超声引导下mammotome微创旋切乳腺良性肿块的技术探讨

Technical details of ultrasound guided mammotome minimally invasive biopsy system for benign breast mass in 186 cases

目的探讨超声引导下mammotome微创旋切治疗乳腺良性肿瘤的临床效果及手术经验。方法对186例212处乳腺肿块行超声引导下mammotome微创旋切，并评价其诊疗效果。结果186例患者超声均清楚显示病变。肿块完全切除率为72．0％（134／186），位于胸大肌表面者和位于乳晕附近者完全切除率分别为31．5％（6／19）和33．3％（4／12）。0．5cm≤肿块直径≤2．5cm的患者134例，超声显示肿瘤完全切除率88．0％（118／134）；2．5cm〈直径≤3．0cm的患者38例，超声显示肿瘤完全切除率42．1％（16／38）；直径〉3．0cm的患者14例，超声显示肿瘤完全切除0例。52例肿块未能完全切除的患者改为开放手术切除。于术后四周进行B超随访，肿块经mammotome完全切除的134例患者均未见肿块残留。其中112例患者术后六个月B超检查随访14．2％（16／112）肿块复发，其中6例开放手术切除，10例再次mammotome微创旋切，六个月后随诊有1例复发改行开放手术。结论超声引导下mammotome切除乳腺肿块，尤其是小的乳腺肿块，简便、安全、有效。

Objective To explore the clinical results and operation experiences for benign breast mass by ultrasound guided mammotome minimally invasive biopsy system （MMIBS）. Methods 212 benign breast masses in 186 patients were resected by ultrasound guided MMIBS. Clinical data of 186 patients were retrospectively analyzed. Results Needle position in 186 patients was visualized. Lesions were completely removed in 134 cases of 186 （72%） patients. The complete resection rate for tumors on major pectoral muscle or near areola were 31.5% （6/19） and 33.3% （4/12） respectively. Identified by postoperative ultrasound,ll8 out of 134 patients （88. 0% ） with tumor sizes 0. 5 to 2. 5 cm and 16 out of 38 patients（42.1% ） with sizes 2, 5 to 3.0 cm were completely removed. No lesions larger than 3.0 cm were completely removed. All 52 cases in which the tumors were not completely removed by MMIBS were converted to open surgery. Ultrasound follow-up after 4 weeks showed that all the 134 cases that had had masses completely removed had no residual masses, whereas 6 months after operation, 16 out of the 112 cases proved tumor recurrent necessitating open reoperation in 6 cases and second MMIBS operation in 10 cases, among them one case recurred after six months and received open operation. Conclusions For small benign breast mass, MMIBS has therapeutic effect with significantly minimal invasion.