內窺鏡輔助假體隆乳的術前精確設計和術中精準控制

唐新輝　李京　劉英　王杰　彭正春　宋茂啟

[摘要]目的：探討內窺鏡輔助假體隆乳手術，術前精確設計和術中精準控制的方法、技巧和作用。方法：采用筆者提出的“十一精確設計法”，進行乳房假體選擇和術前畫線設計;術中全程用內窺鏡進行精準控制，直視下剝離胸大肌后間隙，用針頭穿刺精準定位剝離邊緣;內窺鏡直視下精準形成“高位雙平面”。結果：2015年2月-2018年12月，采用此方法共完成內窺鏡輔助假體隆乳1 658例，術后早期出血3例。隨訪6～24個月，Ⅲ級包膜攣縮8例，可觸及假體邊緣感21例，假體移位2例，無感染、血腫、血清腫、窗簾征、雙泡畸形、Ⅳ級包膜攣縮等并發癥發生。結論：假體隆乳術前精確設計，術中在內窺鏡直視下精準控制，是保證內窺鏡輔助假體隆乳取得良好效果的有效方法，是精準可控的假體隆乳方式，值得在臨床上推廣應用。

[關鍵詞]內窺鏡;隆乳術;乳房假體;雙平面法;胸大肌;并發癥

[中圖分類號]R622? ? [文獻標志碼]A? ? [文章編號]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、精準治療理念的興起，內窺鏡技術被廣泛引入到假體隆乳手術中[1-6]。“追求安全、穩定、持久的美學效果，最大程度地減少手術風險，嚴格控制并發癥”成為當今隆乳術的目標[7]。對于任何手術而言，術前的精確設計和術中精準控制，都是實現這一目標的良好方法。2015年2月-2018年12月，采用筆者提出的“十一精確設計法”，進行乳房假體選擇和術前畫線設計;術中全程運用內窺鏡直視下剝離胸大肌后間隙，用針頭穿刺精準定位剝離邊緣;內窺鏡直視下精準形成“高位雙平面”。共計完成內窺鏡輔助假體隆乳1 658例，效果良好，具體報道如下。

1? 臨床資料

本組患者共計1 658例（3 316側），女性，年齡19～60歲。初次手術患者1 612例，二次修復手術者46例。術前檢查身體健康，排除乳腺炎、乳腺腫瘤等疾病。二次修復手術者是原來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。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。