【作者】 李杨；

【导师】 续哲莉；

【作者基本信息】 吉林大学 ， 临床医学， 2012， 硕士

【摘要】 背景与目的：进入二十一世纪，人类乳房疾病流行趋势及特征依然涵盖了乳腺癌是导致女性因病致死的主要因素；同时明确人类乳房是多种疾病的靶心，而多类型乳房病变及多位点病体同时俱在单侧乳房的临床特征已经成为乳房疾病高发趋势的又一突显特征。因乳腺癌而失去生命或乳房的女性；因治疗疾病而乳房畸形的女性已经成为全人类拯救乳房、呵护女性健康的关爱群体。乳房应用美学是人体乳房美学与外科医学临床高端技术的严谨结合。术前根据病者自身的解剖特点及病体的多位点分布特点，通过对100例患有乳房多位点、多类型病变的病例，遵循腋下小切口微创化手术原则，一次性完成腋下副乳腺切除、乳房多位点良性肿块型病变切除、乳房下垂悬吊矫正术，进行回顾性分析，探讨在完成预定手术实施范围的前提下，将局部手术创伤降低至最低点、乳房视觉美学效果及乳房触觉美学效果保全在最理想的程度。临床研究：选择2006年12月—2012年3月吉林大学白求恩第三医院乳腺外科患有乳房多位点、多类型病变的病例，即：腋下副乳腺，乳房多发性良性肿块型病变、乳房下垂同时并存的100例病例中，实施腋下小切口、微创化一次性完成腋下副乳腺切除、乳房多位点良性肿块型病变切除、乳房下垂悬吊矫正术的典型病例资料，对其病变特点、手术操作流程、手术操作技巧及手术中注意事项进行分析论证。术前病例筛选依照乳房应用美学的数据计算原则，在完成预定手术实施范围的前提下，将局部手术创伤降低至最低点、乳房视觉美学效果及乳房触觉美学效果保全在最理想的程度。方法与结果：1．选择腋下副乳腺病例100例（59人次），其中双侧腋下副乳腺82例（41人次），单侧副乳腺18例；完全性副乳腺24例，不完全性副乳腺55例；副乳腺积乳囊肿6例，副乳腺汗腺囊肿9例，副乳腺囊腺瘤1例，副乳腺脂肪瘤4例；全部手术切除。2．乳房多类型多位点乳房肿块100例（212枚病体）（62人次），其中双侧乳房病变76例（135枚病体）（38人次），单侧乳房病变24例（77枚病体）；多发性乳腺纤维腺瘤18例（52枚病体）（12人次），乳腺陈旧性积乳囊肿66例（109枚病体）（40人次），混合型囊腺瘤3例（19枚病体）（3人次），外伤后陈旧性血肿1例（1枚病体）（1人次），乳腺囊肿12例（31枚病体）（6人次）。全部手术切除。3.不同类型乳房下垂100例（50人次），其中真性乳房下垂38例（中度22例）(重度16例)；腺型中度乳房下垂28例，乳房实质分布不均34例；选择单纯乳房下垂（腺体无肥大）施悬吊固定矫正术52例；术前乳房下垂（术中乳房肿物切除后腺体缩小)，施乳头悬吊移位矫正14例；选择术前乳房下垂（术中乳房肿物切除后），乳腺腺体折叠缝合矫正14例；选择腋窝处楔形切除乳腺腺体及乳房皮肤且已经达到矫正效果20例。4.选择麻醉、手术切口、切口愈合情况、术后并发症：100例手术均选择全麻；切口选择腋下弧形切口4-6cm长；筛选100例标准手术病例切口均一期愈合，切口及腋下无并发症发生。结论：微创乳腺外科手术的乳房应用美学理念必须遵从乳房疾病的发展规律，既选择最小的美学切口微创化切除病体，且将乳腺组织的破坏程度降至最低，手术疤痕减至最小。鉴于乳房对于女性的特殊性，诸多实施乳腺外科手术的病者，希望得到的不仅仅是简单的治愈疾病，而恢复病乳均衡、匀称的健康之美，实现女性美的和谐、统一才是病者们追求的目标。1、拓展性：选择腋下小切口、一次性完成乳房多位点、多类型手术术式的拓展性：是将大切口、多切口转变为单一微创化小切口；一次性完成多位点、多类型手术；缩短病者的手术周期，提早术后康复期。2、可行性：术前病例筛选依照乳房应用美学的数据计算原则，在完成预定手术实施范围的前提下，将局部手术创伤降低至最低点、乳房视觉美学效果及乳房触觉美学效果保全在最理想的程度。3、选择手术适应症略显苛刻，该手术术式的本质为微创化的整合手术，整合手术不能有一点勉强的因素存在，因此手术存在着一定比例的失败几率。4、手术采用的是超声刀切割方式，无需缝合的优势是降低缝线异物导致的异物性疤痕的再生性乳房肿块的发生。5、超声刀止血效果好，术后发生血肿的机遇少，降低术后感染的保险系数高。6、腋下小切口隐蔽，上肢自然下垂即可遮挡，且上肢上抬时亦不暴露切口，且切口张力小利于愈合。完美的手术效果，充分证明了拓展性微创化手术对乳房多位点、多类型病变一次性小切口完成手术的可行性，术后可保持腋窝及乳房的原有曲线美，保持了其功能性，且切口瘢痕隐蔽。有推广、实用价值。更多还原

