乳腺微创真空旋切系统(EnCor)对乳腺肿物的诊治价值及切口的选择

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【正文语种】中 文
【中图分类】R737.9
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1.超声纵横切面联合引导下EnCor真空辅助活检系统在乳腺微创旋切术中的应用价值 [J], 韦力;姚志;徐亮;陈华;周军
2.EnCor真空辅助微创旋切系统在乳腺多发良性肿物切除术中的应用 [J], 汤琦;王茂华;黄云超
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乳腺微创真空旋切系统(EnCor)对乳腺肿物的诊治价值及切口的选择
丁小红;李洁;赵艳;董守义;许俊业
【期刊名称】《中国微创外科杂志》
【年(卷),期】2014(14)4
【摘 要】Objective To investigate the incision selection of EnCor for breast lesion biopsy guided by ultrasonography . Methods For benign lesions , incisions at alar skin line , axillary midline and areola of mamma were considered for good cosmetic results.For possible malignant lesions , incisions were chosen near the lesions . Results Benign lesions were completely removed . Needle biopsy on the surface of the nidus skin was chosen for 1 patient, whose B ultrasound, molybdenum, clinical diagnosis showed highly suspected breast cancer , while Bud needle puncture biopsy showed negative results ;2 incisions were cut for one case on the breast surface due to 2 unreachable palpation and suspicious lesions , and 2 biopsy knives were used respectively;the incisions near the surface of breast lesions were chosen for 3 cases;areola incisions were made for 32 cases; alar skin lines incisions were made for 75 cases;the rest 285 cases had axillary midline incisions .Postoperative pathology: there were 299 cases of breast fibroadenoma , 47 cases of mammary gland hyperplasia with fibroadenoma sample structure , 11 cases of breast intraductal papilloma , 26 cases of breast cystic hyperplasia , 8 cases of retention cystof breast , 2 cases of severe dysplasia , 1 case of intraductal carcinoma and 3 cases of infiltrating ductal carcinoma , including 2 cases of lesions located in the left breast away from the papilla by 1 cm and treated by radical resection of breast cancer , and 1 case of the mass in the right breast away from the papilla by 3 cm, which underwent breast preserving surgery combined with axillary lymph node dissection .Compared with postoperative pathology , positive predictive value of B ultrasound was 75.0%(3/4), misdiagnosis rate (false positive) was 0.2%(1/393), missed diagnosis (false negative) was 25.0%(1/4) and accuracy was 99.5%(395/397).The 393 cases of benign lesions were followed up for 6-24 months, and all of the cases recovered well with hidden incision and good cosmetic results . Conclusion The preferred procedure for patients diagnosed as benign lesions should consider incisions at alar skin lines , axillary midline and areola of mamma;for possible malignant tumor , incisions near lesions should be selected .%目的:探讨超声下乳腺真空旋切系统(EnCor)进行乳腺病灶切除活检的切口选择。方法采用7G旋切探针进行操作,直径5 mm。良性可能性大的病灶,应尽量考虑美容效果好的腋下皮纹线、腋中线及乳晕切口;恶性可能性大的病灶应尽该患者B超、钼靶、临床均高度怀疑乳腺癌,但巴德针穿刺活检阴性;1例因2处触诊不可及的可疑病灶而选择乳房表面2处切口,并且分别使用2把活检刀;3例选择乳房表面病灶附近的切口;乳晕切口32例;腋下皮纹线切口75例;其余285例均选择在腋中线切口。术后病理:乳腺纤维腺瘤299例,乳腺增生病伴纤维腺瘤样结构形成47例,乳腺导管内乳头状瘤11例,乳腺囊性增生病26例,乳腺潴留囊肿8例,重度不典型增生2例,导管内癌1例,浸润性导管癌3例。3例浸润性导管癌,其中2例肿物位于左乳肿物外上象限距离乳头1 cm,择期行乳癌根治术;1例肿物在右乳外上象限距乳头3 cm,择期行保乳术联合腋窝淋巴结清扫术。 B超术前BI-RADS分类与术后病理对比,阳性预测值75.0%(3/4),误诊率(假阳性)0.2%(1/393),漏诊率(假阴性)25.0%(1/4),准确率99.5%(395/397)。393例良性病变随访6~24个月,切口隐蔽,愈合良好,乳腺外形美观。结论拟诊为良性的病灶优先考虑美容效果选腋下皮纹线、腋中线、乳晕切口;拟诊为恶性的病灶应尽可能选择病灶附近的切口。
【总页数】3页(P324-326)
【作 者】丁小红;李洁;赵艳;董守义;许俊业
【作者单位】河南省洛阳乳腺病医院乳腺外科,洛阳 471000;河南省洛阳乳腺病医院乳腺外科,洛阳 471000;河南省洛阳乳腺病医院乳腺外科,洛阳 471000;河南省洛阳乳腺病医院乳腺外科,洛阳 471000;河南省洛阳乳腺病医院乳腺外科,洛阳 471000; 河南省洛阳乳腺病医院病理科,洛阳 471000
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