腔镜技术联合彩色多普勒超声通过不同切口方式取出聚丙烯酰胺水凝胶注射隆乳剂

【】　目的　探讨腔镜技术通过不同切口方式取出聚丙烯酰胺水凝胶（polyacrylamidehydrogel，PAHG）注射隆乳剂手术的临床效果，以取得最大隆乳剂清除率。　方法　2008年1月－2011年3月双侧乳房PAHG注射隆乳术后并发症患者35例，将腔镜技术分别应用于经乳房外侧切口和经乳晕切口PAHG注射隆乳剂取出手术。经乳房外侧切口治疗21例，于乳房外侧缘隐匿部位分别选做长约0.5～1.0cm的切口1～3个，穿刺吸刮PAHG后在腔镜结合彩色多普勒超声彻底清除PAHG；经乳晕切口14例，沿乳晕下缘做2～3cm弧形切口，吸刮PAHG后，以长头拉钩挑起囊腔，在内镜辅助下通过刮除或吸刮交替清除残留PAHG，彩色多普勒超声扫查确认未见PAHG回声团块。总结比较两种切口中应用腔镜技术的临床经验。　结果　所有患者均顺利完成手术，达到最大限度取出隆乳剂的目的。无中转改变手术方式，无术后出血、感染、引流不畅、隆乳剂残留等并发症；患者均对切口感到满意。经乳晕切口组中6例取出隆乳剂后同期置入硅胶囊假体，该组有1例出现乳头乳晕的感觉敏感度降低。　结论　腔镜辅助下经乳腺外侧切口和经乳晕切口都能够安全、有效并最大限度地取出PAHG注射隆乳剂，具有美容、微创和可以同期切除病变组织的优势，经乳晕切口手术方便同期硅胶囊假体的置入。腔镜技术值得在PAHG注射隆乳剂取出术中进一步推广应用。【Abstract】　Objective　Toexploretheclinicaloutcomeofendoscopictechniquesintheremovalofinjectedbreast-augmentationpolyacrylamidehydrogel(PAHG)throughdifferentincisionmethodsinordertoachieveamaximalPAHGremovalrate.　Methods　FromJanuary2008toMarch2011,35patientswithpostoperativecomplicationsafterbilateralbreastsPAHGinjectionwerediagnosedandtreatedinourhospital.EndoscopictechniqueswereappliedtoremovePAHGthroughthelateralincisionofbreastorthemammaryareolarincision.Twenty-onepatientsweretreatedwithlateralincisioninwhich1-3incisionswithalengthof0.5-1.0cmwereselectedathiddenlateralsitesofbreasts,andPAHGwasremovedbyvacuumsuckingfollowedbyendoscopictechniquewithDopplercolorultrasoundtoachieveacompleteremoval.Fourteenpatientsweretreatedwithmammaryareolarincisionwhereanarc-shaped2-3cmincisionwasmadeunderthelowermarginofmammaryareola.AftervacuumsuckingofPAHG,longheadhookwasusedtoliftthecystandendoscopictechniquewasusedalongoralternatewithsuckingtoremovetheremainingPAHG.DopplercolorultrasoundscannedtoconfirmtheabsenceofPAHGmass.Theclinicalexperiencesofthesetwoendoscopictechniqueswerecomparedandsummarized.　Results　AllpatientssuccessfullyunderwentthesurgeryandachievedagoalofmaximalremovalofPAHG.Noneofthepatientshadtoswitchsurgeryapproach,andnosuchcomplicationsaspost-surgerybleeding,infection,obstructeddrainageorPAHGremainingoccurred.Patientswereallsatisfiedwiththeappearanceofincisions.SixpatientsweregivensiliconeprosthesisimplantationafterremovingPANGthroughtheareolaincision,amongwhomonepatientshowedadecreasingsensitivityinmammarynippleandareola.　Conclusions　Bothendoscopictechniquesthroughthelateralincisionofbreastandthemammaryareolarincisionaresafe,andcanachievemaximalremovalofPAHG.Theybothhavetheadvantagesofbeautifying,minimalinvasivenessandsimultaneousremovalofpathologictissues.Themammaryareolarincisionfacilitatesimplantationofsiliconeprosthesissimultaneously.TheendoscopictechniquesareworthytobefurtherappliedintoremovalofPAHG