中国普外基础与临床杂志

中国普外基础与临床杂志

优化手术操作程序的全腔镜皮下腺体切除术治疗男性乳腺发育症的临床研究

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目的 探讨在全腔镜皮下腺体切除术治疗男性乳腺发育症中优化手术操作程序对其手术效果的影响。 方法 根据纳入和排除标准,回顾性搜集了 2014 年 1 月至 2017 年 3 月期间在成都市第三人民医院行全腔镜男性乳腺皮下腺体切除治疗的男性乳腺发育症患者 217 例。根据是否优化步骤(以 2015 年 4 月 1 日为界)分为手术操作程序优化组和未优化组,2015 年 4 月 1 日以前的患者归入未优化组,以后的患者归入优化组。利用倾向评分匹配的方法,根据年龄、体质量指数及乳房大小行 1∶1 配对,比较 2 组患者的手术时间、术后住院时间、治疗费用及患者自评的美容效果。 结果 共配对 47 对,匹配后 2 组患者一般临床病例资料比较差异均无统计学意义(P>0.05)。优化组患者的手术时间、术住院时间及住院费用均明显低于未优化组,分别为(139.9±37.18) min 比(175.2±46.99) min(P=0.002)、(7.13±1.46) d 比(8.47±2.71) d(P=0.021)及(11 426.80±1 861.19)元比(12 315.75±1 306.64)元(P=0.036),优化组患者术后 1 周时的外观效果满意度评分明显高于未优化组,为(7.33±1.16)分比(5.97±1.16)分(P<0.001)。 结论 在全腔镜皮下腺体切除术治疗男性乳腺发育症中优化手术操作程序可以缩短手术时间、减少治疗费用及提高患者的满意度。

Objective To investigate effect of optimizing operation procedure (OOP) on surgical outcomes of complete endoscopic subcutaneous mastectomy (CESM) in treatment of gynecomastia. Methods A total of 217 patients with gynecomastia underwent CESM from January 2014 to March 2017 in the Third People's Hospital of Chengdu were collected according to the criteria for inclusion and exclusion, further, based on a propensity score-matching model, a total of 94 patients were evenly assigned into OOP group (April 2015 later) and non-OOP group (before April 2015). The CESM with or without OOP was performed in the OOP group or the non-OOP group, respectively. The operation time, postoperative length of stay, treatment expenses, and favorable cosmetic effect were compared between the OOP group and the non-OOP group. Results The differences in the general clinical data in both groups was not statistically significant (P>0.05). The operation time (min) was more shorter (139.9±37.18versus 175.2±46.99, P<0.05), the postoperative length of stay (d) was shorter too (7.13±1.46versus 8.47±2.71, P<0.05), and the treatment expenses (yuan) were more less (11 426.80±1 861.19versus 12 315.75±1 306.64, P<0.05) in the OOP group as compared with the non-OOP group. Meanwhile the favorable cosmetic effect of the self-evaluation score in the OOP group was significantly higher than that in the non-OOP group (7.33±1.16versus 5.97±1.16, P<0.05). Conclusion This study demonstrates that using optimizing standard CESM could shorten operation time, reduce treatment expenses, and improve satisfaction of patients.

关键词: 乳腔镜; 男性乳腺发育症; 乳房切除术; 优化手术流程

Key words: endoscopic; gynecomastia; mastectomy; optimizing operation procedure

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