术中超声引导切除不可触及的乳腺病变

Intraoperative ultrasound localization to guide surgical excision of nonpalpable breast lesions

应用术中超声引导技术切除 65例女性患者 83处不可触及的乳腺病变 (nonpalpablebreastlesions ,NPBL) ,并对切除新鲜标本超声扫描确定NPBL是否已切除。 48处采用放射状切口 ,3 5处采用乳晕旁切口。切除标本最大直径10～ 3 0mm (平均 17 5mm) ,标本NPBL最大直径 5～ 17mm (平均 10 7mm) ,超声NPBL最大直径 6～ 19mm (平均11 9mm) ,NPBL的超声最大直径与标本最大直径呈高度一致 ,P <0 0 0 1。 83处NPBL首次切除标本中 ,4处超声未探及病灶 ,立即再切除获得成功。病理检查 :良性 78处 ,分别为 61处纤维腺瘤 ,5处管内乳头状瘤 ,12处纤维囊性乳腺病 ;恶性 5处 ,其中 2处为病理早期癌。恶性 5例追加改良根治术乳房标本无癌组织残留。良性患者术后 3～ 10个月随访 ,乳晕旁切口较放射状切口瘢痕更轻微 ,超声未发现复发病灶。初步研究的结果提示 ,术中超声引导切除NPBL是一种准确可行的手术方法 。

To evaluate the clinical effect of intraoperative ultrasound localization to guide surgical excision of nonpalpable breast lesions (NPBL).83 NPBL in 65 patients were excised using intraoperative ultrasound localization.The successful removal of NPBL was confirmed by scanning excised fresh specimens.There were 48 NPBL with radial incision and 35 with periareolar incision.The largest diameters (mean) of excised specimens were measured from 10 to 30 mm (17.5 mm).That of NPBL on the histological fresh specimens ranged from 5 to 17 mm (10.7 mm),and that on ultrasound scan from 6 to 19 mm (11.9 mm).The largest diameters of NPBL measured on the histological fresh specimens were significantly related with that on ultrasound scan,P<0.001.The absence of 4 NPBL with ultrasound scan of specimen prompted immediate reexcision,which was successful.The pathological results indicated 78 NPBL as benign lesions and 5 as malignant.2 of malignant NPBL were interpreted as early breast cancer pathologically.All patients were followed-up 3 to 10 months.There were more unsightly scars with periareolar incision than radial incision and NPBL were not found on breast ultrasound.The results show that intraoperative ultrasound localization to guide surgical excision of NPBL is an accurate and feasible technique and can find early breast cancer.