乳管镜定位及超声引导下真空辅助空芯针活组织检查治疗乳管内病灶

Vacuum-assisted core-needle biopsy under the guidance of fiberoptic ductoscopy and ultrasound for intraductal breast lesions

目的探讨乳管镜定位及超声引导下乳管内病灶真空辅助空芯针活组织检查的可行性。方法回顾性分析2014年1月至2016年12月在广州市妇女儿童医疗中心行乳管镜检查发现导管内病灶并行手术治疗的75例患者的临床资料,其中,乳管镜定位及超声引导下真空辅助空芯针活组织检查29例(微创手术组),常规开放手术切除病变乳管46例(常规手术组)。对2组患者的手术时间、术后病理结果、切口长度及患者对切口美观性的满意度进行分析。年龄、手术时间及切口长度等指标不符合正态分布,用M(P_(25)～P_(75))表示,采用2个独立样本的非参数检验。率的比较采用χ~2检验。结果微创手术组手术时间为10. 0(8. 0～15. 0) min,低于常规手术组的36. 5(32. 0～40. 3) min(Z=-7. 267,P<0. 001)。微创手术组的病理检出率为100. 0%(29/29),高于常规手术组的71. 7%(33/46)(χ~2=9. 914,P=0. 002)。微创手术组切口长度为0. 5(0. 5～0. 7) cm,常规手术组为2. 0(2. 0～3. 0) cm,差异有统计学意义(Z=-7. 438,P<0. 001)。微创手术组患者对切口美观性的满意度为96. 6%(28/29),高于常规手术组的76. 1%(35/46)(χ~2=4. 124,P=0. 042)。所有病例术后中位随访时间27个月(范围:12～47个月)。微创手术组无一例复发,常规手术组有1例半年后接受了二次手术。结论乳管镜定位及超声引导下的真空辅助空芯针活组织检查治疗乳管内病灶具有微创、手术切口小、美观、手术时间短、准确率高等优点,具有临床可行性。

Objective To investigate the feasibility of vacuum-assisted core-needle biopsy of intraductal breast lesions under the guidance of fiberoptic ductoscopy and ultrasound.Methods The clinical data of 75 patients with intraductal breast lesions detected by fiberoptic ductoscopy and treated by surgery in the Guangzhou Women and Children’s Medical Center from January 2014 to December 2016 were retrospectively analyzed. Twenty-nine patients underwent vacuum-assisted core-needle biopsy （minimally invasive surgery group） and 46 patients underwent conventional ductectomy （conventional surgery group）. The operation time, postoperative pathological results, length of the incision and patient satisfaction with the aesthetic appearance of the incision were analyzed. Because of the non-normal distribution, the indexes including age, operation time and length of the incision were expressed by M（P 25 -P 75 ） and analyzed by nonparametric test of two independent samples. The rates were compared using χ 2 test.Results The operation time in minimally invasive surgery group was 10.0 （8.0-15.0） min, which was significantly lower than 36.5（32.0～40.3） min in conventional surgery group （ Z =-7.267, P 〈0.001）. The pathological detection rate in minimally invasive surgery group was 100.0% （29/29）, which was significantly higher than 71.7% （33/46） in conventional surgery group （χ 2=9.914, P =0.002）. The length of the incision was 0.5 （ 0.5- 0.7） cm in minimally invasive surgery group, 2.0 （2.0-3.0） cm in conventional surgery group, indicating a significant difference （ Z =-7.438, P 〈0.001）. With regards to aesthetic appearance of the incision, patient satisfaction rate was 96.6% （28/29） in minimally invasive surgery group, significantly higher than 76.1% （35/46） in conventional surgery group （χ 2=4.124, P =0.042）. All patients were followed up for median 27 months （range：12-47 months）. There was no recurrence in minimally invasive surgery group and one patient had reoperation six months later in conventional surgery group.Conclusion Vacuum-assisted core-needle biopsy under the guidance of fiberoptic ductoscopy and ultrasound has the advantages of minimally invasive surgery, small incision with aesthetic appearance, short operation time and high accuracy, which is feasible in the treatment of intraductal breast lesions.