【摘要】：目的:探討改良雙環(huán)法與垂直雙蒂法兩種巨乳縮小術(shù)的臨床應(yīng)用效果。方法:回顧分析2000年1月至2014年6月我院收治的乳房肥大癥患者34例,平均年齡(38.76±6.40)歲,其中改良雙環(huán)法巨乳縮小術(shù)18例,設(shè)為觀(guān)察組;垂直雙蒂法巨乳縮小術(shù)16例,設(shè)為對(duì)照組,術(shù)后均隨訪(fǎng)6個(gè)月~1年。評(píng)價(jià)術(shù)后效果:患者術(shù)前癥狀的改善、患者術(shù)后滿(mǎn)意度(術(shù)后乳房整體外形、乳頭乳暈外形及位置、乳頭乳暈感覺(jué)、瘢痕情況等)、醫(yī)師對(duì)術(shù)后乳房評(píng)價(jià)、術(shù)中切除組織量、術(shù)前術(shù)后乳房形態(tài)(包括乳頭至鎖骨中點(diǎn)的距離、兩乳頭間距、乳暈直徑、過(guò)乳頭胸圍)的測(cè)量、術(shù)后并發(fā)癥等。結(jié)果:兩組患者癥狀均明顯緩解,乳房體積明顯減小。觀(guān)察組術(shù)后乳頭和乳暈上方乳腺組織在胸大肌筋膜上的懸吊使得乳房看起來(lái)挺拔、圓潤(rùn)、自然,術(shù)后瘢痕少而隱蔽,術(shù)后僅出現(xiàn)1例切口愈合不良,2例術(shù)后乳暈擴(kuò)大;對(duì)照組患者乳房外形飽滿(mǎn)、挺拔,但術(shù)后瘢痕較明顯,并且出現(xiàn)2例切口部分裂開(kāi),2例脂肪液化,4例術(shù)后乳房瘢痕明顯增生。醫(yī)師對(duì)術(shù)后乳房評(píng)價(jià)與患者滿(mǎn)意度相符合,術(shù)后乳房整體外形及乳頭乳暈外形患者滿(mǎn)意度上兩組無(wú)明顯差異,而乳頭乳暈感覺(jué)及瘢痕滿(mǎn)意度上觀(guān)察組明顯高于對(duì)照組,觀(guān)察組在乳頭乳暈上移距離約(7.98±1.70)cm,切除組織量平均達(dá)到(596.61±152.43)g,與對(duì)照組相仿。并發(fā)癥的發(fā)生率觀(guān)察組明顯少于對(duì)照組。結(jié)論:垂直雙蒂法巨乳縮小術(shù)設(shè)計(jì)精確但較復(fù)雜,血供充分,組織切除量大,但術(shù)后留有倒T瘢痕,且乳頭乳暈感覺(jué)遲鈍,適用于中重度及超重度乳房肥大且對(duì)瘢痕要求不高的患者。改良雙環(huán)法巨乳縮小術(shù)可以有效減小乳房體積,且不影響血供及乳房塑形,可廣泛應(yīng)用于輕、中、重度乳房肥大患者,術(shù)后保留乳頭乳暈感覺(jué),且瘢痕小而隱蔽,因此對(duì)于瘢痕要求高的患者,改良雙環(huán)法巨乳縮小術(shù)優(yōu)于垂直雙蒂法巨乳縮小術(shù)。
[Abstract]:Objective: to investigate the clinical effect of modified double-loop and vertical double-pedicle mammoplasty. Methods: 34 patients with breast hypertrophy from January 2000 to June 2014 were retrospectively analyzed. The mean age was (38.76 鹵6.40) years old. Among them, 18 cases were treated with modified double-ring mammoplasty and were set up as observation group. A total of 16 cases of vertical double pedicle mammoplasty were set up as control group. All patients were followed up for 6 months to 1 year. Evaluation of postoperative effects: improvement of preoperative symptoms, postoperative satisfaction (overall breast shape, nipple areola shape and position, nipple areola sensation, scar condition, etc.), evaluation of postoperative breast by physicians, amount of tissue removed during operation, Preoperative and postoperative breast morphology (including the distance between the nipple and the midpoint of clavicle, the distance between the nipples, the diameter of the areola, the diameter of the nipple and the chest circumference of the nipple), postoperative complications, etc. Results: the symptoms of the two groups were relieved obviously, and the breast volume was obviously reduced. In the observation group, the suspension of the breast tissue above the nipple and areola on the fascia of the major pectoral muscle made the breast look stiff, round, natural, few and hidden scar after operation, only 1 case had bad wound healing after operation, and 2 cases had enlarged areola after operation. In the control group, the breast was full and erect, but the postoperative scar was obvious, and there were 2 cases with partial laceration of incision, 2 cases with fat liquefaction and 4 cases with obvious hyperplasia of breast scar after operation. There was no significant difference in the overall breast shape and the nipple areola appearance between the two groups, but the feeling of nipple areola and scar satisfaction in the observation group were significantly higher than those in the control group, and there was no significant difference in the overall breast shape and the nipple areola appearance between the two groups. The average amount of resected tissue in the observation group was (596.61 鹵152.43) g at the distance from (7.98 鹵1.70) cm, to the nipple areola, which was similar to that in the control group. The incidence of complications was significantly lower in the observation group than in the control group. Conclusion: the design of vertical double pedicle giant mammoplasty is accurate but complex, the blood supply is sufficient, the amount of tissue resection is large, but the inverted T scar is left after operation, and the sense of areola of nipple is dull. It is suitable for patients with moderate to severe breast hypertrophy and low demand for scar. Modified double-ring mammoplasty can effectively reduce breast volume without affecting blood supply and breast shaping, and can be widely used in patients with mild, moderate, or severe breast hypertrophy, and postoperative preservation of nipple areola sensation, and scar is small and concealed. Therefore, for patients with high scar requirements, the modified double-loop macromastectomy is superior to the vertical double-pedicle macromastectomy.
【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R655.8

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