Objective To evaluate the effect of endoscopic surgery combined with intraoperative color Doppler ultrasound on removing the injected breast augmentation agents and share our experiences. Methods Sixteen female who accepted the bilateral removal of injected breast augmentation agents through endoscopic surgery combined with intraoperative color Doppler ultrasound between 2008 and 2010 were enrolled in this study. The results, techniques, and advantages of management were analyzed retrospectively. Results One incision was made in 18 breasts, 2 in 4 breasts, 3 in 10 breasts. The length of incision was 0.5 to 1 cm. The mean operative time was 128.70 min per person. The average amount of bleeding was 52.67 ml per person. Complications such as postoperative bleeding, infection, poor drainage, or breast augmentation agents remain did not happened in all cases. No case was turned into normal operation. Female who accepted this operation were all satisfied with the appearance of incisions. During 1-3 months follow up, neither clinically palpable mass nor sensory disturbance in nipple or areola of breast was observed. Color Doppler ultrasound or magnetic resonance showed 16 cases had been cleared free of breast augmentation agents. Conclusion With the advantages of beauty, safe, minimal invasion, and partial resection of lesions at the same time, endoscopic surgery combined with intraoperative color Doppler ultrasound was an effective approach in the removal of injected breast augmentation agents.
【摘要】 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（polyacrylamide hydrogel，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0.5～1.0 cm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2～3 cm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 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