乳腺病变X线立体定位钢丝置入移位的分析

Locating the displacement of the steel wire implantation with the stereotactic mammography

目的分析乳腺立体定位下钢丝置入移位的表现、原因、处理方法,提高术前定位的准确性。方法行立体定位置入钢丝患者79例,96个病变,发生钢丝移位13例。结果立体定位中发生钢丝移位5例,原因分别来自于患者和操作医师;立体定位完成后钢丝移位5例,原因是局麻注射药物过多,导致乳腺 Z 轴的深度与计算机提示的实际深度不符合、放置定位针的方法不正确、拔出钢丝外套针套时疏忽钢丝是否已锚定病变。处理方法:可按照钢丝提示位置向病变方向移位2 cm 以内进行手术,重新放置第2根钢丝,将双 J 型钢丝收入针套并取出体外,重新定位。手术中钢丝脱出2例,因术后过分提拉钢丝所致,放射科医师放置钢丝后应向外科医师准确描述深度、方向,并从距离钢丝头端距离皮肤最近处取切口手术。术后标本未见钙化1例,与钙化位于手术电刀破坏的腺体内有关,可扩大范围切除并短期复查,证实钙化是否完整切除。结论正确认识乳腺 X 线立体定位下钢丝移位的表现,熟练掌握其处理方法,可提高对不可触及的乳腺病变的定位准确性,正确引导外科手术。

Objective To analyze the manifestation, reason, the processing method of the steel wire implantation with the sereotactic mammography to improve the accuracy of the preoperative positioning, Methods Seventy-nine cases which got the stereotactic steel wire implantation. In 96 lesions, 13 had steel wire displacement. Among them, 5 cases got steel wire displacement during the sereotactic process, 5 cases got steel wire displacement after the stereotactic process, 2 cases got steel wire displacement during the operation, one case did not show the calcification on the postoperative radiography. Results The steel wire displacement occurred in 5 cases during the stereotactic process came from the patients and doctors respectively and the repositioning was needed. The steel wire displacement after the stereoscopic positioning was attributed to the overdose injection of local anesthesia, which led to the mismatch between the depth of Z axis of the mammary gland and the actual depth the computer given, the incorrect method for needle placement, and, neglecting whether the steel wire have got the lesion anchored when pulling out the needle set of steel wire hood, besides, these three kinds of instances above were all exaggerated by the accordion effect. For the displacement within 2 cm, the lesion can be excised toward the pathological change direction according to the position that steel wire prompted and re-place the second steel wire, putting the J-shaped steel wire into the needle hood and taking it out of the body. After repositioning, 2 cases had the steel wire prolapse during operation, which resulted from the over-lifting of the steel wire. After placing the steel wire, the radiologist should give an accurate description on the depth and direction to the surgeon and the notch should be taken for incision from the steel wire head end which is proximate to skin . The postoperative specimen from one case had no calcification, which might be related to the condition that the calcification was located in the gland body, which got destruction from the surgical electrical electrotome. The excisionscope should be extended and the short term reexamination is recommended to make sure the complete excision of the calcification. Conclusion It is the gold standard method that implanting the steel wire with the stereotactic mammography to guide the surgical dissecting technique to diagnose non-palpable breast lesion （NPBL）. Thorough understanding of the displacement manifestation of implanting steel wire with stereotactic technique and the treatment methods will be helpful in the surgical dissecting guidance.