男性乳房发育症手术不同入路方式的比较(1)
[摘要] 目的 观察两种不同手术入路治疗男性乳房发育症(gynecomastia，GYN)的临床疗效，总结治疗经验。 方法 将43例GYN 患者(均为单侧)随机分为环乳晕切口组(23例)、胸肌旁切口组(20例)，均实施乳房肿块全部切除术，记录两组患者一般资料(年龄、肿块厚度、肿块长径)及观察指标(手术时间、切口长度、皮瓣缺血、坏死、术后感染、乳头感觉异常和乳房外形满意评分)情况。 结果 术前两组患者在年龄、肿块厚度、肿块长径比较无差异(P>0.05)；术后两组患者均无术后感染、无皮肤及乳头乳晕坏死的发生；在手术时间、切口长度方面无统计学差异(P>0.05)，但在皮瓣缺血、乳头感觉异常和乳房外形满意评分方面的差异具有统计学意义(P<0.05)。 结论 采用胸肌旁切口入路治疗GYN，能减少皮瓣缺血、坏死和乳头感觉异常的发生，患者对术后乳房外形满意度高，且切口较隐蔽，美容效果好。
[关键词] 男性乳房发育症；手术治疗；胸肌旁切口；环乳晕切口
[中图分类号] R655.8 [文献标识码] B [文章编号] 1673-9701(2018)07-0043-03
[Abstract] Objective To observe the clinical efficacy of two different surgical approaches in the treatment of gynecomastia (Gynecomastia， GYN) and to summarize the experience of treatment. Methods 43 patients with GYN (all for unilateral) were randomly divided into peri-pectoral muscle incision group(n=23) and surround-mammary areola incision group (n=20). All patients underwent total resection of the breast lumps. The general data (age， lump thickness， longest diameter of lumps) and observation indexes(operation time， incision length， flap ischemia， necrosis， postoperative infection， nipple sensory abnormality and breast shape satisfactory score) were recorded. Results There were no differences in age， mass thickness and longest diameter between the two groups before operation(P>0.05). There was no postoperative infection， skin and nipple areola necrosis in the two groups after surgery. There was no significant difference in operative time， incision length(P>0.05). But there were significant differences in flap ischemia， nipple sensory abnormality and breast shape score(P<0.05). Conclusion The treatment of GYN by the peri-pectoral muscle incision can reduce the occurrence of flap ischemia， necrosis and nipple sensory abnormalities. The patients are satisfied with the postoperative breast shape， the incision is more concealed and the cosmetic effect is better.
[Key words] Gynecomastia； Surgical treatment； Peri-pectoral muscle incision； Surround-mammary areola incision
男性乳房發育症(gynecomastia，GYN)大多是生理性或体内激素不平衡所导致，患者多表现有一侧或两侧乳房的肿块，乳晕下可触及盘状块物，边界欠清，可伴有疼痛或触痛，病理结果显示乳管增生和囊状扩大，伴有脂肪及纤维组织，手术治疗多采用环乳晕切口[1]；但由于男性乳头乳晕较小，乳晕最大周长一般小于5 cm，环乳晕切口(1/2周长)较小，手术操作不便，且易损伤乳头乳晕的血供和神经支配，造成皮瓣、乳头的缺血坏死，引起术后乳头的感觉异常，而瘢痕亦不隐蔽；术者在手术时采用胸肌旁切口，现报道如下。
1 资料与方法
1.1 一般资料
选取2013年6月～2017年3月在我院行手术治疗的43例GYN 患者(均为单侧)，按随机数字表随机并结合患者意愿调整后分为环乳晕切口组(23例)、胸肌旁切口组(20例)，两组患者一般临床资料包括年龄、乳腺肿块厚度、肿块长径进行统计学比较无显著性差异(P>0.05)，具有可比性。见表1。
1.2 纳入标准
