超声引导下乳腺良性病灶微创旋切治疗的临床研究

发布时间：2018-06-24 14:52

本文选题：超声引导 + 乳腺良性病灶　；参考：《大连医科大学》2014年硕士论文

【摘要】：目的 1.探讨超声引导下手持式真空微创旋切系统在乳腺良性病灶治疗中应用价值。 2.BIRADS分级标准在乳腺旋切病例选择中的指导作用。资料与方法 1.资料：2012年8月---2013年8月在我院超声科150例女性患者的423个病灶行超声引导下微创旋切术，其中78例为双侧乳腺单发或多发结节，35例为单侧乳腺单发结节，37例为单侧乳腺单发结节，外科医生可扪及病灶96处，主要临床表现为：乳房胀痛，自述包块感或医生扪及包块。患者年龄16-55岁，平均年龄46.7±5.5岁。我们按BIRADS分级法和病灶直径分为两组。BIRADS分级：312处，Ⅲ级共111处；直径：10mm259处，10mm＜D≤20mm141例，20mm＜D≤30mm23例。我们只选择BIRADSⅡ-Ⅲ级，病灶直径3mm-30mm，平均大小为18.7±4.8mm。 2.方法：术前行超声检查，必要时配合钼靶及其它影像学检查，根据BIRADS分级标准，选择Ⅱ—Ⅲ级的病灶，病灶直径小于30mm，由于BIRADSⅢ级的病人可能存在2%的恶性可能，所以术前要与病人与家属沟通利弊，征得同意并签字后方可手术。术前查肝肾功能，出凝血时间，是否服用抗凝药。签写手术风险知情同意书。患者仰卧位，双手置于头上，充分暴露双侧乳腺，如果病灶比较靠近外侧，可要求患者侧卧位，患侧后方垫以小枕头。彩色超声引导下避开血管，确定最佳进针点，用2%利多卡因进行局部皮肤麻醉。如果是一侧乳腺多发结节，则要求尽量减少穿刺进针点，做到一个手术进路切除多个结节，并且尽可能少的损伤乳腺导管。用20ml注射器针管和22G PTC针套管将利多卡因与生理盐水的混合液注入到穿刺针道及病灶的基底部。旋切过程利用超声判断剩余病灶的位置方向，调整手柄上的标志点与旋切刀口的方向，并通过旋切刀手柄上的控制面板对病灶进行旋切、抽吸，直至超声显示目标病灶旋切干净，确定无任何残留后，拔出旋切刀头及套管，结束旋切。胸部捆以弹力绷带加压包扎24小时。 3.旋切术后一个月、半年及一年进行影像学随诊，观察是否有病灶组织残留及复发情况。 4.从手术皮肤创口的直径、出血量、创口周围组织水肿的时间、创口闭合的时间、住院时间，一次性处理病灶个数及瘢痕大小几个方面比较微创手术和外科开放性手术的优势及缺点。结果： 1.423处病灶全部一次性旋切干净，术毕观察病灶区未见组织残留及严重并发症。病理结果显示BIRADSⅡ级中良性病灶307处，占98.4%，良性病变合并不典型增生者为5处；评分为BIRADSⅢ级中良性病病变109处，占98.2%，不典型增生者1处，良性病变合并导管内癌者1处，所有Ⅱ级和Ⅲ级的病灶均被切除干净，，无严重并发症。D≤10mm、10mm＜D≤20mm病灶均被彻底切除，无严重并发症，20mm＜D≤30mm病灶也均被彻底切除，其中一例发生乳腺动静脉瘘。合并不典型增生及导管内癌者于术后进行开放性手术治疗。术后病理提示残腔内未发现异常组织。 2.术后一个月、半年及一年进行影像学随诊，在原病灶切除部位无复发者。其中有1例单发病灶的病人在术后1年超声检查，发现一处再生结节。 3.并发症：手术过程中3例患者出血较多，停止病灶旋切，局部按压15分钟，活动性出血停止，继续手术；其中5例为残腔内积血，血肿于3个月后完全吸收。2例为皮肤瘀斑，均于术后2个月完全消失。 4.旋切手术术中出血量少，皮肤切口小，一次性切除所有超声可显示病灶，手术创伤小，住院时间短，瘢痕小，患者满意度高等，较外科开放性手术有明显优势，这与报道一致[1]。结论： 1.超声引导下手持式真空负压微创治疗乳腺病变是一种简便、有效、美观、安全的微创治疗技术，较外科传统开放性手术有明显的优势，可作为乳腺良性病灶首选治疗方式。 2.BIRADS分级标准使术前病例选择标准化，可以作为乳腺旋切术前病例选择的可靠指导标准。
[Abstract]:objective
1. to explore the value of ultrasound-guided hand-held vacuum minimally invasive rotary biopsy system in the treatment of benign breast lesions.
The guiding role of 2.BIRADS grading criteria in the selection of breast circumrotation cases.
Information and methods
1. data: 423 lesions of 150 female patients in the Department of ultrasound department of our hospital in August ---2013 August 2012 were guided by ultrasound guided minimally invasive surgery, of which 78 were unilateral or multiple nodules, 35 were unilateral and 37 were unilateral, and 96 were treated by surgeons. The main clinical manifestations were breast The patient was 16-55 years old and the average age was 46.7 + 5.5 years old. The BIRADS classification method and the lesion diameter were divided into two groups of.BIRADS grades: 312, grade III, 111; 10mm259, 10mm < D < 20mm141, 20mm < D < 30mm23. We only chose BIRADS II - III, and the focus diameter 3mm-30mm, The average size is 18.7 + 4.8mm.
The 2. method: ultrasound examination before operation, when necessary with molybdenum target and other imaging examination, according to the BIRADS grading standard, select the lesion of class II - III, the diameter of the focus is less than 30mm, because the patient of BIRADS grade III may have 2% malignant possibility, so it is necessary to communicate with the patient and family before the operation, and obtain consent and sign the operation behind the operation. Check the liver and kidney function before the bleeding time, whether to take anticoagulant drugs. Write the informed consent on operative risk.
