外科理论与实践

外科理论与实践 >

2026 , Vol. 31 >Issue 03: 257 - 264

DOI: https://doi.org/10.16139/j.1007-9610.2026.03.12

论著

经腋窝单切口非溶脂逆序法腔镜皮下腺体切除术与传统开放手术治疗男性乳房发育症的临床对比研究

  • 冯玉 ,
  • 罗桂林 ,
  • 梁法清 ,
  • 张栋林 ,
  • 杜正贵
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  • 1 四川省第四人民医院 普通外科， 四川 成都 610016
    2 四川大学华西医院 a.普通外科， b.乳腺疾病中心， 四川 成都 610041
作者贡献/Authors’ contributions

冯玉负责病例资料的收集、数据分析和论文撰写；罗桂林负责数据分析；梁法清负责研究设计、数据分析；张栋林、杜正贵负责指导、审查和修订。所有作者均阅读并确认最终稿。

张栋林，E-mail: zoomail@126.com；
杜正贵，E-mail: docduzg@163.com

收稿日期: 2024-11-26

  网络出版日期: 2026-08-11

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Single axillary incision non-lipolysis reverse-sequence endoscopic nipple-sparing mastectomy in the management of gynecomastia: comparison with the traditional open surgery

  • FENG Yu ,
  • LUO Guilin ,
  • LIANG Faqing ,
  • ZHANG Donglin ,
  • DU Zhenggui
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  • 1 Department of General Surgery, the Fourth People’s Hospital of Sichuan Province, Sichuan Chengdu 610016, China
    2 a.Department of General Surgery, b.Breast Disease Research Center, West China Hospital, Sichuan University, Sichuan Chengdu 610041, China

Received date: 2024-11-26

  Online published: 2026-08-11

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摘要

目的：比较经腋窝单切口非溶脂逆序法腔镜皮下腺体切除与开放手术治疗男性乳房发育症(GYN)的外科学安全性及美容学效果。方法：回顾性分析2021年3月至2024年8月华西医院和四川省第四人民医院收治的51例GYN病人，其中，腔镜组39例，开放组12例。比较两组基本资料、手术相关资料、术后并发症发生及美容学效果。结果：两组的年龄、体质量指数（BMI）、乳房大小及手术时间差异均无统计学意义。两组术后总体并发症发生率分别为7.7%和8.3%，差异无统计学意义（P=1.000）。腔镜组单侧切除腺体较开放组更重（P=0.011）。在医师报道的美容学评估中，腔镜组在提高胸廓平整度及减少手术瘢痕上存在优势。病人报道的Body-Q量表中，腔镜组瘢痕评分较高（91.1±12.2比61.4±4.0；P<0.001），在胸部外形及乳头外形评估方面，两组差异无统计学意义。由于腔镜组无法切除多余皮肤，腔镜组在多余皮肤评分方面较低，但两组比较差异无统计学意义。结论：与传统开放术式相比，经腋窝单切口非溶脂逆序法腔镜皮下腺体切除手术的术后美容学效果好，手术时间术后并发症发生未增加，是GYN安全、有效的手术术式，值得临床推广。

关键词： 男性乳房发育症; 腔镜; 逆序法; 传统开放手术; 美学效果

本文引用格式

冯玉 , 罗桂林 , 梁法清 , 张栋林 , 杜正贵 . 经腋窝单切口非溶脂逆序法腔镜皮下腺体切除术与传统开放手术治疗男性乳房发育症的临床对比研究[J]. 外科理论与实践, 2026 , 31(03) : 257 -264 . DOI: 10.16139/j.1007-9610.2026.03.12

Abstract

Objective To compare the surgical safety and cosmetic outcomes of single axillary incision non-lipolysis reverse-sequence endoscopic nipple-sparing mastectomy and traditional open surgery in the treatment of gynecomastia (GYN). Methods A retrospective cohort study was performed on 51 GYN patients who underwent mastectomy at West China Hospital and the Fourth People's Hospital of Sichuan Province from March 2021 to August 2024. The cohort was divided into the endoscopic group (39 cases) and the open group (12 cases). Baseline characteristics, surgical-related data, postoperative complications and cosmetic outcomes of two groups were collected and analyzed. Results There were no significant differences in age, body mass index (BMI), breast size, and the mean operation time between the two groups. The overall complication rate was 7.7% in the endoscopic group and 8.3% in the open group, with no significant difference (P=1.000. The unilateral resected gland in the endoscopic group was heavier than that in the open group (P=0.011). In the cosmetic outcomes reported by doctors, the endoscopic group showed advantages in improving chest flatness and reducing scars. In the body-Q scale reported by patients, the endoscopic group reported higher scar scores than that of the open group (91.1 ± 12.2 vs. 61.4 ± 4.0; P<0.001). In terms of satisfaction with chest module and nipple, there was no significant difference between the two groups. Due to the inability of the endoscopic group to remove excess skin, the endoscopic group had a lower score in evaluation of appraisal of excess skin than that of open group, but with no significant difference. Conclusions Compared with the traditional open surgery, the single axillary incision non-lipolysis reverse-sequence endoscopic nipple-sparing mastectomy has better postoperative cosmetic outcomes, and with no increased operation time, and postoperative complications. It is a safe and effective surgical option for treating GYN and is worthy of further promotion.

Key words： Gynecomastia(GYN); Endoscopy; Reverse-sequence; Traditional open surgery; Cosmetic outcome

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