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中华乳腺病杂志(电子版)

中华乳腺病杂志(电子版) ›› 2011, Vol. 05 ›› Issue (02) : 161 -170. doi: 10.3877/cma.j.issn.1674-0807.2011.02.007

临床研究

带蒂真皮瓣乳房缩小成形术的临床应用价值
雷秋模1, 王鹤1, 刘序旭1, 宋奇思1, 衷诚任1, 曹亚丽1, 熊秋云1, 罗永辉1, 谢春伟1   
  1. 1.330009 南昌,江西乳腺专科医院乳腺疾病防治专业学部
  • 收稿日期:2001-01-06 出版日期:2011-04-01
  • 基金资助:
    江西省和南昌市1979～1991年重点科研课题资助项目

Clinical value of reduction mammaplasty with pedicle dermal skin flap

Qiu-mo LEI1, He WANG1, Xu-xu LIU1, Qi-si SONG1, Cheng-ren ZHONG1, Ya-li CAO1, Qiu-yun XIONG1, Yong-hui LUO1, Chun-wei XIE1   

  1. 1.Specialty Department of Education of Breast Disease Prevention,Jiangxi Mammary Gland Specialized Hospital,Nanchang 330009, China
  • Received:2001-01-06 Published:2011-04-01
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引用本文：

雷秋模, 王鹤, 刘序旭, 宋奇思, 衷诚任, 曹亚丽, 熊秋云, 罗永辉, 谢春伟. 带蒂真皮瓣乳房缩小成形术的临床应用价值[J/OL]. 中华乳腺病杂志(电子版), 2011, 05(02): 161-170.

Qiu-mo LEI, He WANG, Xu-xu LIU, Qi-si SONG, Cheng-ren ZHONG, Ya-li CAO, Qiu-yun XIONG, Yong-hui LUO, Chun-wei XIE. Clinical value of reduction mammaplasty with pedicle dermal skin flap[J/OL]. Chinese Journal of Breast Disease(Electronic Edition), 2011, 05(02): 161-170.

目的

探讨伴有乳腺良性疾病的乳房下垂及乳房肥大症患者应用乳房缩小成形手术的疗效。

方法

对248 例487 侧乳房采用带蒂真皮瓣法施行乳房缩小成形术,主要是切除足量的乳腺组织及其病变区,同时将乳头乳晕移至胸部适宜位置上,建立正常外观的乳房。

结果

248 例乳房缩小成形术切除的乳房组织量在1352～1840 g之间。除开展初始有21 例乳头小部分坏死脱落,9 例积血致皮肤小面积感染而延迟愈合外,其余均愈合良好、感觉恢复、乳房外形满意。美容效果总优良率达96.4%(239/248)。

结论

带蒂真皮瓣乳房缩小成形术操作简便,术后乳房外形满意,远期效果可靠,值得临床推广。

关键词: 乳房下垂, 乳房肥大, 带蒂真皮瓣法, 缩小成形术

Objective To investigate the therapeutic effect of reduction mammaplasty in the treatment of mastoptosis and hypermastia accompanied with benign diseases.Methods The reduction mammaplasty with pedicle dermal skin flap was performed in 487 breasts of 248 patients. Sufficient volume of gland tissue and the lesion were resected,meanwhile,the areola and the nipple were moved to appropriate position to establish a normal breast appearance. Results The resected tissue volume was 1352-1840 g for the 248 patients. Necrosis in partial nipple occurred in 21 cases and small area of skin infection caused by hemorrhage occurred in 9 cases,which resulted in a delay of recovery. The rest cases all healed well,recovered the sensation,and were satisfied with the breast contour.The overall excellent and good rate for cosmetic effect attained 96. 4% (239/248).Conclusion The reduction mammaplasty with pedicle dermal skin flap has the advantages of easy operation and reliable long-term effect. This technique can be sued clinically.

Key words: mastoptosis, hypermastia, pedicle dermal skin flap, reduction mammaplasy
图1 术前背面观
图2 术前侧面观 1:新乳晕位置;2:梯状瓣;a:倒梯形设计术后切口;b:梯状瓣设计术后弧形切口
图3 乳房成形切口设计示意图 1:新乳晕位置;2.梯状瓣;a:倒梯形设计术后切口;b: 梯状瓣设计术后弧形切口
图4 术前划线设计
图5 手术步骤图-A 在乳晕下作梯状瓣游离,切除表皮保留真皮层。
图6 手术步骤图-B 循半月线切开,切断乳房周围组织。
图7 手术步骤图-C 切除病变腺体与多余皮肤(酷似蝴蝶形状)。
图8 手术步骤图-D 4 定点法缝合移植的乳头乳晕。
图9 手术步骤图-E 乳头转位缝合完毕。
图10 手术步骤图-F 将保留的真皮瓣缝合并悬吊于胸肌筋膜上。
图11 手术步骤图-G 采用双边管负压引流。
图12 手术步骤图-H 乳头乳晕移植后以球形纱布加压固定。
图13 第1 例患者手术前后乳房外观 a:术前正面照; b:术前侧面照;c:术后2 周乳房外形良好;d:术后10年随访照,瘢痕不显。
图14 手术前后乳房外观(弧形切口设计) a:术前正位照;b:术前侧位照;c:术后20 d 侧位照;d:术后3年正位照
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