双环法结合双“V”形乳腺切除法在乳房肥大整形术中的应用(1)
[摘要]目的：探讨双环法结合双“V”形乳腺切除法在乳房肥大整形术中的应用。方法：以乳头为中心设计两个环形切口，去除环形切口间的表皮，根据乳腺肥大情况在乳腺的上下垂直反向设计两个“V”形乳腺瓣，“V”形切除乳腺组织，在乳腺基底部适当分离后拉拢缝合乳腺。将去除表皮的真皮帽边缘与乳腺基底部筋膜缝合固定于胸大肌筋膜，留置负压引流管，沿外环内侧在真皮深层行连续荷包缝合，最后间断缝合切口皮肤。结果：所有受术者均未出现乳头、乳晕或乳房皮肤坏死、脂肪液化、血肿、感染、增生性瘢痕。术后随访3～18个月，切口瘢痕不明显，乳房外形对称，乳头、乳晕感觉良好。结论：双环法结合双“V”形乳腺切除法设计简单，易操作，瘢痕隐蔽，且能很好保留乳房感觉及泌乳功能，临床效果满意。
[关键词]双环法；双“V”形乳腺切除；乳房肥大
[中图分类号]R655.8 [文献标识码]A [文章编号]1008-6455(2014)22-1861-04
Clinical application of round block technique combined with two"V"shaped resection in breast hypertrophy
GAN Xue-wen，SHI Zhi-yan，ZHU Sai-ling，QIU Ji-jun，BO Hong-bing
(Department of Plastic and Aesthetic Center，the 181st Hospital of P.L.A.，Guilin 514002，Guangxi，China)
Abstract： Objective To explore the clinical application of round block technique combined with two"V"shaped resection in breast hypertrophy. Methods Two circular incisions were designed and the nipples were located in the center. The epidermis between the two circular was removed. Two "V"shaped breast flap should be designed upward and downward according to the situation of breast hypertrophy. The breast tissue was excised as "V"shape and the incisions were sutured. The edge of dermis cap and breast basal fascia were fixed to the pectoralis major fascia. Drainage tube was indwellinged. We sutured the deeper dermis continuously along the inner side of the outer circular and placed interrupted sutures in the incision of skin. Results All cases recoverd without necrosis， fat liquefaction， hematoma， infection or hypertrophic scar after 3 to 18 months follow-up. The scars were not obvious and the breasts were in symmetrical shape.The founction of the nerves of nipples and areola was normal. Conclusion It's clinically satisfied for the advantages of simplicity，indistinction of scar and the retainment of founction.
Key words： round block technique；two"V"shaped resection；breast hypertrophy
乳房是女性重要的第二性征，东方女性的乳房以丰满圆润、大小适度为美。乳房的过多发育使乳房的体积过度增大，形成乳房肥大症，俗称巨乳症，常常在不同程度上伴有乳房下垂，造成形体臃肿，使女性失去匀称的曲线美，严重者可引起肩背部畸形，令患者承受着难以启齿的肉体和心理上的压力，失去自信及参加社会生活的勇气[1]。乳房肥大整形手术的方法很多，但大多存在操作繁杂、乳腺损伤大、对乳腺功能有不同程度的影响、术后并发症多等情况。2000年3月至2013年10月，笔者采用双环法结合双“V”形乳腺切除法治疗轻、中度乳房肥大症患者56例共112侧，手术效果满意，术后恢复好，现报道如下。
1 临床资料
本组资料共56例112侧女性受术者，年龄22～45岁，平均34岁，已婚50例，未婚6例。根据高景恒编著的《整形外科学》巨乳分型法，14例受术者为双侧乳房轻度肥大，42例为双侧乳房中度肥大。受术者全身状况良好，既往无糖尿病、高血压、心脑血管疾病、传染病以及其他全身系统器质性疾病，排除心理疾病及对手术期望值过高者。术前行血、尿、大便三大常规、输血前四项、生化功能、凝血时间、心电图、双乳腺彩超等常规检查，均无手术禁忌症(图1A、1B)。
2 手术方法
