目的

探讨全腔镜乳房皮下腺体切除的手术方法及治疗效果。

方法

对2004年8月至2007年10月间共96例男性乳房发育患者和女性乳腺癌患者行全腔镜乳房皮下腺体切除手术。腔镜手术前对乳房皮下和乳房后间隙充分溶脂和吸脂，通过充气法建立操作空间，腔镜下只需切断乳房皮下和腺体间相连的纤维条索及乳房边缘腺体和周围筋膜附着处即可顺利完成腺体切除。并对乳腺癌患者行后续前哨淋巴结活检、腋窝淋巴结清扫及假体植入乳房重建手术，术后行常规辅助治疗。全部患者随访3个月至3年，观察手术安全性及美容效果。

结果

96例共156侧乳房均顺利完成全腔镜皮下腺体切除；单纯腔镜皮下腺体切除的时间为35～125 min，平均71 min；术中出血量30～170 ml，平均94 ml。术后并发症发生率2.6%（4/156），其中单侧乳头部分坏死3例，局部皮下积液1例。术后美容效果良好，患者满意率97.9%（94/96）。随访3个月至3年均未出现疾病复发或转移。

结论

全腔镜乳房皮下腺体切除手术并发症少，安全性高，美容效果好。

Objective

To explore the procedures and efficacy of complete endoscopic subcutaneous mastectomy for gynaecomastia and breast cancer.

Methods

Ninety-six patients with gynaecomastia or breast cancer admitted to our hospital from August 2004 to October 2007 underwent complete endoscopic subcutaneous mastectomy.The space of endoscopic operation was established with insufflation carbon dioxide after lipolysis and liposuction of subcutaneous and retromammary spaces.Then the gland was resected thoroughly by abscinding the fibers between skin and mammary gland and separating the attachments between marginal gland and fascia.In addition，the breast cancer patients underwent sentinel lymph node biopsy，axillary lymph node dissection，immediate reconstruction with implants and regular adjuvant therapies.All patients were followed up for 3 months to 3 years to observe the safety and cosmetic results of operation.

Results

The complete endoscopic subcutaneous mastectomy was carried out in 156 cases of 96 patients.The mean operation time was 71 minutes，ranging 35-125 minutes，and the intraoperative blood loss ranged from 30 ml to 170 ml，with an average of 94 ml.The complications were found in 4 cases（2.6%），including partial necrosis of unilateral nipple in 3 cases and local subcutaneous seroma in 1 case.The appearances of chest wall were satisfying in 94 cases（97.9%）and no recurrence or metastasis occurred during the following-up period.

Conclusion

Complete endoscopic subcutaneous mastectomy，with few complications，high safety and fine cosmetic result，is a reasonable choice for gynaecomastia and early breast cancer.