目的

探讨腔镜技术在注射式隆乳术后隆乳剂取出术中的应用效果。

方法

对45例行注射式隆乳术2～10年出现并发症的患者行腔镜下隆乳剂取出术。所有患者均采用全麻,在乳房外上边缘腋横纹处、腋后线乳头水平、乳房外下边缘腋前线处各取一小切口,经溶脂、吸脂并吸出大部分的隆乳剂后采用充气法建立操作空间,在腔镜下操作以清除残留的隆乳剂。对取出隆乳剂后导致乳房明显缩小者,则在胸大肌后间隙植入假体行乳房重建。

结果

45例患者(共87侧乳房)均顺利完成腔镜隆乳剂取出术,其中仅行腔镜隆乳剂取出者25例,行腔镜隆乳剂取出加假体植入20例,其中1例同时行腔镜乳房皮下腺体切除术。87侧腔镜隆乳剂取出术的手术时间为45～180 min,平均102 min;术中出血量20～90 ml,平均43 ml。所有患者均未出现术后出血、继发感染及皮下积液等并发症。术后1～3个月内行超声复查显示,41例(91.1%)未发现明显的隆乳剂残留。在20例腔镜隆乳剂取出加假体植入患者中,对美容效果非常满意者17例,基本满意者3例。

结论

溶脂抽吸结合腔镜技术在隆乳剂取出术中效果良好,为解决注射式隆乳术后并发症提供了一种新的手术方法。

Objective

To explore the effect of endoscopic technique in removing breast prosthesis from mammary augmentation by polyacrylamide hydrogel(PAHG)injection.

Methods

Forty-five patients underwent breast augmentation with PAHG injection 2 to 10 years ago.Of them 10 cases suffered with breast pain or upper limb dysfunction,5 with mastitis,3 with breast cancer,and 40 were found with breast mass or PAHG displacement by color ultrasound.Treatment of removing the breast prosthesis with endoscopic technique was performed for the 45 cases.Under general anesthesia,three 5-mm incisions were made at the axillary transverse striation,beyond the midaxillary line at nipple level and beyond the inferior lateral margin of the breast,respectively after liposuction and most PAHG was drawn out;then working space for endoscopic operation was made with gas insufflation method,and the residual PAHG was thoroughly cleaned out with endoscopic technique.When breast shrank markedly after PAHG was removed,breast reconstruction with implants was carried out.

Results

PAHG removing was smoothly performed in the 45 patients(87 cases),including endoscopic PHAG removing in 25 patients and endoscopic PAHG removing plus breast reconstruction with implants in 20 patients,of them one patient had concomitant mammary gland resection.The operation duration was 45-180 min,with mean of 102 min;the intra-operative bleeding volume was 20-90 ml,with mean of 43 ml.No complications such as bleeding,infection and seroma,were found in all patients.Reexamination with ultrasound within 1 to 3 months postoperatively showed no residual PAHG in 41 patients(91.1%).In the 20 patients with endoscopic PAHG removing plus breast reconstruction,17 patients were extremely satisfied and 3 patients were passably satisfied to the postoperative cosmetic results.

Conclusion

AHG removing with endoscopic technique following lipolysis and liposuction has good effect and provides a new way for patients with complications after breast augmentation with injection.