内視鏡補助下皮下乳腺全摘術を施行した女性化乳房症の4例

Endoscopy-assisted skin sparing total glandectomy for gynecomastia report of four cases

◆要旨：内視鏡補助下手術を施行した特発性女性化乳房症の4例を経験した．患者は16～28歳で1～10年の病脳期間を有し．2例では軽度の疼痛を認めた．手術は半側臥位にて行った．中腋窩線に4cmの皮切を加え，その尾側に5mmのカメラ用ポートを挿入した．乳腺後隙を剝離したのち，操作腔は吊り上げ法にて確保した．皮下剝離に際して術後の乳輪の変色を防ぐために，乳輪下乳腺組織を切除しすぎないように配慮した．手術時間は85～150分（平均118分），出血量は20～100ml（平均52.5ml）で，合併症は認めず，全例において良好な整容性が得られた．内視鏡下手術は外科的治療に際して第一に選択されるべき手術手技の1つである．

　We presented four patients who were treated for idiopathic gynecomastia by endoscopic surgery. Patients, who were 16～28 years old, had noticed to have gynecomastia for more than one year. Two patients presented symptoms of pain and tenderness. For cosmetic improvement, endoscopic surgery was conducted. A 4 cm skin incision was made in the mid-axillary line. One 5 mm port for the endoscope was placed in the foot side of the skin incision. Dissection was made between the dorsal aspect of the mammary gland and the pectoral major muscle using the Ultra Retractor. The working space was made with the lifting method. Dissection was made between the skin and the mammary gland by blunt thrusting of the 10 mm-diameter endoport. To avoid nipple necrosis postoperatively, the tissue under the nipple areolar complex was dissected more carefully. Operation time was 85～150 min（mean 118 min）, and blood loss was 20～100 ml（mean 52.5 ml）. No complication was observed. Favorable outcome in cosmesis was obtained from all patients. Endoscopic surgery is considered to be the preferable procedure for gynecomastia.