目的 探討腔鏡結合術中彩超取注射式隆乳劑的可行性，總結手術經驗并探討應用價值。方法 2008～2010年期間我院采用腔鏡結合術中彩超的方法對16例雙側乳房接受注射聚丙烯酰胺隆乳者進行隆乳劑取出手術,回顧性分析其臨床資料。結果 經1個切口治療的乳房18個，2個的4個，3個的10個； 切口長0.5～1 cm。手術平均時間128.70 min/例,術中出血量平均52.67 ml/例。無一例中轉開刀手術，無一例出現術后出血、感染、引流不暢、隆乳劑殘留等并發癥,接受取出者均對切口感到滿意。術后1～3個月復診，乳房內無臨床可觸及的包塊，無一例出現乳頭、乳暈的感覺障礙； 16例行彩超或磁共振復查均無隆乳劑殘留。結論 腔鏡結合術中彩超取注射式隆乳劑是目前理想的隆乳劑取出方法，它具有美容、微創、安全和可以同期切除部分病變的優勢，值得臨床進一步探索和應用。
【摘要】 目的 探討腔鏡技術通過不同切口方式取出聚丙烯酰胺水凝膠（polyacrylamide hydrogel，PAHG）注射隆乳劑手術的臨床效果，以取得最大隆乳劑清除率。 方法 2008年1月－2011年3月雙側乳房PAHG注射隆乳術后并發癥患者35例，將腔鏡技術分別應用于經乳房外側切口和經乳暈切口PAHG注射隆乳劑取出手術。經乳房外側切口治療21例，于乳房外側緣隱匿部位分別選做長約0.5～1.0 cm的切口1～3個，穿刺吸刮PAHG后在腔鏡結合彩色多普勒超聲徹底清除PAHG；經乳暈切口14例，沿乳暈下緣做2～3 cm弧形切口，吸刮PAHG后，以長頭拉鉤挑起囊腔，在內鏡輔助下通過刮除或吸刮交替清除殘留PAHG，彩色多普勒超聲掃查確認未見PAHG回聲團塊。總結比較兩種切口中應用腔鏡技術的臨床經驗。 結果 所有患者均順利完成手術，達到最大限度取出隆乳劑的目的。無中轉改變手術方式，無術后出血、感染、引流不暢、隆乳劑殘留等并發癥；患者均對切口感到滿意。經乳暈切口組中6例取出隆乳劑后同期置入硅膠囊假體，該組有1例出現乳頭乳暈的感覺敏感度降低。 結論 腔鏡輔助下經乳腺外側切口和經乳暈切口都能夠安全、有效并最大限度地取出PAHG注射隆乳劑，具有美容、微創和可以同期切除病變組織的優勢，經乳暈切口手術方便同期硅膠囊假體的置入。腔鏡技術值得在PAHG注射隆乳劑取出術中進一步推廣應用。【Abstract】 Objective To explore the clinical outcome of endoscopic techniques in the removal of injected breast-augmentation polyacrylamide hydrogel (PAHG) through different incision methods in order to achieve a maximal PAHG removal rate. Methods From January 2008 to March 2011, 35 patients with postoperative complications after bilateral breasts PAHG injection were diagnosed and treated in our hospital. Endoscopic techniques were applied to remove PAHG through the lateral incision of breast or the mammary areolar incision. Twenty-one patients were treated with lateral incision in which 1-3 incisions with a length of 0.5-1.0 cm were selected at hidden lateral sites of breasts, and PAHG was removed by vacuum sucking followed by endoscopic technique with Doppler color ultrasound to achieve a complete removal. Fourteen patients were treated with mammary areolar incision where an arc-shaped 2-3 cm incision was made under the lower margin of mammary areola. After vacuum sucking of PAHG, long head hook was used to lift the cyst and endoscopic technique was used along or alternate with sucking to remove the remaining PAHG. Doppler color ultrasound scanned to confirm the absence of PAHG mass. The clinical experiences of these two endoscopic techniques were compared and summarized. Results All patients successfully underwent the surgery and achieved a goal of maximal removal of PAHG. None of the patients had to switch surgery approach, and no such complications as post-surgery bleeding, infection, obstructed drainage or PAHG remaining occurred. Patients were all satisfied with the appearance of incisions. Six patients were given silicone prosthesis implantation after removing PANG through the areola incision, among whom one patient showed a decreasing sensitivity in mammary nipple and areola. Conclusions Both endoscopic techniques through the lateral incision of breast and the mammary areolar incision are safe, and can achieve maximal removal of PAHG. They both have the advantages of beautifying, minimal invasiveness and simultaneous removal of pathologic tissues. The mammary areolar incision facilitates implantation of silicone prosthesis simultaneously. The endoscopic techniques are worthy to be further applied into removal of PAHG