乳腺良性肿块微创旋切术的临床应用研究

Application of minimally invasive circumcision in the diagnosis and treatment of benign breast masses

目的探讨乳腺良性肿块微创旋切术的临床应用价值,并评价其操作的安全性和优势,为其临床推广应用奠定基础。方法采用随机对照临床试验的方法进行研究。2017年1月至2019年3月间于西安交通大学第二附属医院收治的符合纳入排除标准的乳腺良性肿块患者,双盲随机数法将患者按2∶1比例分配入实验组(40例)和对照组(20例),实验组采用B超定位下的微创旋切术,对照组采用传统开放的手术,术前准备流程及术后护理方法无差异。观察记录两组患者的基本病历资料,术中术后情况,及术后3个月随访情况。结果实验组的手术操作时间(35.5±4.1min)、手术切口(5.2±0.7mm)、住院日(2.0±0.4 d)、术中出血量(17.6±8.0mL)等各项指标均明显优于对照组,差异有统计学意义(t1=3.93,t2=5.67,t3=3.84,t4=4.21,P值均<0.05)。两组均无大出血、皮肤或胸大肌烫伤、皮肤瘀斑、表面凹陷等并发症。术后随访3个月乳腺外形无明显变化,超声复查未见肿瘤残留及复发,乳腺皮肤感觉正常。结论微创治疗在治疗效果、美容需求、节约医疗社会资源等方面都存在明显的优势,符合外科快速康复理念,同时可较大程度的节约社会医疗资源。

Objective To explore the clinical application value of minimally invasive circumcision in the diagnosis and treatment of benign breast mass,and to evaluate the safety and advantages of its operation so as to lay a foundation for its clinical application.Methods A prospective randomized controlled clinical trial was conducted.From January 2017 to March 2019,patients with benign breast masses who met the exclusion criteria of the 2 nd Affiliated Hospital of Medical School of Xi’an Jiaotong University were randomly assigned to the experimental group(40 cases)and the control group(20 cases)in a ratio of 2∶1.The experimental group was treated with minimally invasive rotary excision,while the control group received traditional surgery.There was no difference in preoperative preparation process and postoperative nursing methods.The basic medical records,intraoperative and postoperative conditions,and 3 months follow-up of the two groups were observed and recorded.Results Compared with the control group,the operation duration of time(35.5±4.1 min),incision of operation(5.2±0.7 mm),hospital stay(2.0±0.4 d)and intraoperative loss of blood volume(17.6±8.0 mL)of the experimental group were significantly better than those of the control group(t1=3.93,t2=5.67,t3=3.84,t4=4.21,P<0.05 for all).No severe bleeding,skin or pectoralis major scald,skin ecchymosis,surface depression and other complications were observed in the two groups.There was no significant change in breast shape after 3 months of follow-up.No residual or recurrence of breast tumors was found in outpatient ultrasound reexamination,and the skin of breast felt normal.Conclusion Minimally invasive treatment has obvious advantages in the effect of treatment,cosmetic demand and saving medical and social resources.It conforms to the concept of rapid surgical rehabilitation and can be used as a case of daytime surgery.