乳手感自然,三角尖瓣切口處瘢痕略微明顯。術(shù)前出現(xiàn)的因乳房過大所伴隨的癥狀得到良好的改善。生活質(zhì)量得以明顯提高。結(jié)論：雙環(huán)形切口真皮帽法巨乳縮小術(shù)和垂直切口雙蒂巨乳縮小整形術(shù)術(shù)后效果均有良好改善,兩種術(shù)式都有各自的優(yōu)缺點(diǎn),并發(fā)癥發(fā)生的幾率無太大差異,早期的并發(fā)癥主要為血腫。雙環(huán)形切口真皮帽法巨乳縮小整形術(shù)主要適用于輕、中度的乳房縮小和矯正乳房下垂,術(shù)后切口瘢痕隱蔽,術(shù)后效果美觀,滿意度高。但手術(shù)設(shè)計(jì)要求較高,術(shù)后易出現(xiàn)血腫,影響乳頭、乳暈的敏感性。垂直切口雙蒂瓣法巨乳縮小整形術(shù)適用于中、重度巨乳癥患者,術(shù)后效果良好但瘢痕較明顯。
[Abstract]:Objective: to select two common breast reduction procedures: double ring incision dermis cap surgery and vertical double pedicle flap mammoplasty. The causes of postoperative complications and how to deal with the prevention of complications were analyzed and compared in terms of postoperative effect and postoperative satisfaction. Methods: 30 cases of breast hypertrophy, aged 26-44 years, were selected. 20 cases were married and 10 cases were unmarried. Thirty patients were divided into two groups: group A (n = 15) and group A (n = 15). In group B, 15 patients were treated with double pedicle flap vertical incision for mammoplasty. According to the clinical symptom data and breast data of the patients, the preoperative design was performed accurately during the operation, the postoperative nursing care was carefully done, and the complications were found and dealt with in time. The preoperative design, intraoperative operation, breast morphology, complications, incision scar and postoperative recovery were observed in both groups. Results: in group A, blisters were found in 3 cases of unilateral areola, which were improved and recovered after a few days of treatment, and 4 cases appeared scar hyperplasia in the incision, among the 15 cases in group A who were treated with double ring incision dermis cap method for large mammary reduction and plastic surgery, 3 cases had local blisters in the unilateral areola after operation, and 4 cases had scar hyperplasia in incision. There were no complications such as fat liquefaction, serum swelling, hematoma and so on. The patients were followed up 6-12 months after operation. The bilateral breasts were basically symmetrical, the breasts were full and full, the nipple areola felt well, and the scar of the incision recovered well. Some patients with scar hyperplasia gradually improved after 6 months after operation. After the operation, the feeling of double breasts was natural, and the wrinkle scar was gradually alleviated and relaxed at the edge of areola. Preoperative symptoms of oversize and overweight were well improved. The patient's quality of life was significantly improved, and the initial design shape determined the final outcome of the operation. The size of breast was determined by the removal of mammary tissue. In group B, 15 patients underwent vertical double pedicle flap surgery, 1 patient had delayed healing of incision, and 1 patient had skin necrosis of triangle tip flap. Incision scar hyperplasia occurred in 1 case. There were no complications such as fat liquefaction, serum swelling and hematoma in both groups. The patients were followed up 6-12 months after operation. The bilateral breasts were roughly symmetrical, the breasts were full and full, the nipple areola felt well, the incision scar recovered well, and some patients had scar hyperplasia at 3 months after operation. After the injection of scar softening drug gradually improved. After operation, both breasts feel natural and the scar at the incision of triangle flap is slightly obvious. Preoperative symptoms associated with breast enlargement were well improved. The quality of life has improved significantly. Conclusion: the results of double ring incision and vertical incision double pedicle mammoplasty have good improvement, both of them have their own advantages and disadvantages, and there is no significant difference in the incidence of complications. The main early complication was hematoma. Double ring incision dermis cap method is mainly suitable for small and moderate breast reduction and correction of breast prolapse. The incision scar is hidden after operation, the effect is beautiful, and the satisfaction is high. But the operation design is high, the postoperative hematoma is easy to appear, which affects the sensitivity of nipple and areola. Vertical incision double pedicle flap surgery is suitable for moderate and severe mammoplasty. The effect is good but the scar is obvious.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R655.8

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