Li Zifei, Mu Dali, Xu Boyang, Wang Chenglong, Cheng Hao, Li Shangshan, Qi Jun
Plastic Surgery Hospital, Chinese Academy of Medical Science, Peking Union Medical College, Beijing, China.
Plast Surg (Oakv). 2020 Feb;28(1):19-28. doi: 10.1177/2292550319880913. Epub 2019 Oct 24.
Endoscopic transaxillary augmentation mammaplasty breast augmentation offers several advantages over other augmentation methods. Nonetheless, this procedure is fraught with some problems, including greater surgical trauma due to the longer separation area. We hypothesized that cold separation of the interpectoral space could reduce surgical injury in comparison to the electrosurgical method. This study aimed to compare the outcomes of endoscopic-assisted transaxillary augmentation mammaplasty using cold separation versus electrosurgical separation of the interpectoral space.
In this prospective clinical trial, cold and electrosurgical separation of the interpectoral space were achieved using a separation shovel and monopolar electrotome, respectively. A total of 20 patients who visited our department in Beijing, China, for primary breast augmentation surgeries from October 1, 2017, and May 31, 2018, were included. The primary outcome was total postoperative drainage volume. The secondary outcomes were operative time, daily drainage volume, daily pain as assessed using the visual analogue scale (VAS), and reoperation rate. Quantitative data were compared using independent-samples test. Chi-square test was used to compare 2 classified indexes.
The total drainage volume was significantly lower in the cold separation group than in the electrosurgical separation group (170.45 ± 75.40 mL vs 281.05 ± 148.43 mL; = .005). The VAS score on the first postoperative day was significantly lower in the cold separation group than in the electrosurgical separation group (6.45 ± 1.93 vs 7.55 ± 1.43; = .048). Two (20%) reoperations owing to postoperative pain or implant stiffness were performed in the electrosurgical separation group.
Cold separation is more conducive to reducing drainage, relieving postoperative pain, and causing less damage than the electrosurgical method in endoscopic-assisted transaxillary dual-plane augmentation mammaplasty.
与其他隆胸方法相比，内镜经腋窝隆胸术具有诸多优势。尽管如此，该手术仍存在一些问题，包括由于分离区域较长导致手术创伤更大。我们推测，与电刀分离法相比，胸肌间间隙冷分离法可减少手术损伤。本研究旨在比较内镜辅助经腋窝隆胸术中采用胸肌间间隙冷分离法与电刀分离法的效果。
在这项前瞻性临床试验中，分别使用分离铲和单极电刀实现胸肌间间隙的冷分离和电刀分离。纳入了2017年10月1日至2018年5月31日期间在中国北京我院接受初次隆胸手术的20例患者。主要结局指标为术后总引流量。次要结局指标为手术时间、每日引流量、采用视觉模拟评分法（VAS）评估的每日疼痛程度以及再次手术率。定量数据采用独立样本t检验进行比较。卡方检验用于比较两项分类指标。
冷分离组的总引流量显著低于电刀分离组（170.45±75.40 ml对281.05±148.43 ml；P = 0.005）。冷分离组术后第1天的VAS评分显著低于电刀分离组（6.45±1.93对7.55±1.43；P = 0.048）。电刀分离组有2例（20%）因术后疼痛或植入物僵硬而进行了再次手术。
在内镜辅助经腋窝双平面隆胸术中，与电刀分离法相比，冷分离更有利于减少引流、减轻术后疼痛且损伤更小。