(1)满足以下GYN的诊断标准[2]：患者常感患乳疼痛不适；体查肿块边界清，活动良好，多位于乳晕下，与皮肤无粘连，可伴有触痛；钼靶X线摄片、彩色多普勒超声、病理学检查提示男性乳腺发育症；排除男性乳房部位的良恶性肿瘤、肝脏疾病及药物因素引起的乳房肿块。(2)患者大于18周岁，发现乳腺肿块6个月以上且强烈要求手术，签署参加研究知情同意书者。(3)患者无严重心、肝、肾及血液和生殖系统疾病，能耐受本次手术，无合并恶性肿瘤病史者。, 百拇医药(张洪伟 曾畅 秦岗 何锋辉 徐楠 田旭珊)
[关键词] 男性乳房发育症；手术治疗；胸肌旁切口；环乳晕切口
[中图分类号] R655.8 [文献标识码] B [文章编号] 1673-9701(2018)07-0043-03
[Abstract] Objective To observe the clinical efficacy of two different surgical approaches in the treatment of gynecomastia (Gynecomastia， GYN) and to summarize the experience of treatment. Methods 43 patients with GYN (all for unilateral) were randomly divided into peri-pectoral muscle incision group(n=23) and surround-mammary areola incision group (n=20). All patients underwent total resection of the breast lumps. The general data (age， lump thickness， longest diameter of lumps) and observation indexes(operation time， incision length， flap ischemia， necrosis， postoperative infection， nipple sensory abnormality and breast shape satisfactory score) were recorded. Results There were no differences in age， mass thickness and longest diameter between the two groups before operation(P>0.05). There was no postoperative infection， skin and nipple areola necrosis in the two groups after surgery. There was no significant difference in operative time， incision length(P>0.05). But there were significant differences in flap ischemia， nipple sensory abnormality and breast shape score(P<0.05). Conclusion The treatment of GYN by the peri-pectoral muscle incision can reduce the occurrence of flap ischemia， necrosis and nipple sensory abnormalities. The patients are satisfied with the postoperative breast shape， the incision is more concealed and the cosmetic effect is better.
[Key words] Gynecomastia； Surgical treatment； Peri-pectoral muscle incision； Surround-mammary areola incision
男性乳房發育症(gynecomastia，GYN)大多是生理性或体内激素不平衡所导致，患者多表现有一侧或两侧乳房的肿块，乳晕下可触及盘状块物，边界欠清，可伴有疼痛或触痛，病理结果显示乳管增生和囊状扩大，伴有脂肪及纤维组织，手术治疗多采用环乳晕切口[1]；但由于男性乳头乳晕较小，乳晕最大周长一般小于5 cm，环乳晕切口(1/2周长)较小，手术操作不便，且易损伤乳头乳晕的血供和神经支配，造成皮瓣、乳头的缺血坏死，引起术后乳头的感觉异常，而瘢痕亦不隐蔽；术者在手术时采用胸肌旁切口，现报道如下。
1 资料与方法
1.1 一般资料
选取2013年6月～2017年3月在我院行手术治疗的43例GYN 患者(均为单侧)，按随机数字表随机并结合患者意愿调整后分为环乳晕切口组(23例)、胸肌旁切口组(20例)，两组患者一般临床资料包括年龄、乳腺肿块厚度、肿块长径进行统计学比较无显著性差异(P>0.05)，具有可比性。见表1。
1.2 纳入标准
(1)满足以下GYN的诊断标准[2]：患者常感患乳疼痛不适；体查肿块边界清，活动良好，多位于乳晕下，与皮肤无粘连，可伴有触痛；钼靶X线摄片、彩色多普勒超声、病理学检查提示男性乳腺发育症；排除男性乳房部位的良恶性肿瘤、肝脏疾病及药物因素引起的乳房肿块。(2)患者大于18周岁，发现乳腺肿块6个月以上且强烈要求手术，签署参加研究知情同意书者。(3)患者无严重心、肝、肾及血液和生殖系统疾病，能耐受本次手术，无合并恶性肿瘤病史者。, 百拇医药(张洪伟 曾畅 秦岗 何锋辉 徐楠 田旭珊)