超细纤维乳管镜引导下乳管内肿瘤切除术

Resection of mammary intraductal tumors under ultra-fine fiberoptic ductoscopy

目的探讨超细纤维乳管镜引导下乳管内肿瘤切除术的应用价值。方法对312例乳头溢液进行乳管镜检查，其中乳管内发现肿瘤者行手术治疗。利用乳管镜冷光源的皮肤透照点定象限，乳管扩张器探针定乳管走行方向，亚甲蓝染色定乳管末梢的分布。结果78例导管内发现肿瘤：单发性乳头状瘤68例，乳头状瘤病5例，导管内癌5例。28．2％（22／78）的病灶位于总导管，48．7％（38／78）位于导管Ⅰ级分支，17．9％（14／78）位于Ⅱ级分支，位于Ⅲ级和Ⅳ级分支病灶仅占3．8％（3／78）和1．3％（1／78）。病灶距乳头开口的平均距离为2．5cm（1～5cm）。78例均行手术治疗。术后病理诊断证实：65例乳头状瘤，8例乳头状瘤病，5例为导管内癌。乳管镜诊断符合率：乳头状瘤96％（65／68），乳头状瘤病100％（5／5），导管内癌100％（5／5）。单纯导管切除术65例，区段切除术8例，保乳根治术3例，改良根治术2例。结论通过光、针、色三位一体的方法定位以最小的切除范围达到最准确的切除目的，实现乳管内肿瘤的微创治疗。

Objective To assess the value of the resection of mammary intraductal tumors under ultra-fine fiberoptic ductoscopy. Methods Ductoscopic examinations were performed in 312 patients with nipple discharge, and those with positive findings of intraductal tumors were given further surgical treatment. The location of lesions was determined according to the position of skin projection of the cold light source, the passage of the mammary ducts was determined depending on the direction of intraductal dilatator, and the distribution of the distal ends of mammary ducts was determined with methylene blue staining. Results Intraductal tumors were found in 78 cases, including solitary papilloma in 68 cases, papillomatosis in 5 cases, and intraductal carcinoma in 5 cases. The lesions were located at the major mammary ducts in 22 cases （28.2%, 22/78）, at the first branches of segmental ducts in 38 cases （48.7%, 38/78）, at the second branches in 14 cases （17.9%, 14/78）, at the third branches in 3 cases （3.8%, 3/78）, and at the fourth branches in 1 case （1.3%, 1/78）. The distance between the lesions and the lacteal outlet was 1～5 cm （mean, 2.5 cm）. All the 78 cases were surgically treated. Postoperative pathological findings revealed 65 cases of papilloma, 8 cases of papillomatosis, and 5 cases of intraductal carcinoma. The diagnostic accordance rate of ductoscopy was 96% （65/68） for papilloma and 100% for papillomatosis （5/5） and intraductal carcinoma （5/5）. There were 65 cases of ductectomy, 8 cases of segmentectomy, 3 cases of breast-conserving radical resection, and 2 cases of modified radical resection. Conclusions On the basis of the position of skin projection of the cold light source, the direction of intraductal dilatator, and the methylene blue staining, the location of lesion can be accurately identified for precise resection, which carries out a minimally invasive treatment for mammary intraductal tumors.