乳管镜定位下乳腺导管内肿瘤切除术的临床应用

Clinical Application of Resection of Breast Intraductal Neoplasm Localized by Breast Fiberoptic Ductoscopy

目的:探索乳管内窥镜(FDS)定位下对乳腺导管内新生物切除的可行性并总结经验。方法:分析我院2004年9月～2006年11月间FDS检查的548例乳头溢液病例资料,并选择乳管镜发现导管内新生物手术的病例,对镜下乳管内新生物的图象特征,诊断、手术方式和术后病理进行分析。结果:548例乳头溢液病例中,FDS下诊断乳管内新生物187例(34.1%),其中乳管内乳头状瘤159例(29.0%),乳管内乳头状瘤病12例(2.2%),乳腺癌16例(2.9%)。135例在我院接受手术治疗,91例在FDS定位下再行肿瘤切除或区段切除手术,44例按常规经溢液乳管内注射染料美蓝,再行选择性区段切除,FDS定位下手术组FDS诊断符合率97.8%(89/91)明显高于传统手术组86.4%(38/44)(χ2=6.96,P=0.008)。结论:FDS不仅是诊断乳腺导管内新生物的可靠方法,而且可以帮助手术中定位切除乳腺导管内新生物。FDS定位下手术能够避免手术盲目性,为病灶的切除提供可靠的帮助。

Objective： To explore the feasibility of breast fiberoptic ductoscopy-localized resection of breast intraductal neoplasm. Methods： From September 2004 to November 2006, data from 548 patients with nipple discharge who underwent fibreoptic ductoscopy （FDS） were collected. Data from those with intraductal neoplasm who underwent surgery were analyzed, including the image features, diagnosis, surgical procedures and postoperative pathological examination. Results： FDS examination showed that there were 187 patients （34.1%） with intraductal neoplasm, 159 patients （29.0%） with intraductal papilloma, 12 patients（2.2%） with intraductal papillomatosis and 16 patients（2.9%） with breast cancer. One hundred and thirty-five patients underwent surgery： 91 were treated wilh tumor resection or segmentectomy localized by FDS, and the other 44 received segmentectomy after infusion of methylene blue into the discharging breast duct. The diagnostic rate of FDS was 97.8%（89/91）, higher than that of the conventional surgery group 86.4% （38/44）（χ^2=6.96, P=0.008）. Conclusion： FDS is an accurate method to diagnose breast intraduetal lesions, and can be used in localizing breast intraduetal neoplasms.