比较三孔全腔镜下皮下腺体切除术对中重度男性乳房发育症(GYN)的治疗效果。

按照纳入及排除标准，纳入2022年6月至2023年6月就诊于哈尔滨医科大学附属第一医院乳腺外科的全部GYN患者103例。其中，40例行开放手术(开放组)，63例行三孔全腔镜手术。为减少误差，采用随机数字表法从63例行三孔全腔镜手术的患者中抽取40例作为腔镜组进行分析。术后6个月时测评患者满意度。采用独立样本t检验比较2组的手术相关指标、患者满意度和术后腺体指标。

腔镜组切口长度明显低于开放组(t＝－3.538，P<0.001)，2组BMI、手术时间、出血量及引流管放置时间差异均无统计学意义(t＝0.943、－1.425、0.102、0.116，P均>0.050)。腔镜组患者满意度、医师满意度、第三方满意度、总体满意度、加权满意度腔镜组均高于开放组(t＝4.065、3.141、3.953、4.405、4.400，P均<0.050)。在术后并发症方面，腔镜组有1例早期出现部分乳头乳晕表皮缺血，开放组4例；腔镜组有1例术后手术区域感觉麻木，开放组3例；2组各有1例出现术后积液；腔镜组有2例术后局部皮下气肿。2组发育腺体半径、手术切除半径、术前凸度、术后凸度比较，差异均无统计学意义(t＝0.813、0.822、0.121、0.153, P均>0.050)。

三孔全腔镜手术治疗中重度GYN安全、有效、美观，患者满意度较高，是一种可行的外科治疗方式。

To compare the therapeutic effect of three-port total laparoscopic subcutaneous gland resection in the treatment of moderate to severe gynecomastia (GYN).

According to the inclusion and exclusion criteria, we enrolled a total of 103 GYN patients in the Department of Breast Surgery, the First Affiliated Hospital of Harbin Medical University from June 2022 to June 2023, including 40 patients who underwent open surgery (open surgery group) and 63 patients who underwent three-port total endoscopic surgery. In order to reduce the bias, 40 patients were selected from 63 patients receiving three-port total endoscopic surgery using random number table as endoscopic surgery group. Patient satisfaction was assessed 6 months after surgery. The independent-sample t test was used to compare surgery-related parameters, patient satisfaction and postoperative gland-related parameters between two groups.

The incision length in endoscopic surgery group was significantly lower than that in open surgery group (t=-3.538, P<0.001), but there were no significant differences in BMI, operation time, blood loss and drainage duration between two groups (t=0.943, -1.425, 0.102, 0.116, all P>0.050). The patient satisfaction, physician satisfaction, third-party satisfaction, overall satisfaction and weighted satisfaction in endoscopic surgery group were significantly higher than those in open surgery group (t=4.065, 3.141, 3.953, 4.405, 4.400, all P<0.050). In terms of postoperative complications, nipple-areolar epidermal ischemia occurred in one case of endoscopic surgery group and 4 cases of open surgery group; numbness in surgical area was observed in one case of endoscopic surgery group and 3 cases of open surgery group; postoperative effusion occurred in one patient of each group; 2 cases had localized subcutaneous emphysemain in endoscopic surgery group. There were no significant differences in preoperative gland radius, radius of surgical resection, preoperative convexity and postoperative convexity between two groups (t=0.813, 0.822, 0.121, 0.153, all P>0.050).

Three-port total endoscopic surgery is a feasible surgical treatment for moderate to severe GYN, with the advantages of safety, effectiveness, good aesthetic effect and high patient satisfaction.