腔镜下男性乳腺切除术的临床效果及经验总结：附17例报告

Clinical outcomes and experience of endoscopic mastectomy for gynecomastia: a report of 17 cases

摘要:

背景与目的 男性乳腺发育症是一种常见的良性乳腺疾病，可导致乳房外形异常和心理负担加重。腔镜下乳腺切除因切口隐蔽、视野清晰及美容效果佳，逐渐成为重要术式。本研究旨在总结腔镜下男性乳腺切除的手术要点、并发症发生情况及随访疗效。方法 回顾性分析2023年5月—2025年2月行腔镜下男性乳腺切除的17例患者的一般资料、手术方式、术后并发症及满意度。记录手术时间、术中出血量、术后前3 d引流量、拔管时间及住院时间；依据BODY-Q胸部模块评价术后满意度；随访3~24个月。结果 全部手术顺利完成，无中转及严重并发症。单侧手术时间（69.88±14.23）min，术中出血量（22.38±10.69）mL。术后1、2、3 d单侧引流量中位数分别为28.00（14.00~57.50）mL、17.50（15.00~24.75）mL、14.00（7.75~24.75）mL。拔管时间（6.50±1.66）d，术后住院时间5~10 d。病理均为良性（15例男性乳腺发育症，2例纤维脂肪增生）。术后并发症包括皮肤青紫3例（17.6%）、皮下血肿1例（5.9%），均自行好转或经处理痊愈。无乳头凹陷、皮瓣坏死、感觉障碍或双侧不对称。随访中无残余腺体及复发。所有患者满意度评分均>3，美容效果显著。结论 腔镜下男性乳腺切除术安全、微创、并发症发生少，切口隐蔽且美观度高，患者满意度良好，是值得推广的手术方式。

Abstract:

Background and Aims Gynecomastia is a common benign breast condition in males that may cause abnormal breast contour and psychological distress. Endoscopic subcutaneous mastectomy has gradually become an important surgical option due to its concealed incision, clear operative field, and superior cosmetic outcomes. This study aimed to summarize the key operative techniques, postoperative complications, and follow-up outcomes of endoscopic mastectomy for gynecomastia.Methods A retrospective analysis was conducted on 17 patients who underwent endoscopic mastectomy for gynecomastia between May 2023 and February 2025. General information, surgical procedures, postoperative complications, and satisfaction results were reviewed. Operative time, intraoperative blood loss, drainage volume during the first three postoperative days, time to drain removal, and length of hospitalization were recorded. Postoperative satisfaction was evaluated using the BODY-Q chest module. Follow-up lasted 3-24 months.Results All procedures were successfully completed without conversion or major complications. The mean unilateral operative time was (69.88±14.23) min, and intraoperative blood loss was (22.38±10.69) mL. The median drainage volumes on postoperative days 1, 2, and 3 were 28.00 (14.00-57.50) mL, 17.50 (15.00-24.75) mL, and 14.00 (7.75-24.75) mL, respectively. The mean time to drain removal was (6.50±1.66) d, and postoperative hospital stay was 5-10 d. All pathological results were benign (15 cases of gynecomastia and 2 cases of fibrofatty hyperplasia). Postoperative complications included skin bruising in 3 patients (17.6%) and subcutaneous hematoma in 1 patient (5.9%); all resolved spontaneously or with simple treatment. No nipple retraction, skin-flap necrosis, sensory disturbance, or breast asymmetry was observed. No glandular residue or recurrence occurred during follow-up. All patients achieved satisfaction scores above 3, indicating excellent cosmetic outcomes.Conclusion Endoscopic mastectomy for gynecomastia is safe, minimally invasive, and associated with a low rate of complications. Its concealed incision and favorable aesthetic results yield high patient satisfaction, making it a technique worthy of wider clinical adoption.