【Abstract】 Background and Purpose:The twenty-first century, the trends and characteristics of human breast disease stillcovers the breast cancer cause illness to death of women; clear the human breast is the bull’seye of many diseases, and multiple types of breast lesions and the number of points ill at thesame time both in the clinical features of unilateral breast has become another highlightfeatures of breast disease of high incidence trends. Lost their lives due to breast cancer orbreast female; women have become the treatment of disease and breast deformity humanityto save the breast, care, women’s health care groups. The aesthetics of the breast applicationof rigorous combination of high-end technology of human breast aesthetics and surgicalclinical. According to the patient’s own anatomical characteristics and ill-locus distributionof preoperative cases by100cases with breast multilocus, multi-type lesions, follow thearmpit minimally invasive surgical principles, and in one armpit Vice-mastectomy breastmultilocus benign tumor lesion, sagging breasts suspension corrective surgery, wereretrospectively analyzed to explore the scope to complete the scheduled surgery under thepremise of local surgical trauma is reduced to the lowest point, breast visual aesthetic effectand breast tactile aesthetic effect preservation of the degree of the ideal.Clinical study:Choose breast surgery in December2006March2012the third Bethune hospital of JilinUniversity suffering from breast multilocus cases of multiple types of lesions, that is, the:armpit vice breast, breast, multiple benign tumor lesions, sagging breasts side by side of the100cases, the implementation of the axillary incision, minimally invasive in one armpit vicebreast removal, breast multilocus benign tumor lesion, sagging breasts suspended thesurgical correction of typical clinical data, lesion characteristics, surgical operatingprocedures, operative techniques and surgical Note analysis and appraisal.Methods and Results:1.Select a the armpit vice breast cases of100cases (59people), including bilateralarmpit vice breast in82cases (41people)18cases of unilateral vice breast;24cases ofcomplete sub breast, not vice breast55cases; plot Vice breast milk cyst in6cases, Deputybreast sweat gland cyst in nine cases, vice breast cystadenoma, vice breast lipoma cases; all surgical resection.2.Breast multi-type multi-locus100cases of breast lumps (212ill)(62people), bilateralbreast disease Change of76cases (135ill)(38trips), unilateral breast lesions in24cases (77ill); multiple fibroadenoma of the breast18cases (52ill)(12people), breast old plot ofbreast cysts66cases (109ill)(40people), mixed cystadenoma in3cases (19ill)(3people),old hematoma after trauma one cases (ill1)(a person), breast cysts12cases (31ill)(6people). All surgical resection.3.Different types of breast sagging100cases (50people), including38cases of truesagging breasts (22cases of moderate)(Severe16cases); gland type moderate saggingbreasts of28cases of breast parenchyma, the uneven distribution of34cases; choose simplesagging breasts (glandular hypertrophy),suspension fixed correction was performed in52cases; preoperative sagging breasts (surgery in breast glands shrink the tumor resection), thenipple suspension shift correction of14cases; select preoperative sagging breasts (surgeryafter the removal of the breast tumor), mammary gland folded suture correction of14cases;choose a wedge resection of the mammary glands of the axilla. The body and breast skin andcorrection effect of20cases.4.Choose to anesthesia, surgical incision, wound healing, postoperative complications:100cases of surgical anesthesia; incision select armpit arc incision4-6cm long; screening of100cases of standard surgical cases incision healed, the incision and axillary nocomplications occurred.Conclusion:Aesthetic concepts of minimally invasive breast surgery, breast application mustcomply with the law of the development of breast disease, only minimal aesthetic minimallyinvasive removal of the ill, and will minimize the extent of the damage of the breast tissue tominimize scar. In view of the particularity of the breast for women, many of the breastsurgery patients, hoping to get just a simple cure disease, and restore a balanced,symmetrical disease milk health beauty, female beauty, harmony and unified is sick theirpursuit of the goal.1. Expandability: Select axillary incision and in one breast more than points, theexpansion of many types of surgical procedures: the large incision, multi-incision into asingle minimally invasive small incision; a one-time completion of a number of points, andmore type of surgery; shorten the cycle of the patient’s surgery and early postoperativerehabilitation period. 2. Viability: preoperative cases screened calculated in accordance with the data from thebreast application of aesthetic principles, to complete the scheduled surgery the scope of thepremise, local surgical trauma, reduced to the lowest point of the breasts visual aestheticeffect and breast tactile aesthetic effect preservation in the best level.3. Select a bit harsh surgical indications, the nature of surgical procedures for theintegration of minimally invasive surgery, integration of the surgery can not be a littlereluctantly factors, the surgery there is a certain percentage of probability of failure.4. Surgery is the harmonic scalpel cutting, without the advantage of the suture is theregeneration of the lower suture foreign body caused by foreign body scar breast lumpsoccur.5. The hemostatic effect of harmonic scalpel, less postoperative hematomaopportunities, high safety factor to reduce postoperative infection.6. Armpit small hidden incision, the upper limbs drooping naturally can be obscuredand upper limb elevation when not exposed to the incision, and incision tension conducive tohealing.Perfect surgical results, fully prove the feasibility of expansion of minimally invasivesurgery for breast multilocus, multi-disease one-time small incision surgery, patients canmaintain the original curve of the armpit and breast, and to maintain its functional, and thescar is hidden. Promotion of practical value.更多还原