超声引导下乳房肿块的微创完全切除

Ultrasound-guided vacuum-assisted minimal invasive excision for complete removal of breast lesions

目的探讨及评价超声引导下微创手术(Mammotome微创旋切术)手术完全切除乳房肿块的可行性及其影响因素。方法2007年1月至2008年10月期间666例患者于我院乳腺外科门诊行B超引导下乳房肿块Mammotome微创完全切除手术,共切除917枚肿块,术后随访至少12个月,评估术后并发症、术后残留或复发以及患者的满意度,比较和分析影响术后残留或复发的各项相关因素。结果所有病例均顺利完成手术,主要的术后并发症为术后疼痛、皮肤瘀斑和局部血肿,发生率分别为1.7%、10.9%、7.6%,术后6个月内均消失,患者满意率达98.1%。术后病理证实有3例为浸润性导管癌,其余均为良性乳房肿块。随访1年时,有13例发现残留或复发,手术的完全切除率达98.6%。残留的病例均为良性乳房肿块,残留病灶直径2～4 mm。比较发现肿块较大、多发性肿块、术中活动性出血及肿块靠近乳晕易发生残留或复发。Logistic回归分析得出肿块直径较大、术中活动性出血以及肿块靠近乳晕等因素与肿块残留或复发呈正相关。结论对于合适的病例,掌握好手术技巧,超声引导下Mammatome手术完全可以做到乳房肿块的完全切除,值得在临床应用中推广。

Objective To explore and evaluate the effectiveness of ultrasound-guided vacuum-assisted minimal invasive excision（Mammotome procedure） for complete removal of breast lesions and factors affecting the presence of residual lesion. Methods A total of 666 patients were treated with ultrasound-guided vacuum-assisted minimal invasive breast lesion excision between January 2007 to October 2008.Altogether 917 lesions were excised.All the patients completed interval follow-ups for at least twelve months after the procedure.Main post-procedure complications,residual lesion or recurrence,and patients＇ satisfaction were evaluated.Characteristics between the lesions with and without residual lesion or recurrence after the procedure were compared in order to analyze the factors correlated with the completeness of the removal. Results All the patients were treated successfully.Main post-procedure complications were post-procedure pain,skin ecchymosis,and local hematoma.All the complications,with the incidence of 1.7%,10.9% and 7.6%,respectively,disappeared within six months after the procedure.The patients＇ satisfaction rate was 98.1%.Almost all the lesions removed were benign breast lesions except for only three cases of invasive ductal carcinoma.Thirteen cases with residual lesion or recurrence were confirmed at twelve months＇ follow-up.The rate of complete removal was as high as 98.6%.The thirteen cases,of which the residual lesion was tiny,were all benign breast lesions,with no need of a second procedure.Larger lesion,lesion closer to the nipple,cases in which multiple lesions were removed at a time and active bleeding during the procedure showed more possibility of residual lesion or recurrence.Large lesion,active bleeding and lesion closer to the nipple were significant factors of residual lesion or recurrence according to the Logistic regression. Conclusions Ultrasound-guided vacuum-assisted minimal invasive excision（Mammotome procedure） is highly successful for complete removal of appropriately selected presumed benign breast lesions with good surgical techniques.