探讨达芬奇机器人辅助乳房皮下腺体切除手术的可行性、安全性和临床应用价值。

回顾性分析2014年2月至2017年8月济南军区总医院10例行达芬奇机器人乳房皮下腺体切除术患者的临床资料，其中8例为男性乳房发育，1例为乳腺癌，1例为多次复发的双乳多发性乳腺纤维腺瘤，评估以下因素：手术时间、引流量、中转开放手术的比例、住院时间、淋巴结清扫数目及术后并发症。

用时最短的一台机器人辅助单侧乳腺皮下腺体切除手术时间约为114 min，显示学习曲线较快，10例共16侧乳房均顺利完成达芬奇机器人皮下腺体切除，没有中转开放手术。手术时间为114～336 min，平均190 min；无血肿、血清肿、乳头乳晕坏死、皮瓣坏死、感染等重大并发症，伤口均愈合良好。术后1例患者出现乳房皮肤小水泡，可能是由于超声刀烫伤，未做特殊处理，1周后自愈。随访0.5～18.0个月，均未出现疾病复发或转移。

达芬奇机器人乳房皮下腺体切除术手术并发症少，安全性好，可行性高，患者满意度较高。

To assess the feasibility, safety and clinical application of robotic subcutaneous mastectomy.

Totally 10 patients who underwent robotic subcutaneous mastectomy in Jinan Military General Hospital from February 2014 to August 2017 were retrospectively analyzed. They included 8 patients with gynecomastia, 1 breast cancer and 1 recurrent multiple breast fibroadenoma. The following parameters were evaluated: operative time, postoperative discharge, conversion rate to open surgery, length of hospitalization, number of dissected lymph nodes and postoperative complications.

The minimal duration of one-side robotic surgery in this study was 114 min, indicating a very rapid learning curve. We successfully performed the robotic subcutaneous mastectomy in 10 cases (16 breasts). None converted to open surgery. The operative time was 114-336 min, mean 190 min. There were no major complications, including hematoma, seroma, skin or nipple-areola necrosis and infection. One patient had small blisters on the breast skin, which might be caused by ultrasound scalpel during operation and was resolved one week later without any specific treatment. In the follow-up of 0.5-18.0 months, no recurrence or tumor metastasis was observed.

The robotic subcutaneous mastectomy has the advantages of low incidence of postoperative complications, high safety, feasibility and patient satisfaction.