Patients in the supine position, both hands on the head, fully exposed bilateral breast, if the focus is closer to the outside, you can ask the patient lateral position, the side pad with a small pillow. Color ultrasound guidance to avoid blood vessels, determine the best needle point, use 2% lidocaine for local skin anesthesia. If it is one of the multiple nodules of the breast, it is required to reduce as much as possible. When the needle is punctured, multiple nodules are removed by an operative approach, and the breast ducts are damaged as little as possible. The mixture of lidocaine and saline is injected into the puncture needle path and the base of the lesion with the 20ml syringe needle tube and the 22G PTC needle sleeve. The sign point and the direction of the cutting edge of the cutting knife are rotated and sucked through the control panel on the handle of the rotary cutting knife. Until the target focus is swirled clean, and no residue is determined, the rotary cutting tool and the casing are pulled out. The chest bundle is pressurized by elastic bandage for 24 hours.
After one month, six months and one year after 3. circumcision, imaging follow-up was performed to see if there were any residual tissue and recurrence.
4. compare the advantages and disadvantages of minimally invasive surgery and open surgery from the diameter of the surgical skin, the amount of bleeding, the time of edema around the tissue, the time of the wound closure, the time of hospitalization, the number of lesions and the size of the scar.
Result:
1.423 lesions were cleaned completely at one time. No tissue residual and serious complications were observed in the lesion area. The pathological results showed that 307 of benign lesions in BIRADS II, 98.4% of the benign lesions with atypical hyperplasia, 109 of BIRADS grade middle grade benign disease, 1 of the atypical hyperplasia, benign lesions, benign lesions, and benign lesions. In 1 cases of intraductal carcinoma, all lesions of grade II and grade III were removed, no serious complications were.D < 10mm, 10mm < D < 20mm was completely removed, no serious complications were found, and 20mm < D < 30mm lesions were completely removed. One of them had mammary arteriovenous fistula. Patients with atypical hyperplasia and intraductal carcinoma were opened after operation. Operative pathology revealed no abnormal tissue in the residual cavity.
2., one month, half a year and one year after the operation, there was no recurrence in the resection of the primary lesion. Among them, 1 patients with single lesion were examined by 1 year postoperatively, and a regenerative nodule was found.
3. complications: during the operation, 3 patients had more bleeding, cessation of circumcision of the focus, local compression for 15 minutes, active bleeding stop, and continued operation, of which 5 cases were hematoma in the residual cavity and the hematoma was completely absorbed by.2 as skin ecchymosis after 3 months, and all disappeared in 2 months after the operation.
4. circumflex surgery has less bleeding, small skin incision, all ultrasound can show the focus of ultrasound, the operation is small, the time of hospitalization is short, the scar is small and the patient's satisfaction is high. It has obvious advantage compared with the surgical open operation, which is consistent with the report [1].
Conclusion:
The minimally invasive treatment of breast lesions with 1. ultrasound guided vacuum negative pressure is a simple, effective, beautiful and safe minimally invasive treatment technology, which has obvious advantages over the surgical traditional open surgery. It can be used as the first choice for the treatment of benign breast lesions.
The 2.BIRADS grading standard makes preoperative case selection standardized, and can be used as a reliable guidance standard for preoperative selection of patients before excision of breast.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.1;R737.9

【参考文献】