时间:2007-06-03 17:44 来源:当代医学 作者:林迎春
浙江省永康市中医院外科 林迎春
【摘要】 目的:阐明改良垂直下蒂瓣法巨乳缩小成形术中的优点。方法:有几何数学原理进行受区乳晕和新乳晕的设计,改进了传统的垂直
下蒂瓣法,应用于临床36例。结果:本组36例中36例71侧均圆满完成,无乳头乳晕血运障碍,外形效果满意,乳头勃起满意;1例1侧乳头乳晕部分坏死,经换药后痊愈。术后随访0.5~5年,效果满意。结论:改良垂直下蒂瓣法是目前巨乳缩小成形术中一种科学而切实可行的方法。
【关键词】 改良垂直下蒂瓣法 巨乳缩小成形术 巨乳症
Clinic Application of Modified Inferior Pedicle Reduction Mammaplasty .
【Abstract】 Objective :To elucidate the benefits of the improved vertical inferior pedicle technique for reduction mammaplasty . Methods :Using the principles of geometry in the desing of areola receptin sites and new areolas to improve traditional vertical inferior pedicle reduction mammaplasty . Clinical application on thirty-six patients using the improved technique . Results :Thirty-six patients (71 breasts ) reported being “ very satisfied ” with the outcome , no mammilla-areolar necrosis , aesthetic effects and erection of mammillae satisfactory . In one patient parital mammilla-areolar necrosis occurred in one breast , which was brought to full recovery after achagen in medicine . Follow-ups 0.5~5 years after surgery showed that results were still satisfactory . Conclusion :This study demonstrates modified inferior pedicle is a feasible and ideal standard technique for reduction mammaplasty .
【Key words】 Improved vertical inferior pedicle technique ; Reduction mammaplasty ;Macromastia .
垂直下蒂瓣法由Robbins在1977年设计应用于临床[1]。1998年起我们应用并改进了该术式,用几何数学原理进行乳晕设计,称改良垂直下蒂瓣法,取得了满意的手术效果。现将36例报告如下。
1、 临床资料
1.1 一般资料:本组36例患者,年龄18~48岁,乳房体积(侧)590~1350ml,术中切除乳房纠织量220~800g;下蒂瓣蒂宽7~12cm;新乳头定位17~19cm;新乳晕直径40mm24例48侧,45mm12例24侧:受区乳晕直径54mm24例48侧,60mm12例24侧:受区圆心角90°29例58侧,100°7例14例。
1.2 手术要点
1.2.1 按乔群法测量计算出术前乳房体积及术后理想乳房之体积,两者之差为所需切除之体积 。
1.2.2 新乳头定点(X点) ⑴以胸骨切迹中点为圆心,身高的(12%~12.5%)±1㎝为半径,画弧与乳房中线的交点为X点;⑵双侧上臂中点的连线与乳房中线的交汇点,为X点;⑶乳房下皱襞中点到乳房表面乳房中线的体表投影点为X点。
1.2.3 杨氏新乳晕及受区乳晕的设计方法⑴设新乳晕半径为R1 ,直径为D1 ,则其周径为C1 =πD1 =2πR1 ;⑵设受区乳晕直径为D2 ,半径为R2 ,圆心角∠BAC=θ,小BC弧长为l,大BC弧长为L,则:1=(πR2θ)÷180 ,L= 2πR2-(πR2θ)÷180 ;⑶由于新乳晕周径(C1)与受区乳晕大BC弧长(L)相等,则πD1(C1)= 2πR2-(πR2θ)÷180即R2= D1÷(2-θ÷180),D2 =2 R2 ;⑷下表为新乳晕直径(D1)在不同值,受区乳晕圆心角(θ)在不同角度时,受区乳晕直径(D2)的大小(单位:毫米)。
R2 / D2 80° 90° 100° 110° 120° D1 |
30 19/38 20/40 21/42 22/44 23/46 40 26/52 27/54 28/56 29/58 30/60 45 29/58 30/60 31/62 32/64 34/68 50 32/64 33/66 35/70 36/72 38/76 |