不同类型乳房假体隆乳术后并发症的临床分析

目的 统计不同类型的乳房假体置人人体后，远期并发症发生的几率，并分析其原因。方法 总结1993年至2002年间假体隆乳573例，随访到手术方法相同、假体放置位置相同、同一医生组手术的隆乳妇女427例共852只乳房，使用4种不同类型乳房假体：毛面硅凝胶、光面硅凝胶、毛面生理盐水充注式、光面生理盐水充注式乳房假体。出现的远期并发症有纤维包膜挛缩、假体破裂渗漏、疼痛移位等，对各种假体并发症发生率进行统计分析，比较各类假体的优劣。结果 427例852只中803只效果满意，无明显并发症，占94．24％。发生并发症者42例49只乳房，占5．76％。并发症中乳房硬化属Baker‘s分级Ⅲ～Ⅳ级的有26只，缩小变形24只，移位疼痛10只，经手术取出发现假体破裂渗漏的有30只。其中纤维包膜挛缩引起乳房硬化多发生于硅凝胶假体，假体渗漏引起乳房缩小变形多发生于生理盐水充注式假体；假体在体内放置时间越长，发生并发症的几率越高。结论 经统计学处理发现，光面生理盐水假体并发症明显少于光面硅凝胶假体，毛面硅凝胶假体和毛面生理盐水假体并发症发生率没有明显差异。49只有不同并发症的乳房假体中有30只假体破裂渗漏，占61．22％，假体破裂渗漏后又容易引发其它并发症，说明假体质量的提高是减少并发症的关键，长期留置体内假体的老化是目前的难题。

The clinic analysis of complications of varied breast implant

OBJECTIVE: The study was carried out through summarizing and comparing the percentages of long-term complications of four types breast implants, and analyzing the cause of complications. METHODS: The study reviewed 573 patients with breast implants including textured or smooth silicone gel-filled or saline filled implants which were placed between 1993 and 2002. 427 cases were selected to followed-up in which the surgical technique, the plane of placement and the operator were all the same. Basing on outcomes of following-up, we summarized all kinds of long-term complications and the incidence of every type of implant. RESULTS: There were 803 of 832 prostheses (94.24%) with good results in 427 cases, while 49 prostheses (5.76%) with varied complications in 42 cases. Baker level III or IV contracture occurred in 26 prostheses, reduction of the breast in 24 prostheses, malposition or pain in 10 prostheses. Rupture or leakage were detected in repeated surgery in 24 prostheses. The more severe capsular contracture happened in cases with silicone gel-filled implant than in cases with saline-filled implant. The reduction of the breast due to the rupture or leakage of implants almost occurred in cases with saline-filled implants. The study also implied the complication incidence had the positive correlation with the length of time after implantation. CONCLUSIONS: The data provided by the statistic analysis demonstrated that the distinctly difference of the complication incidence exist only between smooth saline-filled implants and smooth silicone gel-filled implants. But there were no difference among the others. In 30 of 49 prostheses with varied complication of rupture or leakage were detected which could cause the other severe complication. So the quality of implants is the key to decrease the complication incidence, then the degeneration of prostheses after being implanted becomes the urgent and troublesome problem to solve for all of us.