探讨如何合理选择2种聚丙烯酰胺水凝胶取出术。

回顾性分析2012年6月至2018年12月在成都市第三人民医院就诊的213例行聚丙烯酰胺水凝胶取出术的患者资料。采用χ²检验比较61例微创抽吸术(抽吸组)和152例乳晕切口开放性聚丙烯酰胺水凝胶及包膜取出术(开放组)患者的术前伴随症状(疼痛、结节、红肿、破溃、乳头溢液和乳房肿大)；患者的年龄和手术数据(手术时间、术中出血量、术后引流时间)为偏态分布计量资料，用M (P₂₅ , P₇₅ )表示，组间比较采用非参数检验；2种手术方式比例逐年变化趋势的组间比较采用趋势χ²检验。

(1)抽吸组患者术前疼痛发生率更低，无伴随症状者更多[疼痛：29.5%(18/61)比50.7%(77/152)，χ²＝7.881，P＝0.005；无症状：52.5%(32/61)比29.6%(45/152)，χ²＝9.850，P＝0.002]，其余伴随症状(结节、红肿、破溃、乳头溢液和乳房肿大)发生率的组间比较，差异均无统计学意义(χ²＝3.323、3.349、2.869、0.000、0.020，P均>0.050)。(2)开放组手术时间和出血量都明显多于抽吸组[手术时间：141(120，190) min比90(76，116) min，Z＝-8.719，P<0.001；出血量：20(10，20) ml比10(5，20) ml，Z＝-6.076，P<0.001]，2组患者术后引流时间差异无统计学意义[5(5，6) d比5(5，6) d，Z＝0.111，P＝0.912]。(3)从2012年开始，开放组患者多于抽吸组，2种手术方式比例变化趋势比较，差异有统计学意义(χ²＝6.936，P＝0.008)。

虽然开放性切除术比微创抽吸术手术创伤更大、难度更高，但是其能最大限度地取出聚丙烯酰胺水凝胶，并清除其周围包膜和变性组织；对于注射聚丙烯酰胺水凝胶时间长，术前伴随症状较多的患者，更倾向于选择开放性切除术。

To compare two surgical methods for removal of polyacrylamide hydrogel.

We retrospectively analyzed the clinical data of 213 patients who underwent surgery to remove polyacrylamide hydrogel in their breasts in the Third People’s Hospital of Chengdu from June 2012 to December 2018. χ² test was used to compare concomitant symptoms (pain, nodes, redness and swelling, ulcer, nipple discharge and breast enlargement) between 61 patients receiving minimally invasive aspiration (aspiration group) and 152 patients receiving open surgery to remove hydrogel and capsule via an areola incision (open surgery group). The age and the surgical parameters(the operation time, bleeding volume and postoperative drainage time) was expressed as M (P₂₅, P₇₅) because of skewed distribution. The rank sum test was used to compare the age and the surgical parameters between two groups. The χ² test for trend was used to compare the proportion of patients receiving two different surgeries year by year.

(1) The aspiration group had a lower incidence of preoperative pain and more patients without concomitant symptoms compared with open surgery group [29.5%(18/61)vs 50.7%(77/152), χ²=7.881, P=0.005; 52.5%(32/61) vs 29.6%(45/152), χ²=9.850, P=0.002]. There was no significant difference in the incidence of other concomitant symptoms (nodes, redness and swelling, ulcer, nipple discharge and breast enlargement) between two groups (χ²=3.323, 3.349, 2.869, 0.000, 0.020; P all>0.050). (2) The operation time and bleeding volume in open surgery group were significantly higher than those in aspiration group [141(120, 190) min vs 90(76, 116) min, Z=-8.719, P<0.001; 20(10, 20) ml vs 10(5, 20)ml, Z=-6.076, P<0.001]. There was no significant difference in postoperative drainage time between two groups [5(5, 6) d vs 5(5, 6) d, Z=0.111, P=0.912]. (3) Since 2012, more patients chose open surgery and the trend presented a significant difference between two groups (χ²=6.936, P=0.008).

Compared with minimally invasive aspiration, open surgery is more traumatic and difficult, but it can remove polyacrylamide hydrogel to the maximum and clear the residual capsule and degenerated tissues. Open surgery is preferred in patients with long-time polyacrylamide hydrogel breast augmentation and more concomitant symptoms.