2.1双环形切口设计：受术者取站立位，双上肢自然下垂，以乳头中心为圆心，以2.0～2.5cm 为半径画圆，此范围即为术后的乳晕范围，此画线为双环的内环。用手将下垂的乳房托起至水平位，于第4肋间水平距胸骨中线7～8cm处定点为内侧点，沿此水平线向外侧延伸定点外侧点，两点距乳头距离相等，从乳房下皱襞中点向乳头方向6～8cm处标记下端点，从第二肋间乳房上界中点向乳头方向6～8cm处标记为上端点，四点弧形连接便是双环切口的外环，外环可根据乳房肥大和下垂的具体情况，灵活设计呈圆形或椭圆形等形状(图2A、2B)。 (甘学文等)
[关键词]双环法；双“V”形乳腺切除；乳房肥大
[中图分类号]R655.8 [文献标识码]A [文章编号]1008-6455(2014)22-1861-04
Clinical application of round block technique combined with two"V"shaped resection in breast hypertrophy
GAN Xue-wen，SHI Zhi-yan，ZHU Sai-ling，QIU Ji-jun，BO Hong-bing
(Department of Plastic and Aesthetic Center，the 181st Hospital of P.L.A.，Guilin 514002，Guangxi，China)
Abstract： Objective To explore the clinical application of round block technique combined with two"V"shaped resection in breast hypertrophy. Methods Two circular incisions were designed and the nipples were located in the center. The epidermis between the two circular was removed. Two "V"shaped breast flap should be designed upward and downward according to the situation of breast hypertrophy. The breast tissue was excised as "V"shape and the incisions were sutured. The edge of dermis cap and breast basal fascia were fixed to the pectoralis major fascia. Drainage tube was indwellinged. We sutured the deeper dermis continuously along the inner side of the outer circular and placed interrupted sutures in the incision of skin. Results All cases recoverd without necrosis， fat liquefaction， hematoma， infection or hypertrophic scar after 3 to 18 months follow-up. The scars were not obvious and the breasts were in symmetrical shape.The founction of the nerves of nipples and areola was normal. Conclusion It's clinically satisfied for the advantages of simplicity，indistinction of scar and the retainment of founction.
Key words： round block technique；two"V"shaped resection；breast hypertrophy
乳房是女性重要的第二性征，东方女性的乳房以丰满圆润、大小适度为美。乳房的过多发育使乳房的体积过度增大，形成乳房肥大症，俗称巨乳症，常常在不同程度上伴有乳房下垂，造成形体臃肿，使女性失去匀称的曲线美，严重者可引起肩背部畸形，令患者承受着难以启齿的肉体和心理上的压力，失去自信及参加社会生活的勇气[1]。乳房肥大整形手术的方法很多，但大多存在操作繁杂、乳腺损伤大、对乳腺功能有不同程度的影响、术后并发症多等情况。2000年3月至2013年10月，笔者采用双环法结合双“V”形乳腺切除法治疗轻、中度乳房肥大症患者56例共112侧，手术效果满意，术后恢复好，现报道如下。
1 临床资料
本组资料共56例112侧女性受术者，年龄22～45岁，平均34岁，已婚50例，未婚6例。根据高景恒编著的《整形外科学》巨乳分型法，14例受术者为双侧乳房轻度肥大，42例为双侧乳房中度肥大。受术者全身状况良好，既往无糖尿病、高血压、心脑血管疾病、传染病以及其他全身系统器质性疾病，排除心理疾病及对手术期望值过高者。术前行血、尿、大便三大常规、输血前四项、生化功能、凝血时间、心电图、双乳腺彩超等常规检查，均无手术禁忌症(图1A、1B)。
2 手术方法
2.1双环形切口设计：受术者取站立位，双上肢自然下垂，以乳头中心为圆心，以2.0～2.5cm 为半径画圆，此范围即为术后的乳晕范围，此画线为双环的内环。用手将下垂的乳房托起至水平位，于第4肋间水平距胸骨中线7～8cm处定点为内侧点，沿此水平线向外侧延伸定点外侧点，两点距乳头距离相等，从乳房下皱襞中点向乳头方向6～8cm处标记下端点，从第二肋间乳房上界中点向乳头方向6～8cm处标记为上端点，四点弧形连接便是双环切口的外环，外环可根据乳房肥大和下垂的具体情况，灵活设计呈圆形或椭圆形等形状(图2A、2B)。 (甘学文等)